Outcome Study of Subjects With Insertional Plantar Fasciitis.

Martin RL, Irrgang JJ, Conti SF (University of Pittsburgh, Pittsburgh, Pa), Foot Ankle Int. 1998;19:803-811.

This study was a retrospective correlational study using chart reviews and a mailed survey to obtain outcome information about patients with insertional plantar fasciitis. Three criteria were required for inclusion in the study: the same attending orthopedic surgeon performed the evaluation; the history given was consistent with insertional plantar fasciitis, with maximum tenderness at the medial calcaneal tubercle; and the subject did not have a coexisting symptomatic foot or ankle problem.

A total of 237 of approximately 400 consecutive subjects met the 3 criteria. Once diagnosed, the subject was prescribed the following: an oral nonsteroidal anti-inflammatory drug (NSAID), a one-time physical therapy session for a home exercise program consisting of Achilles tendon and plantar fascia stretching exercises, a resting dorsiflexion night splint, and either a custom orthosis or a heel cup (randomly assigned). A "compliant subject" was defined as a subject who took the oral NSAID 4 times per day for 4 weeks, completed the exercise program 3 times per day, used the resting splint nightly, and wore the orthosis all day. If no improvement was noted after 4 months, the subject was offered a steroid injection and encouraged to continue with the same program. If no improvement was seen after 6 months, surgery was considered. Data were collected through a mailed survey, and no attempt was made to contact potential subjects by phone.

One hundred fifty-seven of the 237 potential subjects returned their surveys. The average age of the subjects was 45 years, and 60% of the subjects were men. Fifty-one percent of these subjects reported a "good" result (no pain), 33.8% reported "fair" results (intermittent pain), and 14.6% reported "poor" results (constant pain). Satisfaction with their final outcome was reported by 81.8% of the subjects.

The authors found that subjects were less likely to have a good outcome if their symptoms persisted longer than 12 months before they reported to the clinic. There was no significant relationship between outcome and the following factors: How often the subjects did the exercise, the length of time they did the exercises, the setting where they were shown the exercises, how frequently they wore the night splint, how long they wore the night splint, whether they received medication, whether they took the medication as prescribed, whether they received a custom orthosis or heel cup, how frequently they wore the orthosis or heel cup, and how long they wore the orthosis or heel cup. There was a significant relationship between a good outcome and wearing the night splint as prescribed 7 nights per week.

In conclusion, the authors found that adherence to a nonsurgical treatment program was low and, for the most part, did not correlate to outcome. The authors reported that subjects with chronic conditions who adhered to the use of the night splint did have a better outcome. According to the researchers, the results suggested that early, aggressive, nonsurgical treatment within 12 months after the onset of symptoms improved the chance of a good outcome. The patients perceived that stretching, night splints, and orthoses or heel pads were equally important components of the treatment program.

Robert Tank, PT, ATC Orthopaedic Associates Inc Evansville, Ind