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Erschienen in:

15.11.2018 | Award winner: Best paper at the ESSKA Congress in Glasgow 2018

Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training

verfasst von: Finn E. Johannsen, Robert B. Herzog, Nikolaj M. Malmgaard-Clausen, Maren Hoegberget-Kalisz, S. Peter Magnusson, Michael Kjaer

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 1/2019

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Abstract

Purpose

Plantar fasciitis is a very common (lifetime incidence ~ 10%) and long-lasting injury with major impact on daily function. Combining corticosteroid injection and physical training (strength training and stretching) was hypothesized to result in a superior effect compared to each treatment separately.

Methods

A single blinded randomized controlled superiority trial conducted in 2013–2014 with a 2-year follow-up (end Sept 2016). 123 consecutive patients (20–65 years) referred to two study centers in Denmark: Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen and a private rheumatology clinic with symptoms of plantar fasciitis, and ultrasound measured thickness above 4.0 mm were invited. 25 did not fulfill the inclusion criteria (mainly ultrasound criteria) and 8 refused participation. 90 patients were randomized (pulling sealed envelopes) to 3 groups: (1) 3 months strength training and stretching (n = 30), (2) corticosteroid injections with monthly intervals until thickness < 4.0 mm (maximum 3 injections) (n = 31), (3) combination of the two treatments (n = 29). During the 3 months intervention period load reduction was recommended (cushioning shoes and insoles and abstaining from running and jumping). The main outcome was improvement in Pain at function on a 100-mm VAS score and in Foot Function Index (FFI, range 0–230) at 6 months (Clinicaltrials.gov Identifier: NCT01994759).

Results

All groups improved significantly over time, but the combination of corticosteroid injection and training (strength training and stretching) had a superior effect at all time points. The mean difference between the combined treatment and training was 40 points in FFI (95% confidence interval (CI) 63–17 points, p < 0.001) and 20 mm for VAS function pain (CI 35–5 mm, p < 0.01). The mean difference between the combined treatment and corticosteroid injections only was 29 points in FFI (CI 52–7 points, p < 0.01) and 17 mm for VAS function pain (CI 32–2 mm, p < 0.05). All differences were clinically relevant.

Conclusion

The best treatment for plantar fasciitis is the combination of corticosteroid injections and training (strength training and stretching). This combined treatment is superior both in the short- and in the longterm. Corticosteroid injections combined with controlled training are recommended as first line treatment in patients with plantar fasciitis.

Level of evidence

1.
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Metadaten
Titel
Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training
verfasst von
Finn E. Johannsen
Robert B. Herzog
Nikolaj M. Malmgaard-Clausen
Maren Hoegberget-Kalisz
S. Peter Magnusson
Michael Kjaer
Publikationsdatum
15.11.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 1/2019
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5234-6

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