Comparions the Effect of Different Treatment Modalities on Chronic Plantar Fasiitis
Condition: Plantar Fasciitis, Chronic
MeSH terms: Fasciitis; Fasciitis, Plantar
Study type: Interventional

Summary: 
      Plantar fasciitis is a common cause of heel pain affecting about 20% of the general
      population. The basic treatment of plantar fasciitis is conservative. Approximately 85-90% of
      plantar fasciitis patients can be successfully treated without surgery. Methods include
      resting, nonsteroidal anti-inflammatory drugs, stretching, shoe orthotics, corticosteroid
      injections, physical therapy, night splints, and extracorporeal shock wave therapy (ESWT) and
      ultrasound therapy. Plantar fasciitis treatment is a chronic treatment that has been clearly
      described in the literature despite the use of treatment modalities. In the literature,
      treatment modalities which should be used respectively in the treatment of plantar fasciitis
      are expressed. Nevertheless, it is a chronic disease caused by skipping the treatment steps
      for various reasons or applying the treatments in the wrong hierarchy. The aim of this
      project is to compare the effects of stretching exercises, ESWT and instrument-assisted
      myofascial relaxation technique (Graston Technique®) in the treatment of chronic plantar
      fasciitis in terms of pain, disability level, quality of life and static and dynamic plantar
      pressure analysis.
    

Detailed description: 
      Traditionally, the fascia tissue was described as a single connective tissue surrounding each
      muscle, muscle fiber and myofibril. In the International Fascia Research Congress held in
      Vancover, Canada in 2012, the definition of fascia was redefined, including aponeurosis,
      ligament, tendon, joint capsule, central nervous system, epinerium, bronchial connective
      tissue and abdominal mesentery. With the emphasis on the importance of fascia in the
      literature, soft tissue techniques, including fascia, have gained popularity.

      Plantar fasciitis is a common cause of heel pain affecting about 20% of the general
      population. It is usually caused by biomechanical imbalance resulting from tension occurring
      along the plantar fascia.Plantar fascia is thought to be effective in the pathogenesis of
      micro-ruptures and inflammation caused by recurrent tension in the insersio. A variety of
      predisposing factors have also been proposed, including minor trauma, foot pronation,
      inappropriate shoes, obesity, and prolonged standing. Diagnosis is usually based on clinical
      history and local sensitivity. The pain is typically felt in the morning and / or after long
      sitting, in the origin of the plantar aponeurosis, and a centimeter distal to this area, and
      typically occurs in the first steps after getting out of bed in the morning, resulting in
      difficulty in daily activities. Basic treatment of plantar fasciitis is conservative.
      Approximately 85-90% of plantar fasciitis patients can be successfully treated without
      surgery. Methods include resting, nonsteroidal anti-inflammatory drugs, stretching, shoe
      additions, orthoses, corticosteroid injections, physical therapy, night splints, and
      extracorporeal shock wave therapy (ESWT) and ultrasound therapy. Plantar fasciitis treatment
      is a chronic treatment that has been clearly described in the literature despite the use of
      treatment modalities.In 2000, the Food and Drug Administration (FDA) approved the use of
      Extracorporeal Shock Wave Therapy (ESWT), an electrohydraulic device for use in the treatment
      of chronic plantar fasciitis. Pain, redness, edema and ecchymosis are rarely reported during
      ESWT treatment, but these effects are not permanent.The exact mechanism of action of the ESWT
      has not been clearly established. However it is believed that the body responds by increasing
      the healing ability in that area, by stimulating a repair process. For the patients who
      treated with ESWT, there was a decrease in pain and an increase in walking ability compared
      to a control group. ESWT is recommended in chronic plantar fasciitis patients who do not
      respond to conservative treatment.

      Tight bands in the gastrocnemius muscles, myofascial / intramuscular trigger points, may
      interfere with the development of plantar heel pain. Intramuscular trigger points are defined
      as hyperirritable areas that are painful on the compression, contraction, or stretching of
      the muscles in a skeletal muscle stretched and produce pain that is reflected at a distant
      point away from the intramuscular trigger point, and may affect their stiffness, myofascial
      constraints and the extensibility of the muscles or fascia.

      Instrument-assisted soft tissue mobilization is a treatment approach developed by James
      Cyriax. Although there are many different name instruments used for myofascial release, the
      most popular is Graston Technique® (GT®). GT® is a therapeutic technique based on soft tissue
      mobilization logic, which is used with specially designed instruments and by applying
      longitudinal pressure along the muscle fibers. This technique differs from conventional cross
      friction or transverse friction massage. Longitudinal pressure is applied along the fibers of
      the muscles associated with specially designed instruments. By changing the tissue properties
      with the instruments, it enables the patient to realize the changing feeling in the treated
      areas. Damaged tissues are determined by changing the tissue vibration under the instrument.
      In addition, the clinician's hands with the depth can be much more than the depth that can be
      brought down and the clinician's fatigue level is reduced. Treatment typically involves
      greater application at the points of pain than at other tissues.The clinical use of this
      technique aims to increase the effectiveness of treatment, especially in patients. It is
      believed that by creating microtrauma in tissue, it will produce a local inflammatory
      response that promotes the disintegration of scar tissue, opening of adhesions, new collagen
      synthesis and connective tissue remodeling. The treatment efficacy of the instruments
      increases the local inflammation response, especially with microtrauma created in the damaged
      areas, increases the scar tissue destruction, loosens the adhesions, increases collagen
      synthesis and stimulates the remodeling of the connective tissue.

      In the literature, treatment modalities which should be used respectively in the treatment of
      plantar fasciitis are expressed. Nevertheless, it is a chronic disease caused by skipping the
      treatment steps for various reasons or applying the treatments in the wrong hierarchy.

      The comparison of stress, GT® and the effectiveness of ESWT applications will contribute both
      to the deficiency of the literature and to decide on effective treatment.
    

Intervention name(s): ESWT, Graston Technique
Intervention type(s): Device
Intervention description(s): The treatment period for each group was determined as 4 weeks. Stretching program for each group will be given as home exercise program. Stretching exercises will be completed in 3 sets, 2 sets per day, stretching for 30 seconds.
Graston Technique Group will take treatment 2 times per week, ESWT group will take treatment 1 time per week.
Other intervention name(s): stretching
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Plantar Fasciitis; Extracorporeal shock wave therapy; Graston Technique; Instrument assisted soft tissue mobilization; Stretching; Plantar pressure analysis