Fascitis Plantar: intervencionismo.

Posibilidades y evidencia

José M. Climent

HGUAlicante

Sumario

Infiltraciones con fármacos y otras técnicas

Procedimientos y dianas terpéuticas

Sustancias y modalidades Corticoide

Proloterapia

Toxina

Hialuronato

Plasma rico en plaquetas

P seca

Radiofrecuencia

Otras

Corticoides

Cochrane Databaseof SystematicReviews

Injected corticosteroidsfor treatingplantar heel pain in adults

(Review)

David JA, Sankarapandian V, Christopher PRH, Chatterjee A, Macaden AS

David JA, Sankarapandian V, Christopher PRH, ChatterjeeA, Macaden AS.

Injected corticosteroids for treating plantar heel pain in adults.

CochraneDatabaseof SystematicReviews 2017, Issue6. Art. No.: CD009348.

DOI: 10.1002/14651858.CD009348.pub2.

www.cochranelibrary.com

Injected cort icosteroids for treat ing plantar heel pain in adults (Review)

Copyright © 2017The CochraneCollaboration. Published by John Wiley & Sons, Ltd.

2017

of confirmation of allocation concealment. With two exceptions, werated theavailableevidenceasvery low quality, implying in each

casethat weare ’very uncertain about theestimate’.

The39trialscovered18comparisons, with sixof theseven trialswith threeor four groupsprovidingevidencetowardstwocomparisons.

Eight trials(724 participants) compared steroid injection versusplaceboor no treatment. Steroid injection may lead to lower heel pain

visual analogue scores(VAS) (0 to 100; higher scores= worsepain) in theshort-term (< 1 month) (MD -6.38, 95% CI -11.13 to -

1.64; 350 participants; 5 studies; I² =65%; lowquality evidence). Based on aminimal clinically significant difference(MCID) of 8 for

averageheel pain, the95% CI includesamarginal clinical benefit. Thispotential benefit wasdiminished when datawererestricted to

threeplacebo-controlled trials. Steroid injection madenodifferencetoaverageheel pain in themedium-term(1to6monthsfollow-up)

(MD -3.47, 95% CI -8.43 to 1.48; 382 participants; 6 studies; I² = 40%; low quality evidence). Therewasvery low quality evidence

for no effect on function in themedium-term and for an absence of seriousadverseevents(219 participants, 4 studies). No studies

reported on other adverseevents, such aspost-injection pain, and on return to previousactivity. Therewasvery low quality evidence

for fewer treatment failures(defined variously aspersistent heel pain at 8 weeks, steroid injection at 12 weeks, and unrelieved pain at 6

months) after steroid injection.

Theavailableevidence for other comparisonswasrated asvery low quality. Weare thereforevery uncertain of theestimates for the

relativeeffectson peoplewith heel pain of steroidscompared with other interventionsin:

1. Tibial nerveblock with anaesthetic (2 trials); orthoses(4 trials); oral NSAIDs(2 trials); and intensivephysiotherapy (1 trial).

2. Physical modalities: ESWT (5 trials); laser (2 trials); and radiation therapy (1 trial).

3. Other invasiveprocedures: locally injectableNSAID (1 trial); platelet-rich plasmainjections(5 trials); autologousblood injections

(2 trials); botulinum toxin injections(2 trials); cryopreserved human amniotic membraneinjection (1 trial); localised pepperingwith

aneedle(1 trial); dry needling (1 trial); and mini scalpel needlerelease(1 trial).

We are also uncertain about theestimates from trials testing different techniquesof local steroid injection: ultrasonography-guided

versuspalpation-guided (5 trials); and scintigraphy-guided versuspalpation-guided (1 trial).

Anexploratoryanalysisinvolvingpoolingdatafrom21trialsreportingonadverseeventsrevealedtworupturesof plantar fascia(reported

in 1 trial) and threeinjection siteinfections(reported in 2 trials) in 699 participantsallocated tosteroid injection studyarms. Fivetrials

reported atotal of 27 participantswith lessseriousshort-term adverseeventsin the699 participantsallocated steroid injection study

arms. Reported treatmentswereanalgesia, iceor both. Given thehigh risk of selectivereporting for theseoutcomesand imprecision,

thisevidencewasrated at very low quality.

Authors’ conclusions

Wefound lowquality evidencethat local steroid injectionscompared with placebo or no treatment may slightly reduceheel pain up to

onemonth but not subsequently. Theavailableevidencefor other outcomesof thiscomparison wasvery low quality. Whereavailable,

theevidencefromcomparisonsof steroid injectionswith other interventionsused to treat heel pain and of different methodsof guiding

theinjection wasalsovery lowquality. Although seriousadverseeventsrelatingtosteroid injection wererare, thesewereunder-reported

and ahigher risk cannot beruled out.

Further research should focuson establishing theeffects(benefitsand harms) of injected steroidscompared with placebo in typical

clinical settings, subsequent to acourse of unsuccessful conservative therapy. Ideally, thisshould bepreceded by research, including

patient involvement, aimed to obtain consensuson thepriority questionsfor treatingplantar heel pain.

P L A I N L A N G U A G E S U M M A R Y

Steroid injectionsfor painful solesof heelsin adults

Review question

Wewanted to assesstheeffectsof injected steroidsfor treatingadultswith painful solesof heels(plantar heel pain).

Background

2Injected corticosteroidsfor treating plantar heel pain in adults(Review)

Copyright © 2017 The Cochrane Collaboration. Published by John W iley & Sons, Ltd.

Figure 4. Forest plot of comparison: 1 Local steroid injection versus placebo, outcome: 1.1 Heel pain

Pooled data from six trials showed slightly better pain scores at

short-term follow-up after steroid injection (MD -6.38, 95% CI

-11.13 to -1.64; 350 participants; I² = 65%; low quality evidence

downgraded one level for serious risk of bias and one level for

serious inconsistency and imprecision). Although the 95% CI

includes the 8 mm MCID, the clinical importance of this re-

sult is marginal. The trial results are dominated by Abdihakin

2012; using therandom-effectsmodel, which givesamoreequal

distribution of weights, shows an increased effect in favour of

steroid injection (MD -9.22, 95% CI -18.00 to -0.45; analysis

not shown). However, asensitivity analysispresenting data from

the four placebo-controlled trialsonly (thusremoving data from

Kriss2003 and McMillan 2012), showssteroid injection madeno

clear difference to heel pain in the short-term, the 95% CI now

including thelineof no effect (MD -4.21, 95% CI -9.43 to 1.00;

265 participants, I² = 41%; analysisnot shown).

At medium-term follow-up, pooled datafrom seven trialsshowed

no clear between-group differencesin heel pain (MD -3.47, 95%

CI -8.43 to 1.48; 382 participants; I² =40%; low quality evidence

downgraded one level for serious risk of bias and one level for

inconsistency and seriousimprecision). The95% CI included the

lineof no effect but also thepossibility of a marginally clinically

important reduction in pain after steroid injection. Restrictingthe

data to those from the placebo-controlled trials (thus excluding

data from Kriss 2003 and McMillan 2012) showed no benefit

from steroid injection in the medium-term (MD -2.34, 95% -

7.76 to 3.08; 297 participants; I² = 55%; analysisnot shown).

21Injected corticosteroidsfor treating plantar heel pain in adults (Review)

Copyright © 2017 The Cochrane Collaboration. Published by John W iley & Sons, Ltd.

Cortoicoide: otras versiones

Whittaker GA, Munteanu SE, Menz HB, Bonanno DR, Gerrard JM, Landorf KB. Corticosteroid injection for plantar heel pain: a

systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Aug 17;20(1):378.

Toxina vs corticoide

Díaz-Llopis IV, Rodríguez-Ruíz CM, Mulet-Perry S, Mondéjar-Gómez FJ, Climent-Barberá JM, Cholbi-Llobel F. Randomized controlled study of the efficacy of

the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil. 2012 Jul;26(7):594-606.

Toxina seguimiento a 1 año

Díaz-Llopis IV, Gómez-Gallego D, Mondéjar-Gómez FJ, López-García A, Climent-Barberá JM, Rodríguez-Ruiz CM. Botulinum toxin

type A in chronic plantar fasciitis: clinical effects one year after injection. Clin Rehabil. 2013 Aug;27(8):681-5.

Proloterapia vs fisiológico/lidocaína

21

Table 2: Comparison of the clinical data of the groups

Control Prolotherapy pc Effect

size

Mean difference

(95% CI)

VAS-A

Median

(IQR)

Pre-

treatment

9 (8-10) 10 (9-10) 0.06

Week 7 5 (4-7) 1 (0-3) <0.001 2.41 -4.5(-5.4/-3.5)

Week 15 6 (4-8) 0 (0-2) <0.001 2.94 -5.4(-6.3/-4.4)

pa <0.001 (1>2=3) <0.001 (1>2=3)

VAS-R

Median

(IQR)

Pre-

treatment

7 (6-7) 7 (6-8) 0,47

Week 7 3 (2-4) 0 (0-1) <0.001 1.66 -2.6(-3.4/-1.8)

Week 15 3 (2-5) 0 (0-1) <0.001 2.11 -3.2(-4.0/-2.4)

pa <0.001 (1>2=3) <0.001 (1>2=3)

Control Prolotherapy pd Effect

size

Mean difference

(95% CI)

FFI -pain

Mean ± SD

(min-max)

Pre-

treatment

87.7 ± 17.1 (36-

100)

88.7 ± 10.9 (70-100) 0.78

Week 7 52.2 ± 24.3 (12-88) 11.4 ± 14.5 (0-56) <0.001 2.09 -41.8(-52.1/-31.4)

Week 15 54.5 ± 22.2 (25-89) 8.2 ± 12.3 (0-46) <0.001 2.48 -47.2(-57.0/-37.4)

pb <0.001 (1>2=3) <0.001 (1>2>3)

FFI -disability

Mean ± SD

(min-max)

Pre-

treatment

81.7 ± 16.3 (55-

100)

88.2 ± 11.1 (56-100) 0.08

Week 7 52.1 ± 23.8 (12-84) 7.4 ± 12.9 (0-45) <0.001 2.91 -51.1(-60.1/-42.0)

Week 15 53.1 ± 22.8 (14-90) 5.6 ± 10.2 (0-36) <0.001 3.09 -53.9(-63.0/-44.9)

pb <0.001 (1>2=3) <0.001 (1>2>3)

FFI -activity

Mean ± SD

Pre-

treatment

23.3 ± 11.3 (2-46) 28.0 ± 14.5 (2-60) 0.17

Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

ACCEPTED

Mansiz-Kaplan B, Nacir B, Pervane-Vural S, Duyur-Cakit B, Genc H. Effect of Dextrose Prolotherapy on Pain Intensity, Disability and Plantar

Fascia Thickness in Unilateral Plantar Fasciitis: A Randomized, Controlled, Double-Blind Study. Am J Phys Med Rehabil. 2019 Oct 18.

PRP vs Proloterapia

Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar

fasciitis. PM R. 2014 Feb;6(2):152-8.

Resultados semejantes

PRP a largo plazo

Shetty SH, Dhond A, Arora M, Deore S. Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo

for Chronic Plantar Fasciitis: Randomized Control Trial. J Foot Ankle Surg. 2019 Jan;58(1):42-46.

Hialuronato

Kumai T, Samoto N, Hasegawa A, Noguchi H, Shiranita A, Shiraishi M, Ikeda S, Sugimoto K, Tanaka Y, Takakura Y. Short-term efficacy and

safety of hyaluronic acid injection for plantar fasciopathy. Knee Surg Sports Traumatol Arthrosc. 2018 Mar;26(3):903-911.

