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

Abstract

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.