Plantar Fasciitis, Operation or Conservative Treatment
Condition: Plantar Fasciitis
MeSH terms: Fasciitis; Fasciitis, Plantar
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to compare in a randomized controlled trial the effect of
      endoscopic operation with the standard conservative treatmentprotocol with training
      supplemented with 1-3 injections of glucocorticoids in patients with chronic plantar
      fasciopathia.
    

Detailed description: 
      Plantars 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 and in most
      clinics the standard treatment, despite the fact that a recent Cochrane review found limited
      evidence for treatment of plantar heelpain.

      Once the condition gets chronic the response to several kinds of treatment is less
      predictable. However it has been demonstrated that endoscopic surgery for plantar fasciitis
      using a deep-fascial approach was successful in individuals with an active sports anamnesis,
      and all patients returned with this treatment to full athletic activities within 8-15 weeks.
      This high succesrate is not seen in conservative treatment with decrease in activity,
      training and injections of glucocorticosteroid, eventhough they had shorter disease duration.
      Therefore the investigators think it would be interesting to offer this minimal invasive
      operation to patients much earlier in the disease, especially as there is no reported severe
      sideeffects .

      However, surgery is very seldom compared with results of other treatment modalities, and no
      randomized studies exist on the effect of operation vs the normal conservative
      standard-treatment.

      The purpose of this study is to compare in a randomized controlled trial the effect of
      endoscopic operation with the standard conservative treatmentprotocol with training
      supplemented with 1-3 injections of glucocorticoids in patients with chronic plantar
      fasciopathia.
    

Intervention name(s): endoscopic surgery; methylprednisolon; lidokaine; Training
Intervention type(s): Procedure; Drug; Drug; Behavioral
Intervention description(s): Through 2 portals profound for the fascia plantaris (deep-fascial) lateral and medial a heel-spur will be resected and the medial half of the fascia is released from its attachment to the calcaneus.
A mikroskopic X-ray sensitive pearle (Tantalum-pearle) will be inserted in the fascia in the proximal end of the distal part of the remaining fascia for measuring distance (resorbtion).
Three weeks after operation, the patients are instructed to start a specific training program. Training is supervised every third week by a physiotherapist (week 3,6,9,12 after operation), and daily training is carried out at home. Sutures are removed after 10 days,; 1ml methylprednisolon is mixed with 1ml of Lidocain and injected underneath the plantar fascia as close to the medial attachment on calcaneus as possible; 1ml methylprednisolon is mixed with 1ml of Lidocain and injected underneath the plantar fascia as close to the medial attachment on calcaneus as possible; the patient is instructed in reduction in impact. strength training 3 times weekly and stretching exercises daily are recommended.
Other intervention name(s): Fascial release; Heel spur resection; Training; Depo-medrol; Glucocorticosteroid injection; Xylocain; strength training; stretching
Intervention MeSH terms: Methylprednisolone Acetate; Methylprednisolone; Methylprednisolone Hemisuccinate; Prednisolone; Prednisolone acetate; Prednisolone hemisuccinate; Prednisolone phosphate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment