Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training
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 se...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2019-01, Vol.27 (1), p.5-12 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Johannsen, Finn E. Herzog, Robert B. Malmgaard-Clausen, Nikolaj M. Hoegberget-Kalisz, Maren Magnusson, S. Peter Kjaer, Michael |
| description | 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 |
| doi_str_mv | 10.1007/s00167-018-5234-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2135126620</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2133676143</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-4e0c44b72a87ec483cfb9076e46059314d8b45e261d154ee07867092818f4e573</originalsourceid><addsrcrecordid>eNp1kU-LFDEQxYO4uOPoB_AiAS9e2q0k1Un3UYb1Dyx4cc-hO129k6E7GZMM4rffDLMqCJ6Son716lGPsTcCPggAc5MBhDYNiK5ppcJGP2MbgUo1RqF5zjbQo2wktPqavcz5AFC_2L9g1woQlda4YftdTMW7mAul6Cfuw4Fc8TFwn3nZEx8pF14SDWWlUGqfH5chlCHxecjO-1I5P3MX19EHmvhPX_a1CiXFZal1SYMPPjy8YlfzsGR6_fRu2f2n2--7L83dt89fdx_vGqeMLA0SOMTRyKEz5LBTbh57MJpQQ9srgVM3YktSi0m0SASm0wZ62YluRmqN2rL3F91jij9O1bxdfXa0VNMUT9lKoVohtZZQ0Xf_oId4SqG6O1NKG30-5paJC-VSzDnRbI_Jr0P6ZQXYcwz2EoOtMdhzDFbXmbdPyqdxpenPxO-7V0BegFxb4YHS39X_V30Eq1OSQA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2133676143</pqid></control><display><type>article</type><title>Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training</title><source>SpringerNature Journals</source><source>Access via Wiley Online Library</source><creator>Johannsen, Finn E. ; Herzog, Robert B. ; Malmgaard-Clausen, Nikolaj M. ; Hoegberget-Kalisz, Maren ; Magnusson, S. Peter ; Kjaer, Michael</creator><creatorcontrib>Johannsen, Finn E. ; Herzog, Robert B. ; Malmgaard-Clausen, Nikolaj M. ; Hoegberget-Kalisz, Maren ; Magnusson, S. Peter ; Kjaer, Michael</creatorcontrib><description>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.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-018-5234-6</identifier><identifier>PMID: 30443664</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Award winner: Best paper at the ESSKA Congress in Glasgow 2018 ; Combined treatment ; Confidence intervals ; Corticosteroids ; Cushioning ; Fasciitis ; Injection ; Insoles ; Jumping ; Medicine ; Medicine & Public Health ; Orthopedics ; Pain ; Patients ; Physical training ; Randomization ; Sports medicine ; Sports training ; Strength ; Strength training ; Stretching ; Thickness measurement ; Ultrasonic imaging ; Ultrasound</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-01, Vol.27 (1), p.5-12</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018</rights><rights>Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-4e0c44b72a87ec483cfb9076e46059314d8b45e261d154ee07867092818f4e573</citedby><cites>FETCH-LOGICAL-c372t-4e0c44b72a87ec483cfb9076e46059314d8b45e261d154ee07867092818f4e573</cites><orcidid>0000-0002-3732-6229</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-018-5234-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-018-5234-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30443664$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Johannsen, Finn E.</creatorcontrib><creatorcontrib>Herzog, Robert B.</creatorcontrib><creatorcontrib>Malmgaard-Clausen, Nikolaj M.</creatorcontrib><creatorcontrib>Hoegberget-Kalisz, Maren</creatorcontrib><creatorcontrib>Magnusson, S. Peter</creatorcontrib><creatorcontrib>Kjaer, Michael</creatorcontrib><title>Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>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.