Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment

Özet

Objective: The aim of this study was to define a quantitative parameter to indicate which cases of plantarfasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of twodifferent treatment modalities.Methods: Seventy patients (mean age: 49.10; range: 41e58) with chronic plantar fasciitis unresponsiveto conservative treatment for 3 months were treated with either betamethasone injection or extracorporealshock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration ofsymptoms, age and calcaneal spur length were assessed.Results: Degree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFASscores (r ¼ 0.054). Plantar fascia thickness significantly decreased in both groups after treatment(1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores(68% for steroid and 79% for ESWT, p ¼ 0.069) and fascial thickness (24% for steroid and 26% for ESWT,p ¼ 0.344) were similar between two groups. Functional recovery was not correlated with baselinefascial thickness (r ¼ 0.047) or degree of fascial thinning after treatment (r ¼ 0.099). Percentage ofchange in AOFAS scores was correlated only with baseline AOFAS scores (r ¼ 0.943).Conclusions: Plantar fascia thickness increases significantly in plantar fasciitis and responds to treatment.Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantarfascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery interms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is nothelpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis.