Comparison of the Effect of Three Types of Treatment on Plantar Fasciitis: Ultrasonographic Follow-up

ABSTRACT

OBJECTIVE: To compare effectiveness of corticosteroid injection, foot orthoses and oral anti-inflammatory medication for the management of the plantar fasciitis by sequential ultrasonographic follow-up. METHOD: Thirty-three patients with plantar fasciitis were assigned to one of 3 treatment groups. Twelve patients received steroid injection and ten were applied with custom-made foot orthoses and eleven received 4-week course of a non-steroidal anti-inflammatory medication. All patients of each group were instructed to perform self stretching exercise of the Achilles tendon and plantar fascia for the follow-up period. Ultrasonographic evaluation and clinical assessments were performed during 12 weeks; before treatment, every week during the first 8 weeks, and then every 2 weeks during the last 4 weeks. RESULTS: On ultrasonographic examination, fascial thickness decreased significantly in all three groups (p<0.05) but earlier and greater change was noticed in injection group (p<0.05). Hypoechoic lesions were observed less commonly after treatment in injection and orthoses groups (p<0.05). Pain was not significant different among three groups after two or three weeks of treatment. CONCLUSION: Corticosteroid injection showed earlier and greater effect on pain and ultrasonographic feature than other treatments. Although pain aspects of three groups were similar after 12 weeks of follow-up, improved ultrasonographic features were well preserved in injection and orthoses groups. Ultrasonographic feature that was mostly related to the symptom relief was the decrease in fascial thickness other than resolution of hypoechoic lesion.