Physical Examination Variables Predict Response to Conservative Treatment of Nonchronic Plantar Fasciitis: Secondary Analysis of a Randomized, Placebo-Controlled Footwear Study.
Physical Examination Variables Predict Response to Conservative Treatment of Nonchronic Plantar Fasciitis: Secondary Analysis of a Randomized, Placebo-Controlled Footwear Study.
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DOI：
10.1016/j.pmrj.2015.09.011
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Jarrett B
中科院分区：
文献类型：
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作者：
Wrobel JS;Fleischer AE;Matzkin-Bridger J;Fascione J;Crews RT;Bruning N;Jarrett B
足底筋膜炎是一种常见的致残性疾病，保守治疗的预后很难预测。确定初步临床结果是否有助于预测患者对主要包括支撑鞋和伸展运动的保守治疗的反应。患者被招募并在伊利诺伊州芝加哥都会区的两家足病诊所就诊。招募了 77 名非慢性足底筋膜炎患者。如果患者在过去六个月内接受过足跟注射或在筛选时目前正在使用定制足部矫形器，则被排除在外。六十九名患者在接受鞋类干预三个月后完成了最后一次随访。三个月后，治疗失败被认为足跟疼痛减轻 <50%23 Logistic 回归模型评估了入组时前瞻性评估的 30 多个临床和体检结果与治疗反应之间的可能关联。踝关节无法背屈超过-5°（OR 27 3.9，p = .024）、非严重（按顺序量表≤ 7）第一步疼痛（OR 3.8，p = .021）和放松姿势下的足跟外翻（OR 4.0，p = .014）在多变量分析中均预测治疗失败（曲线下受试者工作特征面积= .769）。踝关节背屈受限也与初次出现时脚后跟疼痛严重程度相关（r = -.312，p =.006）。患有严重踝关节马蹄足的患者对以家庭跟腱拉伸和支持治疗为中心的治疗产生良好反应的可能性高出近四倍。因此，早期使用更先进的疗法可能最适合那些没有严重踝关节马蹄足或没有严重第一步疼痛的患者。我们的研究结果可能在临床上并不直观，因为马蹄足症状较轻且疼痛较轻的患者在保守治疗下表现更差。
Plantar fasciitis is a common disabling condition and the prognosis of conservative treatment is difficult to predict. To determine whether initial clinical findings could help predict patient response to conservative treatment primarily consisting of supportive footwear and stretching. Patients were recruited and seen at two outpatient podiatric clinics in the Chicago, Illinois metropolitan area. Seventy-seven patients with non-chronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous six months or were currently utilizing custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit three months after receiving the footwear intervention. Treatment failure was considered a <50% reduction in heel pain at three month follow23 Logistic regression models evaluated the possible association between over thirty clinical and physical exam findings prospectively assessed at enrollment, and treatment response. Inability to dorsiflex the ankle past −5° (OR 27 3.9, p=.024), non-severe (≤ 7 on ordinal scale) first-step pain (OR 3.8, p=.021), and heel valgus in relaxed stance (OR 4.0, p=.014) each predicted treatment failure in multivariable analysis (Receiver operating characteristic area under the curve=.769). Limited ankle dorsiflexion also correlated with higher heel pain severity at initial presentation (r = −.312, p =.006). Patients with severe ankle equinus were nearly four times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive as patients with less severe equinus and less severe pain at presentation did worse with conservative care.