Research progress of extracorporeal shock wave therapy for plantar fasciitis

Plantar fasciitis is a common and frequently occurring disease in clinic.It is a kind of local aseptic inflammation caused by chronic strain.In severe cases,pain is unbearable,which affects the quality of life of patients.Extracorporeal shock wave(ESW)is a new non-invasive treatment for bone and muscle diseases.It can significantly relieve the pain and other symptoms of patients with plantar fasciitis,and promote the functional recovery of patients.In order to provide reference for the clinical treatment of plantar fasciitis,this paper reviews the literature of extracorporeal shock wave treatment of plantar fasciitis at home and abroad.

Use of orthotics with orthotic sandals versus the sole use of orthotics for plantar fasciitis:Randomised controlled trial

BACKGROUND Plantar fasciitis(PF)affects around 10%of the population.Prefabricated orthotics with arch support has been shown to provide symptom relief in PF by decreasing the repetitive stress sustained by the plantar fascia.However,prefabricated orthotics are only effective when shoes are worn,meaning the foot may be left unsupported when it is impractical to wear shoes.Using orthotic sandals in conjunction with prefabricated orthotics may increase PF symptom relief,as they can be worn inside the home,extending the period in which the foot is supported.AIM To compare the combined use of prefabricated orthotics and orthotic sandals vs the sole use of prefabricated orthotics in the treatment of PF.METHODS 98 participants with PF were randomised into two groups.The intervention group received the Aetrex L420 Compete orthotics and the Aetrex L3000 Maui Flips(orthotic sandals),whilst the control group received the Aetrex L420 Compete orthotics only.Foot pain was assessed both by the numerical rating scale(NRS)and the pain sub-scale of the foot health status questionnaire(FHSQ).Foot functionality was measured using the function sub-scale of the FHSQ.Symptom change was measured using the global rating of change scale(GROC).RESULTS Foot pain scores measured both by NRS and FHSQ pain sub-scale showed statistically significant reductions in foot pain in both groups(P<0.05)at six months.Both groups also reported statistically significant improvements(P<0.05)in function as measured by the FHSQ function subscale and improvement of symptoms as measured by the GROC scale.Between-group analysis showed that the intervention group with the combined use of orthotics and orthotic sandals scored better on all four outcome measures as compared to the control group with the sole use of orthotics.However,the between-group analysis only reached statistical significance on the NRS pain score(P<0.05).CONCLUSION Combined use of prefabricated orthotics and orthotic sandals provides a greater decrease in foot pain and improvement in foot function in PF compared to using prefabricated orthotics alone.

Plantar Spitz Nevus Resembling Malignant Melanoma: Description of Immunohistochemical Findings

Spitz nevus (SN) is predominantly distributed throughout the lower extremities, while an acral location is rare. Since SN occasionally resembles the clinicopathological presentation of malignant melanoma (MM), it presents a diagnostic challenge, especially on glabrous skin. Past reports suggest that several genetic aberrations are associated with specific clinicopathological subtypes of melanocytic tumors. Immunohistochemistry can provide a clue to the presence or absence of a molecular aberration typical of Spitz tumors. We describe a case of a plantar SN with genetic analysis, including anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), BRAF (V600E) protein, and BRCA1-associated protein-1 (BAP1). However, we were not able to detect a characteristic gene aberration. To the best of our knowledge, no genetic aberrations in plantar SN cases have been reported. A comprehensive understanding of tumor genomics is expected to play an essential role in the classification of melanocytic tumors. Further genetic research on plantar SN is required to establish new criteria for distinguishing between SN and MM.

