Asmaa Mahmoud Ali Moustafa1, Eshrak Hassanein2, Calogero Foti3. 1. Physical medicine, Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt; Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University, Rome, Italy. 2. Radio-diagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 3. Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University, Rome, Italy.
Abstract
BACKGROUND: although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. METHODS: this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. RESULTS: increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. CONCLUSION: US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis.
BACKGROUND: although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. METHODS: this prospective observational trial included 21 plantar fasciitispatients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. RESULTS: increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. CONCLUSION: US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis.
Authors: Patricia Palomo-López; Ricardo Becerro-de-Bengoa-Vallejo; Marta Elena Losa-Iglesias; David Rodríguez-Sanz; César Calvo-Lobo; Daniel López-López Journal: J Pain Res Date: 2018-04-27 Impact factor: 3.133