Otras

ORIGINAL PAPER

Effectiveness of polydeoxyr ibonucleotide injection versus normalsaline injection for treatment of chronic plantar fasciitis:a prospective randomised clinical tr ial

Jae Kwang Kim1&Jae Yoon Chung1

Received: 8 January 2015 /Accepted: 22 March 2015# SICOT aisbl 2015

Abstract

Purpose Polydeoxyribonucleotide(PDRN) hasbeen used for

the treatment of chronic tendinosis. This prospective

randomised study was conducted to evaluate the efficacy

and complicationsof PDRN injection for treatment of plantar

fasciitis.

Methods Forty patients with a clinical diagnosis of plantar

fasciitis were randomly allocated to PDRN injection (PDRN

group, n=20) or normal saline injection (placebo group, n=

20). Injections wereperformed weekly for threeweeks. Clin-

ical evaluations were doneat baselineand four and 12 weeks

after treatment began using the visual analogue scale (VAS)

for foot pain and Manchester-Oxford Foot Questionnaire

(MOXFQ). We also monitored the complications in both

groups at one, two, four and 12 weeks after initial treatment.

Results ThePDRN groupachievedasignificant improvement

in VASand MOXFQ scoresat four weeksafter treatment, and

this improvement continued until 12 weeks after treatment.

On theother hand, theplacebo group did not achieveasignif-

icant improvement in the VAS or MOXFQ scores at four or

12 weeks. The initial VAS and MOXFQ scores of the PDRN

group werenot significantly different from thoseof theplace-

bo group. At four weeks after treatment, the VAS and

MOXFQ scores of the PDRN group were better than those

of the placebo group, but the difference was not statistically

significant. At 12 weeks after treatment, the VAS and

MOXFQ scores of the PDRN group weresignificantly better

than those of the placebo group. We noticed no injection-

related complications, such as itching, urticaria, redness or

infection signs around the injection site in either group.

Conclusions PDRN injection is an effective and safe treat-

ment option and may beconsidered for plantar fasciitis.

Keywords Plantar fasciitis . Polydeoxyribonucleotide

Introduction

Plantar fasciitis is themost commonly reported cause of infe-

rior heel pain [1]. It is a frequent problem among peoplewho

practice sports regularly; however, it also has a high preva-

lence in the general population (3.6–10 % in the USA) [2].

The diagnosis of plantar fasciitis can be madeon the basis of

clinical assessment alone. Thepain ischaracteristically worse

during thefirst stepsupon getting up from bed in themorning

or after periods of inactivity [3]. It is also exacerbated by

prolonged standing, walking or sports. Although this condi-

tion iscommonly described asbenign and self-limiting, it can

lead to significant pain and disability for monthsor even years

[3, 4].

Conservative treatment is the mainstay of treatment of

plantar fasciitis, and a variety of conservative management

strategieshavebeen proposed for treatment of plantar fasciitis

[4]. Commonly usedconservativetreatment methodsfor plan-

tar fasciitis are nonsteroidal anti-inflammatory drugs, ortho-

ses/insoles, physical therapy, night splints and walking casts

[4, 5]. Any of these methods can be used alone, but multiple

methodscan beand areused ascombination therapy, and this

is a reason that comparison of results is difficult in the treat-

ment of plantar fasciitis [5]. These conservative management

methods are usually successful for the treatment of plantar

fasciitis. However, persistent or recurrent symptoms may

* JaeKwang Kim

kimjk@ewha.ac.kr

1 Department of Orthopedic Surgery, EwhaWomans University

School of Medicine, 911-1, Mok-5-dong, Yangcheon-gu, Seoul 158-

710, South Korea

International Orthopaedics (SICOT)

DOI 10.1007/s00264-015-2772-0

ORIGINAL ARTICLE

Autologous whole blood versus corticosteroid local injectionin treatment of plantar fasciitis: A randomized, controlledmulticenter clinical tr ial