Regional plantar foot pressure distributions on high-heeled shoes-shank curve effects

Forefoot pain is common in high-heeled shoe wearers due to the high pressure caused by the center of body mass moving forward and the increased arch height with heel elevation.Sufficient arch support could reduce the high pressure over forefoot.However,too much arch support could lead to abnormal foot alignment and pain over midfoot.Little information is reported on the relationship among plantar arch height,shank curve design and plantar pressure.This study aimed at quantifying the plantar arch height changes at different heel heights and investigating the effect of shank curve on plantar pressure distribution.The plantar arch height increased to（7.6±1.3） mm at heel height of 75 mm.The Chinese standard suggests the depth of last should be 8.5 mm for heel height of 75 mm.When a shank curve with higher depth of last（11 mm） was used,the peak pressure over forefoot further decreased in midstance phase,which might ease the forefoot problems,while the peak pressure over midfoot increased but not exceeded the discomfort pressure thresholds.To achieve a more ideal pressure distribution in high-heeled shoes,a higher than expected depth of last would be suggested that would not cause discomfort over midfoot.

Ultrasound-Guided Plantar Fascia Release with Needle: A Novel Surgical Technique

The purpose of this study was to assess the effectiveness of a new procedure, ultrasound-guided partial plantar fasciotomy with needle for plantar fasciosis. Methods: This study was carried out on 16 patients, 9 men and 7 women, with average age 47.5, diagnosed with plantar fasciosis, who were treated through ultrasound-guided partial plantar fasciotomy using multiple perforations. Clinical assessments and ultrasounds of all patients were carried out before treatment, after a week, then after 1, 3 and 12 months. For the clinical assessment the Visual Analogue Scale (VAS) and the Foot and Ankle Disability Index (FADI) were used. Results: There was significant progress at 95% (Greenhouse-Geisser p < 0.001) of the VAS and the FADI during the study. We had no nerve or other complications: paraesthesia of the entry portal or vascular lesions. Conclusion: Ultrasound- guided partial plantar fasciotomy using multiple perforations is a safe technique, with very satisfactory preliminary results, reducing recovery times and time off work. The technique can be performed in the specialist’s consultation room with local anaesthesia, without the need for stitches and with very fast recovery, thus reducing costs. It can be performed on patients with underlying pathology such as diabetes mild to moderate, vascular insufficiency, heart disease or other comorbidities, so this technique could be an improvement on other open plantar fasciotomy surgical techniques.

Comparison of walking quality variables between incomplete spinal cord injury patients and healthy subjects by using a footscan plantar pressure system

The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury(SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University(approval No. 2015 PS54 J) on August 13, 2015. This trial was registered in the ISRCTN Registry(ISRCTN42544587) on August 22, 2018. Protocol version: 1.0.

Surface effects on in-shoe plantar pressure and tibial impact during running

Purpose： This study aims to explore the effects of running on different surfaces on the characteristics of in-shoe plantar pressure and tibial acceleration. Methods： Thirteen male recreational runners were required to run at 12 km/h velocity on concrete, synthetic track, natural grass, a normal treadmill, and a treadmill equipped with an ethylene vinyl acetate （EVA） cushioning underlay （treadmill_EVA）, respectively. An in-shoe plantar pressure system and an accelerometer attached to the tibial tuberosity were used to record and analyze the characteristics of plantar pressure and tibial impact during running. Results： The results showed that there were no significant differences in the 1 st and 2nd peak plantar pressures （time of occurrence）, pressure-time integral, and peak pressure distribution for the concrete, synthetic, grass, and normal treadmill surfaces. No significant differences in peak positive acceleration were observed among the five tested surface conditions. Compared to the concrete surface, however, running on treadmillEVA showed a significant decrease in the 1st peak plantar pressure and the pressure time integral for the impact phase （p 〈 0.05）. These can be further ascribed to a reduced peak pressure observed at heel region （p 〈 0.05）. Conclusion： There may not be an inevitable relationship between the surface and the lower-limb impact in runners. It is, however, still noteworthy that the effects of different treadmill surfaces should be considered in the interpretation of plantar pressure performance and translation of such results to overground running.

