Optimal Treatment of Plantar Fasciitis: Physical Training, Glucocorticoid Injections or a Combination Thereof.
- Conditions
- Plantar Fasciitis
- Interventions
- Other: TrainingDrug: Glucocorticosteroid injectionBehavioral: Reduction in impact
- Registration Number
- NCT01994759
- Lead Sponsor
- Bispebjerg Hospital
- Brief Summary
The purpose of this study is to determine whether reduced load to patients with plantar fasciitis (reduced standing, walking, landing) together with either controlled heavy resistance training or glucocorticosteroid injection or a combination thereof is the best treatment.
- Detailed Description
Plantar fasciitis (PF) is a frequently diagnosed condition, defined as pain at the medial tubercle of the calcaneus, and 10% of the population will at some points in their life experience this condition. Accumulated loading of the plantar fascia seems to relate to development of PF, as it is commonly seen in runners and those who are overweight, and number of daily steps or simply time of standing has been shown to be a predisposing factor for PF development.
Orthosis and glucocorticoid injections are 2 widely used treatments with proven effect. However treatment of overuse injury in other tendon/aponeurosis-like structures, has over the later years been dominated by an increasing documentation of a good curative effect of heavy controlled mechanical loading (eccentric strength exercises or heavy slow concentric strength training) upon tendinopathies in Achilles or patella tendon. However, no studies have looked at the influence of physical training (e.g. strength training) on the diseased plantar aponeurosis. Also no studies have looked at the effect of a combination of giving local glucocorticoid injection and training on this or other tendon overuse entities.
We hypothesize that heavy strength training will have a positive effect upon PF, and that a combination of training and glucocorticoid injections will have an additive effect upon this disease and be even more effective than each of the treatments alone. Glucocorticoid injection acting as the standard control treatment.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 90
- Pain at the medial attachment of fascia plantaris.
- First step pain in the morning
- Symptoms for at least 3 months.
- Age 20-65 years
- Ultrasound scanning at the first visit shows thickness of the fascia above 4 mm.
- Patient can read and understand danish
- known arthritis, inflammatory bowl disease, psoriasis or clinical signs of any of these
- Leg ulcerations
- Longlasting oedema of the leg and foot
- Palpatory decreased puls in the foot
- Diabetes
- Reduced sensibility in the foot
- Infections in the foot
- Daily use of pain killers
- Pregnancy or planning to become pregnant
- Earlier operations on the foot, that is judged to complicate training
- Patient assessed not to be able to participate in the training for other reasons
- Glucocorticosteroid injection to the diseased plantar fascia within the last 6 months.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Training Training strengthening and stretching exercises. Training Reduction in impact strengthening and stretching exercises. Glucocorticosteroid injection Glucocorticosteroid injection Injection of 40 mg methylprednisolone. Glucocorticosteroid injection Reduction in impact Injection of 40 mg methylprednisolone. Training and Glucocorticosteroid injections Training A combination treatment of the two above. Training and Glucocorticosteroid injections Glucocorticosteroid injection A combination treatment of the two above. Training and Glucocorticosteroid injections Reduction in impact A combination treatment of the two above.
- Primary Outcome Measures
Name Time Method Foot Function Index 6 month Foot function Index is a validated score for patients with plantar fasciitis. It consists of 23 questions concerning pain, function and impact on daily life. Each question is answered on a box scale 0-10, giving a score range: 0-230.
100 mm VAS score pain at function. Average pain during everyday living. 6 month
- Secondary Outcome Measures
Name Time Method 100 mm VAS score for morning pain at entry, 3 month (after intervention), 6 month, 12 month, 24 month Ultrasound scanning thickness measure at entry, 3 month (after intervention), 6 month, 12 month, 24 month measurement of the thickness of the thickest part of the fascia by B-mode Ultrasound scanning
100 mm VAS score pain at function. Average pain during everyday living. 3 months, 12 months, 24 months Foot Function Index 3 month, 12 month, 24 month Foot function Index is a validated score for patients with plantar fasciitis. It consists of 23 questions concerning pain, function and impact on daily life. Each question is answered on a box scale 0-10, giving a score range: 0-230.
Trial Locations
- Locations (1)
Institute of Sports Medicine Copenhagen, Bispebjerg Hospital
🇩🇰Kobenhavn, Denmark