Afshin kar imzadeh1&Seyed Ahmad Raeissadat 2

&Saleh Erfani Fam3&

Leyla Sedighipour 3&Arash Babaei-Ghazani 4

Received: 13 April 2016 /Revised: 8 October 2016 /Accepted: 11 November 2016# International League of Associations for Rheumatology (ILAR) 2016

Abstract Plantar fasciitis is the most common cause of

heel pain. Local injection modalities are among treatment

options in patients with resistant pain. The aim of the

present study was to evaluate the effect of local autolo-

gous whole blood compared with corticosteroid local in-

jection in treatment of plantar fasciitis. In this randomized

controlled multicenter study, 36 patients with chronic plan-

tar fasciitis were recruited. Patients were allocated random-

ly into three treatment groups: local autologous blood,

local corticosteroid injection, and control groups receiving

no injection. Patients were assessed with visual analog

scale (VAS), pressure pain threshold (PPT), and plantar

fasciitis pain/disability scale (PFPS) before treatment, as

well as 4 and 12 weeks post therapy. Variables of pain

and function improved significantly in both corticosteroid

and autologous blood groups compared to control group.

At 4 weeks following treatment, patients in corticosteroid

group had significantly lower levels of pain than patients

in autologous blood and control groups (higher PPT level,

lower PFPS, and VAS). After 12 weeks of treatment, both

corticosteroid and autologous blood groups had lower av-

erage levels of pain than control group. The corticosteroid

group showed an early sharp and then more gradual im-

provement in pain scores, but autologous blood group had

a steady gradual drop in pain. Autologous whole blood

and corticosteroid local injection can both be considered

as effective methods in the treatment of chronic plantar

fasciitis. These treatments decrease pain and significantly

improve function compared to no treatment.

Keywords Autologouswholeblood .Corticosteriod .Plantar

fasciitis

Introduction

Plantar fasciitis (PF) is the most common cause of heel pain

[1, 2]. Thiscondition ischaracterized by pain at thecalcaneal

origin of the plantar fascia, exacerbated by weight bearing,

also the initial stage of active dorsiflexion and hallux exten-

sion after prolonged periods of rest [3, 4].

A conservativemanagement isusually preferred in theinitial

treatment of PF [1–4]. Common conservative treatment modal-

ities includemodification in daily activities, applying orthoses,

stretching exercises, taping, and non-steroidal anti-inflammato-

ry drugs (NSAID) [5, 6]. Other conservative strategies include

physical agent modalities such as extra corporeal shockwave

therapy [7], low-level laser therapy [6, 8], myofascial release[6,

9] acupuncture [10], and dry needling [5].

PF is a disabling disease in its chronic form [11, 12]. It is

widely believed that plantar fasciitis is a degenerative tissue

condition of the plantar fascia rather than an inflammation [4],

which ischaracterized by microtearsand necrosisof theplantar

fascial ligament and intrinsic flexor muscles of the foot at their

* Seyed Ahmad Raeissadat

a_raeissadat@sbmu.ac.ir

1 Department of Physical Medicineand Rehabilitation, Imam Hossein

Educational Hospital, School of medicine, Shahid Beheshti

University of Medical Sciences, Tehran, Iran

2 Shahid Modarres Hospital, Physical Medicine and Rehabilitation

Research Center, School of medicine, Shahid Beheshti University of

Medical Sciences, Tehran, Iran

3 Physical Medicineand Rehabilitation Research Center, School of

medicine, Shahid Beheshti University of Medical Sciences,

Tehran, Iran

4 Rasoul-e-Akram Hospital, School of medicine, Iran University of

Medical Sciences, Tehran, Iran

Clin Rheumatol

DOI 10.1007/s10067-016-3484-6

https://doi.org/10.1177/1071100718788549

Foot & Ankle International ®

2018, Vol. 39(10) 1151 –1161

© The Author(s) 2018

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/1071100718788549

journals.sagepub.com/home/fai

Article

Inflammation of the plantar fascia, or plantar fasciitis, is a

common condition. In the United States, approximately 1

million outpatient visits are made annually for plantar fasci-

itis.16 Plantar fasciitis is characterized by classic signs of

inflammation, including pain, swelling, and loss of func-

tion. It frequently presents as heel pain that is most severe

during the first few steps after prolonged inactivity or is

exacerbated by increased activity. A diagnosis of plantar

fasciitis is generally based on patient-reported symptoms,

history, and physical examination.

Historically, plantar fasciitis was believed to be a chronic

inflammatory condition. However, recent histopathologic

788549FAIXXX10.1177/1071 100718788549 Foot & Ankle International Cazz ell et alresear ch-article 2018

1Limb Preservation Platform, Inc, Fresno, CA, USA2Timonium Foot & Ankle Center, Timonium, MD, USA3Coastal Podiatry Center, Virginia Beach, VA, USA4Union Memorial Hospital, Baltimore, MD, USA5Southern Arizona VA Health Care System, Tuscon, AZ, USA6Baylor / Scott & White Podiatry Center, Temple, TX, USA7Center for Clinical Research, Inc, Castro Valley, CA, USA8MedStar Union Memorial Hospital, Baltimore, MD, USA

Corresponding Author:

Stuart D. Miller, MD, MedStar Union Memorial Hospital, 3333 North

Calvert Street, Johnson Professional Building, Suite 400, Baltimore,

MD 21218, USA.

Email: stubonedoc@aol.com

Randomized Controlled Trial of Micronized Dehydrated Human Amnion/Chorion Membrane (dHACM) Injection Compared to Placebo for the Treatment of Plantar Fasciitis

Shawn Cazzell, DPM 1, Jordan Stewart, DPM 2, Patrick S. Agnew, DPM 3, John Senatore, DPM4, Jodi W alters, DPM 5, Douglas Murdoch, DPM 6, Alex Reyzelman, DPM 7, and Stuart D. Miller, MD 8

Abstract

Background: Failure of conservative management to reduce/eliminate symptoms of plantar fasciitis (PF) may indicate

need for advanced treatments. This study reports Level 1 evidence supporting 3-month safety and efficacy of micronized

dehydrated human amnion/chorion membrane (dHACM) injection as a treatment for PF.

Methods: A prospective, single-blind, randomized controlled trial was conducted at 14 sites in the United States. Subjects

were randomized to receive 1 injection, in the affected area, of micronized dHACM (n=73) or 0.9% sodium chloride

placebo (n=72). Safety/efficacy assessments were conducted at 4 weeks, 8 weeks, 3 months, 6 months, and 12 months

postinjection, using visual analog scale (VAS) for pain, Foot Function Index–Revised (FFI-R) score, and presence/absence of

adverse events. Primary outcome was mean change in VAS score between baseline and 3 months expressed as difference

in means for treatment versus control subjects. Secondary outcome was mean change in FFI-R score between baseline and

3 months expressed as difference in means for treatment versus control subjects.

Results: Baseline VAS scores were similar between groups. At the 3-month follow-up, mean VAS scores in the treatment

group were 76% lower compared with a 45% reduction for controls (P < .0001), FFI-R scores for treatment subjects had

mean reduction of 60% versus baseline, whereas control subjects had mean reduction of 40% versus baseline (P = .0004).

Of 4 serious adverse events, none were related to study procedures.

Conclusion: Pain reduction and functional improvement outcomes were statistically significant and clinically relevant,

supporting use of micronized dHACM injection as a safe and effective treatment for PF.

Level of Evidence: Level I, prospective randomized trial.

Keywords: dehydrated human amnion/chorion membrane, chronic pain, plantar fasciitis

Otras

¿Qué

tratamiento es

mejor?

Yang WY, Han YH, Cao XW, Pan JK, Zeng LF, Lin JT, Liu J. Platelet-rich plasma as a treatment for plantar fasciitis: A

meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Nov;96(44):e8475.

¿Qué tratamiento es mejor?

Whittaker GA, Munteanu SE, Menz HB, Bonanno DR, Gerrard JM, Landorf KB. Corticosteroid injection for plantar heel pain: a

systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Aug 17;20(1):378.