Activation of brain areas following ankle dorsiflexion versus plantar flexion Functional magnetic resonance imaging verification

Changes in activated areas of the brain during ankle active dorsiflexion and ankle active plantar flexion were observed in six healthy subjects using functional magnetic resonance imaging. Excited areas of ankle active dorsiflexion involved the bilateral primary motor area and the primary somatosensory area, as well as the bilateral supplementary sensory area, the primary visual area, the right second visual area, and the vermis of cerebellum. Excited areas of ankle active plantar flexion included the ipsilateral supplementary motor area, the limbic system, and the contralateral corpus striatum. Fine movements of the cerebral cortex control the function of the ankle dorsiflexion to a larger extent than ankle plate flexion, and the function of ankle plate flexion is more controlled by the subcortical area.

The Effects of Pain Neuroscience Education with Conventional Physical Therapy on Chronic Plantar Fasciitis: A Case Study

Background and Purpose: Plantar Fasciitis (PF) is a condition that affects the foot and causes complaints such as pain and stiffness. The most common symptom of this condition is pain. There are many treatment options to deal with this condition, such as conservative therapy, medications, and surgical interventions in rare cases. This case study aims to investigate the potential impact of pain neuroscience education (PNE), combined with a conventional Physical Therapy (PT) program on a 37-year-old-patient with chronic plantar fasciitis. Case description: A 37-year-old male health care professional presented to an outpatient physical therapy clinic with a diagnosis of chronic PF for around two years. The participant had tried several treatment options with no improvement of his symptoms. After undergoing a physical therapy evaluation, he was given a plan of care for twelve sessions by a skilled physical therapist for a six-week period, with each session consisting of 30 minutes of conventional PT, followed by 5 to 15 minutes of PNE. Results: After completing the prescribed plan of care, the patient reported a reduction in subjective symptoms via the Visual Analog Scale (VAS). He also reported improvement with symptoms and functional independence via the Foot Function Index (FFI). The patient reported no change in the quality of sleep via Pittsburg Sleep Quality Index (PSQI). Lastly, he demonstrated no objective improvement in foot pressure with the Navicular Drop Test. Discussion: This case report indicates that PNE, combined with conventional PT for PF can have a positive impact on subjective pain and foot function. PNE should involve many topics about the physiology of pain and the nervous system and should be administered by a certified therapeutic pain specialist. Further studies are recommended to investigate the impact of this intervention in combination with traditional PT for PF in larger populations.

Synovial sarcoma in the plantar region: A case report and literature review

BACKGROUND Synovial sarcoma (SS),a rare malignant soft tissue tumor whose histological origin is still unknown,often occurs in limbs in young people and is easily misdiagnosed.CASE SUMMARY We report a 24-year-old man who sought treatment for plantar pain thought to be caused by a foot injury that occurred 4 years prior.Currently,he had been seen at another hospital for a 1-wk history of unexplained pain in the left plantar region and was treated with acupuncture,a kind of therapy of Chinese medicine,which partly relieved the pain.Because of this,the final diagnosis of biphasic SS was made after two subsequent treatments by pathological evaluation after the last operation.SS is rarely seen in the plantar area,and his history of a left plantar injury confused the original diagnosis.CONCLUSION This study shows that pathological and imaging examinations may play a vital role in the early diagnosis and treatment of SS.

Effects of Different Types of Socks on Plantar Pressures,In-shoe Temperature and Humidity in Diabetic Patients

This study aims to evaluate the efficacy of different types of socks for patients with diabetes on reducing in-shoe plantar foot pressure when standing and walking. A total of 5 types of socks,including 3 types of diabetic socks and 2 types of daily /sports socks of various structures are studied. The effects of sock fabrication and design on plantar pressure redistribution that resulting in increasing the underfoot contact area and reducing the risk of pressure ulceration,as well as foot skin temperature and humidity, are examined. The results reveal that regardless of the different knitting structure,thickness and airspace ratio of the sock,both diabetic and daily /sports socks can effectively reduce high plantar pressure on the rear foot,and re-distribute the pressure to other foot regions,like the metatarsal heads. The effects of fabrication and knitting structure on pressure reduction and redistribution are not apparent in this study. However,they have a major impact on the control of foot skin temperature and humidity. The results of the study provide a reference for optimizing the design and functional performance of socks for patients with diabetes.

Performance Analysis of Cushioned Sport Soles with Plantar Pressure Test

Plantar pressure distribution of the designed cushioned soles was studied and compared with that of the commercially available sport shoes.A three-dimensional motion measurement system was used to obtain the peak plantar force,the peak plantar pressure,force-time integrals and pressure-time integrals,and one-way analysis of variance was used to analyze the performance of the designed cushioned shoes.The results revealed that in normal walking and jogging states,compared with the commercially available sport shoes,the peak plantar pressure in the heel region decreased by 13.65%and 6.05%,respectively.The peak plantar force decreased by 15.98%and 15.32%,respectively.The force-time integral decreased by 4.36%and 6.83%,respectively,and the pressure-time integral decreased by 10.58%and 11.00%,respectively.In conclusion,the cushioning performance of shoes is related to the exercise mode.For normal walking,the designed cushioned soles absorbed greater impact in the heel region,which was effectively cushioned,whereas in the jogging state,the designed cushioned soles exhibited a favorable cushioning effect in the forefoot region.The designed cushioned soles exhibited cushioning performance through the coupling design of material and structure,which effectively reduced impact force when landing and could optimize plantar pressure distribution.

The Influence of Insole with Metatarsal Retro-Capital on Posture, Plantar Pressure and Body Segments Positions in Runners

Objectives. The aim of this study was to investigate the effects of orthopaedic soles on the body posture. Methods. Forty-eight runners (21 men and 28 women) maintained a standing-up position on both feet with bare feet with neutral soles and orthopedic soles which contained bilaterally a podiatrist element of 3 mm height behind the metatarsal heads (Metatarsal Retro Capital Bar, MRCB). Stabilometric, plantar pressure and kinematic data in the sagittal plane on both sides were measured at 40 and 60 Hz, respectively. The position of the center of pressure on the anteroposterior axis (YCoP), the forefoot plantar pressure (FPP) and the anteroposterior position of the knee (Yk), the hip (YH), the shoulder (YS) and the ears (YE) with respect to the vertical axis passing through the joint of the ankle were determined for each experimental condition. Findings. The addition of a MRCB orthopedic element induced in backward displacement of CoP, hip, shoulder and ears (p CoP and FPP changes were significantly correlated with YH, YS and YE changes (p Conclusion. These results suggest that the addition of an orthopedic element located behind the metatarsal heads influences the overall position of the body and can help podiatrist in the care of their patients.

Plantar lichen planus masquerading eumycetoma of dark grains

Lichen planus is a common inflammatory disease but its perforating variety is not so common and it has been described in small number of text and articles. Here we reported a case of plantar lichen planus where there was a history of discharge of dark grains from the sole of foot and diagnosing the disease as eumycetoma of dark grains repeated antifungal therapy could not resolve the lesions and histopathologically it showed the classical pictures of lichen planus. Collaborating the clinical and histological features we have diagnosed the case as perforating lichen planus but Verhoeff-Van Gieson stain could not elucidate the perforating channel which ot difficult to delineate and often missed. So, we have put the diagnosis of plantar lichen planus and treated with intramuscular triamcinolone and the lesions resolved.

