Comparison of a Physiotherapy Program versus Dexamethasone Injections for Plantar Fasciopathy in Prolonged Standing Workers: A Randomized Clinical Trial

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Author(s)
Ryan, M
Hartwell, J
Fraser, S
Newsham-West, R
Taunton, J
Year published
2014
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Objective: To investigate the effectiveness of a physiotherapy-based exercise program versus dexamethasone injection for chronic plantar fasciopathy in workers standing for prolonged periods of time. Design: A parallel group nonblinded randomized controlled trial with 12-week follow-up. Setting: An outpatient sports medicine clinic in Vancouver, Canada. Participants: Fifty-six workers required to stand for greater than 5 h/d with chronic plantar fasciopathy took part. Diagnosis from a physiotherapist must include signs of structural changes to the plantar fascia seen on ultrasound. Interventions: The PHYSIO group included ...
View more >Objective: To investigate the effectiveness of a physiotherapy-based exercise program versus dexamethasone injection for chronic plantar fasciopathy in workers standing for prolonged periods of time. Design: A parallel group nonblinded randomized controlled trial with 12-week follow-up. Setting: An outpatient sports medicine clinic in Vancouver, Canada. Participants: Fifty-six workers required to stand for greater than 5 h/d with chronic plantar fasciopathy took part. Diagnosis from a physiotherapist must include signs of structural changes to the plantar fascia seen on ultrasound. Interventions: The PHYSIO group included 7 physiotherapy-lead exercises performed daily over a 12-week period. The INJECTION group received 1 palpation-guided dexamethasone injection followed by a daily routine of calf stretching. Main Outcome Measures: The Foot and Ankle Disability Index (FADI) scores 12-weeks postintervention and ultrasound-based measures of ligament appearance. Results: At follow-up, both groups reported significant improvements in FADI and visual analog scales for pain at work and with activities of daily living at 6 and 12 weeks compared with baseline scores (P < 0.001). There were no significant between-group differences. There were no significant changes to plantar fascia thickness reported at the 6- and 12-week follow-up point. Both the number of cases with focal anechoic areas and the size of these anechoic areas improved significantly in the PHYSIO (P = 0.003) and INJECTION (P < 0.001) groups at 12-week follow-up. Conclusions: Workers standing for prolonged periods experienced the same short-term therapeutic effectiveness with a physiotherapy-lead exercise program compared with an injection of corticosteroid with stretching.
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View more >Objective: To investigate the effectiveness of a physiotherapy-based exercise program versus dexamethasone injection for chronic plantar fasciopathy in workers standing for prolonged periods of time. Design: A parallel group nonblinded randomized controlled trial with 12-week follow-up. Setting: An outpatient sports medicine clinic in Vancouver, Canada. Participants: Fifty-six workers required to stand for greater than 5 h/d with chronic plantar fasciopathy took part. Diagnosis from a physiotherapist must include signs of structural changes to the plantar fascia seen on ultrasound. Interventions: The PHYSIO group included 7 physiotherapy-lead exercises performed daily over a 12-week period. The INJECTION group received 1 palpation-guided dexamethasone injection followed by a daily routine of calf stretching. Main Outcome Measures: The Foot and Ankle Disability Index (FADI) scores 12-weeks postintervention and ultrasound-based measures of ligament appearance. Results: At follow-up, both groups reported significant improvements in FADI and visual analog scales for pain at work and with activities of daily living at 6 and 12 weeks compared with baseline scores (P < 0.001). There were no significant between-group differences. There were no significant changes to plantar fascia thickness reported at the 6- and 12-week follow-up point. Both the number of cases with focal anechoic areas and the size of these anechoic areas improved significantly in the PHYSIO (P = 0.003) and INJECTION (P < 0.001) groups at 12-week follow-up. Conclusions: Workers standing for prolonged periods experienced the same short-term therapeutic effectiveness with a physiotherapy-lead exercise program compared with an injection of corticosteroid with stretching.
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Journal Title
Clinical Journal of Sport Medicine
Copyright Statement
© 2013 Lippincott Williams & Wilkins. This is a non-final version of an article published in final form in Clinical Journal of Sport Medicine, May 2014 - Volume 24 - Issue 3 - p 211–217. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal link for access to the definitive, published version.
Subject
Clinical sciences
Physiotherapy
Sports science and exercise
Sports medicine
Medical physiology