</description><subject>Award winner: Best paper at the ESSKA Congress in Glasgow 2018</subject><subject>Combined treatment</subject><subject>Confidence intervals</subject><subject>Corticosteroids</subject><subject>Cushioning</subject><subject>Fasciitis</subject><subject>Injection</subject><subject>Insoles</subject><subject>Jumping</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Patients</subject><subject>Physical training</subject><subject>Randomization</subject><subject>Sports medicine</subject><subject>Sports training</subject><subject>Strength</subject><subject>Strength training</subject><subject>Stretching</subject><subject>Thickness measurement</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU-LFDEQxYO4uOPoB_AiAS9e2q0k1Un3UYb1Dyx4cc-hO129k6E7GZMM4rffDLMqCJ6Son716lGPsTcCPggAc5MBhDYNiK5ppcJGP2MbgUo1RqF5zjbQo2wktPqavcz5AFC_2L9g1woQlda4YftdTMW7mAul6Cfuw4Fc8TFwn3nZEx8pF14SDWWlUGqfH5chlCHxecjO-1I5P3MX19EHmvhPX_a1CiXFZal1SYMPPjy8YlfzsGR6_fRu2f2n2--7L83dt89fdx_vGqeMLA0SOMTRyKEz5LBTbh57MJpQQ9srgVM3YktSi0m0SASm0wZ62YluRmqN2rL3F91jij9O1bxdfXa0VNMUT9lKoVohtZZQ0Xf_oId4SqG6O1NKG30-5paJC-VSzDnRbI_Jr0P6ZQXYcwz2EoOtMdhzDFbXmbdPyqdxpenPxO-7V0BegFxb4YHS39X_V30Eq1OSQA</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Johannsen, Finn E.</creator><creator>Herzog, Robert B.</creator><creator>Malmgaard-Clausen, Nikolaj M.</creator><creator>Hoegberget-Kalisz, Maren</creator><creator>Magnusson, S. Peter</creator><creator>Kjaer, Michael</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3732-6229</orcidid></search><sort><creationdate>20190101</creationdate><title>Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training</title><author>Johannsen, Finn E. ; Herzog, Robert B. ; Malmgaard-Clausen, Nikolaj M. ; Hoegberget-Kalisz, Maren ; Magnusson, S. Peter ; Kjaer, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-4e0c44b72a87ec483cfb9076e46059314d8b45e261d154ee07867092818f4e573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Award winner: Best paper at the ESSKA Congress in Glasgow 2018</topic><topic>Combined treatment</topic><topic>Confidence intervals</topic><topic>Corticosteroids</topic><topic>Cushioning</topic><topic>Fasciitis</topic><topic>Injection</topic><topic>Insoles</topic><topic>Jumping</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Pain</topic><topic>Patients</topic><topic>Physical training</topic><topic>Randomization</topic><topic>Sports medicine</topic><topic>Sports training</topic><topic>Strength</topic><topic>Strength training</topic><topic>Stretching</topic><topic>Thickness measurement</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Johannsen, Finn E.</creatorcontrib><creatorcontrib>Herzog, Robert B.</creatorcontrib><creatorcontrib>Malmgaard-Clausen, Nikolaj M.</creatorcontrib><creatorcontrib>Hoegberget-Kalisz, Maren</creatorcontrib><creatorcontrib>Magnusson, S. Peter</creatorcontrib><creatorcontrib>Kjaer, Michael</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Johannsen, Finn E.</au><au>Herzog, Robert B.</au><au>Malmgaard-Clausen, Nikolaj M.</au><au>Hoegberget-Kalisz, Maren</au><au>Magnusson, S. Peter</au><au>Kjaer, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>27</volume><issue>1</issue><spage>5</spage><epage>12</epage><pages>5-12</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30443664</pmid><doi>10.1007/s00167-018-5234-6</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3732-6229</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-01, Vol.27 (1), p.5-12 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2135126620 |
| source | SpringerNature Journals; Access via Wiley Online Library |
| subjects | Award winner: Best paper at the ESSKA Congress in Glasgow 2018 Combined treatment Confidence intervals Corticosteroids Cushioning Fasciitis Injection Insoles Jumping Medicine Medicine & Public Health Orthopedics Pain Patients Physical training Randomization Sports medicine Sports training Strength Strength training Stretching Thickness measurement Ultrasonic imaging Ultrasound |
| title | Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training |
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