Optimal Treatment of Plantar Fasciitis: Physical Training, Glucocorticoid Injections or a Combination Thereof.
Condition: Plantar Fasciitis
MeSH terms: Fasciitis; Fasciitis, Plantar
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to determine whether reduced load to patients with plantar
      fasciitis (reduced standing, walking, landing) together with either controlled heavy
      resistance training or glucocorticosteroid injection or a combination thereof is the best
      treatment.
    

Detailed description: 
      Plantar 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 with proven effect.
      However treatment of overuse injury in other tendon/aponeurosis-like structures, has over the
      later years been dominated by an increasing documentation of a good curative effect of heavy
      controlled mechanical loading (eccentric strength exercises or heavy slow concentric strength
      training) upon tendinopathies in Achilles or patella tendon. However, no studies have looked
      at the influence of physical training (e.g. strength training) on the diseased plantar
      aponeurosis. Also no studies have looked at the effect of a combination of giving local
      glucocorticoid injection and training on this or other tendon overuse entities.

      We hypothesize that heavy strength training will have a positive effect upon PF, and that a
      combination of training and glucocorticoid injections will have an additive effect upon this
      disease and be even more effective than each of the treatments alone. Glucocorticoid
      injection acting as the standard control treatment.
    

Intervention name(s): Training; Glucocorticosteroid injection; Reduction in impact
Intervention type(s): Other; Drug; Behavioral
Intervention description(s): Patients are instructed to carry out strengthening exercises for the fascia plantaris 3 days a week and stretching exercises every day. Four times in the first 2 months supervised training in groups is carried out with a physiotherapist supervising the exercises and instructing in progression and new exercises, and all participants are instructed to carry out a specific training program daily at home. The amount of training performed by each patient, is registered in a diary weekly; Ultra sound guided injection af 1 ml og Glucocorticosteroid (methylprednisolone 40 mg) and 1 ml of lidocaine 5mg/ml from the medial side profound to the thickened part of the fascia plantaris.
Glucocorticosteroid injections are given every month until the aponeurosis thickness is less than 4 mm as determined by ultrasonography (max 3 injections).; advocate reduction in standing, walking, running, jumping. advocate shock absorbing shoes advocate prefabricated insoles advocate taping in special occasions.
Other intervention name(s): Heavy slow resistance exercise; Eccentric training; stretching; Methylprednisolone; Depo-medrol; Shock absorbtion
Intervention MeSH terms: Methylprednisolone; Methylprednisolone Acetate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Plantar fasciitis; Treatment; Training; Glucocorticosteroid injection