Plantar Fascia and Foot Structure and Function in Living Individual： A Literature Review

The purpose of this literature review is better comprehension about role of the plantar fascia on the structure （arch height） and function （adaptation） of the foot and ankle in living individual. It has long been accepted that plantar fascia supports medial longitudinal arch both in weight bearing and locomotion. Literatures were reviewed through a systematic method. First, current knowledge about plantar fascia properties were established and analyzed; second, previous studies and methods to study plantar fascia were analyzed; finally, the problems in previous researches to study plantar fascia were argued. It was found that plantar fascia affects foot arch and foot adaptation under vertical load in living individual. In accordance with results of this literature review, the modification of plantar fascia thickness under vertical load is specific property of the plantar fascia in living individual. Additionally, the specific property of plantar fascia can help clinicians to diagnose the necessity of plantar fascia assessment along its length.

Assessment of the Plantar Pressure, Muscle Strength and Balance in Patients with Type 2 Diabetes Mellitus in Cyprus

Aims: Diabetes Mellitus (DM) is a metabolic disorder which affects whole systems of human body. This study aimed to compare the strength of foot muscles, dynamic balance, and peak plantar pressure between diabetic patients before developing polyneuropathy and healthy peers. Methods: 21 people, 11 diabetic patients and 10 age-matched healthy peers, were included in the study. A manual muscle tester (model 01163 Lafayette) was used to assess muscle strength. Pedobarography was the device to determine the distribution of plantar pressure into nine regions of foot. Dynamic balance was also measured by using a mobile platform (Techno-body, PK 200 WL, Italy). Results: Diabetic and control groups had similar muscle strength and dynamic balance (p > 0.05). Most of the plantar pressure findings were also similar (p > 0.05). There were significant differences in only two regions of foot between two groups (p < 0.05). Conclusion: Diabetes Mellitus is not a factor influencing balance and muscle strength before polyneuropathy. However, it is possible to state that it may negatively affect the distribution of plantar pressure so clinians should assess and treat this distribution in the patients with DM.

Smart passive gait retraining intervention via pebbles for reducing peakplantar pressure: Short-term results

Recently, there has been a growing interest in gait retraining to alter the gait parameters of different populations.In these gait retraining, peak plantar pressure (PPP) was considered as an important parameter of the footbiomechanics. It has been found that high PPP correlates to the common foot deformities including pes planus/cavus. However, previous studies utilized excessive electronics in gait retraining, which is challenging toimplement daily especially when device cleaning, flexibility and portability are considered. Therefore, this studyinvestigated feasibility of a novel unpowered gait retraining for reducing high PPP. Twelve potential participantsidentified for investigation through a baseline PPP evaluation with Novel Pedar-x system. Participants received asingle session for the gait retraining with pebbles in the form of rigid spherical inserts (RSI) placed in locations ofhigh PPP inside the deformable insole. This provides tactile cues alerting the participants to alter their gait toreduce excess PPP. The PPP values were tracked in weekly follow-up sessions for 6 weeks. The results demonstrated that participants responded to RSI altering their gait to reduce PPP and maximum force by 14% and 10.5%after six weeks respectively. This study is valuable for physicians in reducing PPP when non-electronics arerequired.

The medial plantar artery:anatomy and implications in local flaps of the foot

The medial plantar artery(MPA),as a terminal branch of the posterior tibial artery,provides perfusion to the musculature of the medial compartment of the plantar foot as well as cutaneous branches to the skin.The artery and its perforators serve as the foundation for several flaps based on various soft tissue components for the coverage of small defects of the foot.Most noteworthy is the fasciocutaneous flap,which utilizes the skin and the unique properties of the plantar foot.Understanding the anatomical relationship of the terminal branches of the MPA,the superficial and deep branches,is necessary in determining the type of tissue and the flap design to be utilized for reconstruction.

The Effect of Internal Heat Acupuncture on the Tolerance Time of Plantar Hot Plate and Pain Threshold of Gastrocnemius Muscle in Rats with Chronic Myofascial Pain Syndrome

Objective:To investigate the effect of internal heat acupuncture on the tolerance time of plantar hot plate and the pain threshold of gastrocnemius in rats with chronic myofascial pain syndrome(MPS).Methods:A total of 80 adult Wistar rats were randomly selected to establish chronic MPS rat models,and randomly divided into four groups:control group,acupuncture group,internal heat acupuncture group A,and internal heat acupuncture group B,with 20 rats in each group.The rats in the control group were not given any treatment,and the rats in the acupuncture group were only given acupuncture treatment.The rats in group A were treated with internal heat acupuncture(needle heating up to 42℃),and the rats in group B were treated with internal heat acupuncture(needle heating up to 44℃).The tolerance time of plantar hot plate,the pain threshold of gastrocnemius muscle and the level of tumor necrosis factor-α(TNF-α)were observed and compared before modeling,1 d before treatment,and 1,7 and 14 d after treatment.Results:There were significant differences in hot plate tolerance time,time and interaction among the four groups(P<0.05),as well as in gastrocnemius tenderness threshold,time and interaction among the four groups(P<0.05),and there were also significant differences in TNF-αlevel among the three groups(P>0.05).There were significant differences in the number of electric shocks,time and interaction among the four groups(P<0.05).Conclusion:In contrast to conventional acupuncture treatment,internal heat acupuncture demonstrates greater efficacy in extending the tolerance duration of hot plate exposure and enhancing the pain threshold of the gastrocnemius muscle in rats afflicted with myofascial pain syndrome.Additionally,it accelerates the amelioration of inflammatory markers and motor function.However,it is important to note that the therapeutic impact of internal heat acupuncture may be influenced by its temperature,with 44℃being the most effective in this research.

平衡生物反馈训练对脑卒中足内翻患者足底压力和平衡功能的影响

目的探讨平衡生物反馈训练对脑卒中足内翻患者的足底压力和平衡功能的作用。方法选择60例脑卒中足内翻患者,其中男性35例,女性25例;年龄50~58岁,平均年龄54.79岁;病程79~92 d,平均病程87.76 d;偏瘫左侧33例,右侧27例;脑梗死31例,脑出血29例。随机选择30例作为对照组,另外30例为试验组。对照组和试验组都进行综合训练,试验组在此基础上进行平衡生物反馈训练。两组连续训练8周,每周5 d,每天2次,每次共60 min。选用美国Tekscan公司的Footscan三维动态足底压力步态分析系统。在治疗前和治疗后8周,对患者的足底压力和平衡运动学参数进行对比。结果在足底压力方面,治疗前,两组患者内外侧压力和接触面积差异无统计学意义(P>0.05);治疗后,两组患者内侧压力增大(P<0.05),外侧压力减小(P<0.05)[试验组治疗前后内侧压力(150.18±96.30)N vs(175.70±99.95)N,外侧压力(184.14±85.72)N vs(166.46±112.01)N;对照组治疗前后内侧压力(147.11±74.22)N vs(165.97±71.93)N,外侧压力(230.13±93.73)N vs(223.57±114.75)N]。两组患者内侧接触面积增大(P<0.05),外侧接触面积减小(P<0.05)[试验组治疗前后内侧接触面积(26.75±12.07)cm^(2)vs(34.97±9.17)cm^(2),外侧接触面积(45.79±21.57)cm^(2)vs(37.86±21.99)cm^(2);对照组治疗前后内侧接触面积(39.28±22.25)cm^(2)vs(42.44±14.76)cm^(2),外侧接触面积(45.74±22.66)cm^(2)vs(41.73±20.54)cm^(2)],且与对照组相比,试验组内外侧压力和接触面积变化更为显著(P<0.05)。在平衡运动学参数方面,治疗前两组患者运动学参数差异无统计学意义(P>0.05);治疗后两组患者的X、Y轴上的轨迹长度、均方差、最大动摇径、总轨迹、偏移长度和包络面积均显著降低(P<0.05),速度、单位面积轨迹长度均显著升高(P<0.05),试验组平衡运动学参数改善更为显著(P<0.05)。结论平衡生物反馈训练可显著提高脑卒中足内翻患者的足底压力和平衡功能。