Exercise Versus Corticosteroid Randomized Clinical Trial for Plantar Fasciitis
Condition: Fasciitis, Plantar
MeSH terms: Fasciitis; Fasciitis, Plantar
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      Chronic plantar fasciopathy is a painful condition common in the workplace, particularly for
      those workers required to stand for long periods of time, and is typically associated with
      point tenderness at heel and arch of the foot. This clinical trial will investigate the
      effectiveness of an innovative multi-element exercise program versus the standard of care for
      plantar fasciopathy. The observation period will be 12-weeks. Outcomes are determined through
      questionnaire and ultrasound imaging. Workers with long-standing plantar fasciopathy who must
      stand for prolonged periods of time (i.e. > 6 hours) during their workday will be invited to
      participate in this study. After ensuring eligibility, each subject will be randomly assigned
      to either the intervention group who will receive a multi-element exercise program, or the
      control group who will receive a cortisone injection followed by a stretching program for
      their calf-muscles (standard of care). The treatment length for both groups will be 12-weeks.
    


Intervention name(s): Karaoke Exercise; Balance walking exercise; Forefoot extension exercise; Standing one-legged balance exercise:; Ankle inversion/eversion exercise; Gastrocnemius and soleus stretching; Tissue-specific plantar fascia self massage; Dexamethasone
Intervention type(s): Other; Other; Other; Other; Other; Other; Other; Drug
Intervention description(s): lateral side step movement involving crossing one foot over the next for 5 sets of 15 cross-overs in each direction; Walking along a straight line on the ground, for 5 sets of 30 strides; The subject stands feet shoulder width apart with one foot ahead of the other and then contracting only calf muscles of the back leg, lifts the heel of the back leg until the metatarsophalangeal joint of that foot is maximally extended. The subject is instructed to concentrate on maintaining balance on the back leg over the first and second metatarsophalangeal joints throughout movement for 5 sets of 15 repetitions.; This exercise is performed initially with eyes open, then with mastery exhibited by being able to hold balance and not touch the ground with contralateral leg performed with eyes closed, then on an unstable surface with and without eyes open for 1 minute.; The foot is placed sideways at the edge of a step. After stabilizing the remainder of the foot and leg, the ankle is inverted and everted to the limits of the range for 3 sets of 15 repetitions.; This stretch is performed while standing in a neutral position and the knee extended the foot is placed on top of a ramp or phone-book elevating the forefoot on the rearfoot (talocrural dorsiflexion) and held for 3 sets of 30 seconds each. Next the foot is again placed on top of a phone-book with the knee flexed approximately 15-20 degrees and held for 3 sets of 30 seconds each.; This deep massage is performed in a sitting position the right foot is crossed over the left while one hand passively extends the right forefoot. The left hand then applies light to moderate pressure in 3-5 second intervals along the length of the medial longitudinal arch. Same procedure is then repeated for the left foot.; A 22-gauge, 1.5" needle and 3 cm syringe filled with 1ml of dexamethasone mixed with 0.5ml of 1% lidocaine. Prior to injection, the skin will be sterilized with povidone-iodine. The needle is inserted 2-3 cm anteromedial to the focal point of pain in the inferior heel near the calcaneal tuberosity and moved toward the tenderest area.
Intervention MeSH terms: Dexamethasone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Chronic plantar fasciitis; Workplace injury; Foot and Ankle Disability Index; Ultrasound measure of disease severity