Network metanálisis

SUCRA: Surface under acumulative curve. 0-100. Más cerca de 100, mejor tratamiento

Network metanalysis

Tsikopoulos K, Vasiliadis HS, Mavridis D. Injection therapies for plantar fasciopathy ('plantar fasciitis'): a systematic review and

network meta-analysis of 22 randomised controlled trials. Br J Sports Med. 2016 Nov;50(22):1367-1375. doi: 10.1136/bjsports-2015-095437.

El efecto temporal

0

1

2

3

4

5

6

7

8

Previo 1 mes 3 mes 6 mes 12 meses

24 m 36 m

O Choque (n = 39)

Corticoide (n = 40)

PRP (n = 39)

Proloterapia (n = 40

3 inyecciones (o sesiones) de cada modalidad

Uğurlar M, Sönmez MM, Uğurlar ÖY, Adıyeke L, Yıldırım H, Eren OT. Effectiveness of Four Different Treatment Modalities in the Treatment of

Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial. J Foot Ankle Surg. 2018 Sep - Oct;57(5):913-918.

Punto de inyección

Gurcay E, Kara M, Karaahmet OZ, Ata AM, Onat ŞŞ, Özçakar L. Shall We Inject Superficial or Deep to the Plantar Fascia? An

Ultrasound Study of the Treatment of Chronic Plantar Fasciitis. J Foot Ankle Surg. 2017 Jul - Aug;56(4):783-787.

VAS

Combinación de tratamientos

Celik D, Kuş G, Sırma SÖ. Joint Mobilization and Stretching Exercise vs Steroid Injection in the Treatment of

Plantar Fasciitis: A Randomized Controlled Study. Foot Ankle Int. 2016 Feb;37(2):150-6.

Mejor ecoguiado

Li Z, Xia C, Yu A, Qi B. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis.

PLoS One. 2014 Mar 21;9(3):e92671.

Mejor ecoguiado

Li Z, Xia C, Yu A, Qi B. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis.

PLoS One. 2014 Mar 21;9(3):e92671.

Procedimientos sin fármacos

Punción seca: músculos diana

Cotchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys

Ther. 2014 Aug;94(8):1083-94

30 % de efectos

adversos:

• Hematomas

• Repuntes de dolor

Punción seca

ORIGINAL PAPER

Comparison of dry needling and steroid injection in thetreatmentof plantar fasciitis: a single-blind randomized clinical tr ial

Shirvan Rastegar 1,2&Sadegh Baradaran Mahdavi 3,4,5

&Babak Hoseinzadeh1,2,5&

Sajad Badiei 1,5

Received: 17 February 2017 /Accepted: 27 October 2017# SICOT aisbl 2017

Abstract

Introduction Plantar fasciitis isacommon causeof heel pain.

Considering different interventions which are applied for pa-

tientswith plantar fasciitis, dry needling isproposed asanew

modality of treatment recently. The aim of this study is to

evaluatetheeffectivenessof dry needling versussteroid injec-

tion for plantar fasciitis.

Methods Sixty-six patients were recruited to this single-

blind clinical trial study. Participants were randomly al-

located to receive 1 ml (40 mg) of Depo-Medrol (meth-

ylprednisolone acetate) or dry needling. They were

followed up for 12 months and monitored for total per-

ception of pain using the visual analogue scale (VAS),

with data obtained in baseline and at three weeks, six

weeks, three months, six months and one year after

treatment.

Results Mean VAS score before treatment was 6.96 ±

0.87 for the steroid group and 6.41 ± 0.83 for the

dry-needling group (P value = 0.54). Steroid injection

reduced VAS scores rapidly until three weeks after treat-

ment compared with dry needling (0.32 ± 0.71 and 3.47

± 1.32, respectively; P value < 0.001). However, pa-

tients who were underwent dry needling reported lower

VAS scores at the end of follow-up compared with the

steroid group (0.69 ± 0.93 and 2.09 ± 1.58, respective-

ly; P value = 0.004). Over the long term, 82.3% and

17.6% of changes in pain were contributed to time since

treatment and treatment method, respectively (P values

< 0.001).

Conclusions Steroid injection can palliate plantar heel pain

rapidly but dry needling can providemoresatisfactory results

for patients with plantar fasciitis in the long term.

Keywords Dry needling .Steroidinjection .Plantar fasciitis .

Plantar heel pain

Abbreviations

FHSQ Foot Health Status Questionnaire

MSN Miniscalpelneedle

MTrP Myofascial trigger points

VAS Visual analoguescale

Introduction

Plantar fasciitis (plantar heel pain) as a common cause

of plantar pain has been associated with lower quality

* Babak Hoseinzadeh

Babak.med85@gmail.com

Shirvan Rastegar

shirvani295@gmail.com

Sadegh Baradaran Mahdavi

Sadegh.b.mahdavi@gmail.com

Sajad Badiei

sajad.badiei.md@gmail.com; s_badiei@edc.mui.ac.ir

1 Department of Orthopaedics, School of Medicine, Isfahan University

of Medical Sciences, Isfahan, Iran

2 Department of Orthopaedic Surgery, Al-ZahraTeaching Hospital,

Sofeh St, Isfahan, Iran

3 Department of Physical Medicine and Rehabilitation, School of

Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Physical Medicine and Rehabilitation, Al-Zahra

Teaching Hospital, Sofeh St, Isfahan, Iran

5 StudentsResearch Committee, Isfahan University of Medical

Sciences, Isfahan, Iran

International Orthopaedics (SICOT)

https://doi.org/10.1007/s00264-017-3681-1

Radiofrecuencia pulsada

Li X, Zhang L, Gu S, Sun J, Qin Z, Yue J, Zhong Y, Ding N, Gao R. omparativeeffectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive

neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis: A systematic review and network meta-analysis. Medicine (Baltimore). 2018 Oct;97(43):e12819.

Resultados pobres

Radiofrecuencia del nervio tibial posterior

Wu YT, Chang CY, Chou YC, Yeh CC, Li TY, Chu HY, Chen LC. Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial

Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis. Arch Phys Med Rehabil. 2017 May;98(5):964-970.

• PRF stimulation

was applied for 120

seconds at 2Hz,

with a 30-

• 0.5mL of 2%

lidocaine was

injected around the

PTN

EPI

Fernández-Rodríguez T, Fernández-Rolle Á, Truyols-Domínguez S,Benítez-Martínez JC, Casaña-Granell J. Prospective

Randomized Trial of Electrolysis for Chronic Plantar Heel Pain. Foot Ankle Int. 2018 Sep;39(9):1039-1046.

Cómo cambia la evidencia...

Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of

diagnosis and therapy. Am Fam Physician. 2005 Dec 1;72(11):2237-42. Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019 Jun

15;99(12):744-750.

Técnicas de inyección

Dianas terapéuticas

Dianas terapéuticas

Fasciales

Miofasciales

Nervios

Ligamentos

Fascia vía posterior

Fascia vía medial

Miofascial: flexor digitorum

brevis y fascia media

FDB

Fascia

Miofascial: gastrocnemius medialis

Miofascial: soleus

Miofascial:Abductor hallucis

Miofascial: quadratus plantae

Nervio Tibial posterior y ramas

Nervio tibial posterior: bloqueo

Nervio: ramas tibial posterior

Nervio: rama calcánea

inferior (Baxter)

Ligamentos: Calcáneo escafoideo (Spring)

Astrágalo STalli

Esc

TTP

Spring

Para recordar, intervencionismo en fascitis:

Hay evidencia de eficacia:

Corto plazo: Corticoide

Largo plazo: Toxina, PRP

Otras alternativas en estudio

Probablemente los tratamientos multimodales sean más

eficaces

Cada paciente presenta dianas terapéuticas alternativas

que pueden ayudar a resolver casos refractarios