A Novel Approach to Plantar Fasciitis in the Aging Population The NAPA trial

足底筋膜炎是一种重复性劳损，是引起足部疼痛的最常见原因之一。百分之十的老化 成年人经历足底筋膜炎，其中50%的病例致残。脚痛会导致其他问题 例如行动不便、抑郁和使用处方药，导致生活质量下降。 已经建立了足部疼痛和虚弱，静态和动态平衡降低， 以及老年人行走速度的降低。足底筋膜炎的护理标准是用 足部矫形器和支撑鞋。然而，长期支持的弓已被证明会导致内在的 足部肌肉萎缩。由于足底筋膜炎与这种萎缩有关，用慢性足弓支撑治疗 只会增加复发的风险事实上，有50%的复发率和45.6%的风险， 足底筋膜炎10年后的症状在老年人发病。 极简鞋的设计是为了让脚自然地发挥功能，就像赤脚一样。调解人已 成功应用于老年人膝关节骨关节炎的治疗。极简鞋是高度 柔韧且缺乏传统鞋类的支撑。这对足部肌肉的要求更高， 促进强化。更强的脚内在的脚肌肉已经被证明可以减少对 每走一步都要注意足底筋膜，从而降低患足底筋膜炎的风险。 长期目标：改善老年人足底筋膜炎的治疗干预。 具体目标：1。比较最小鞋（MF）和足部矫形器之间的疼痛和身体功能 (FO)在3个月和6个月随访时，2.比较内在足部肌肉大小和力量的变化 MF组和FO组在3个月和6个月随访时的差异，以及3.比较复发率， 12个月随访时MF组和FO组之间的足底筋膜疼痛 方法：120例足底筋膜炎患者（>6个月）。将从2个研究中心招募。他们将 随机分为最小鞋类（MF）和足部矫形器（FO）组。足部肌肉尺寸的基线测量 和力量，静态和动态平衡，6分钟步行测试和两个功能结果问卷将被 得到了MF组将获得2双最小鞋，FO组将获得2双支撑鞋 鞋和预制足矫形器。MF组将接受为期4周的足部强化计划 和柔韧性练习，而FO组只接受柔韧性练习。两组都将获得 一个为期8周的鞋类过渡计划，根据他们的个人基线步数。他们将返回。 实验室在3个月和6个月重复基线测量。足底筋膜疼痛和每日步数将 在这一年中，我们一直在监测。结局指标和足底筋膜炎的比较 将比较各组之间的复发率。

Plantar fasciitis, a repetitive strain injury, is one of the most common causes of foot pain. Ten percent of aging adults experience plantar fasciitis with 50% of the cases being disabling. Foot pain can lead to other problems such as reduced mobility, depression and prescription medication use, leading to a reduced quality of life. Relationships have been established between foot pain and weakness, reduced static and dynamic balance, and reduced walking speed in aging adults. The standard of care for plantar fasciitis is to brace the foot with foot orthoses and supportive shoes. However, chronic support of the arch has been shown to lead to intrinsic foot muscle atrophy. As plantar fasciitis is associated with this atrophy, treating it with chronic arch support only increases the risk for recurrence. In fact, there is a 50% recurrence rate and a 45.6% risk of having plantar fasciitis 10 years after the onset of symptoms in older adults. Minimal shoes are designed to allow the foot to function naturally, as if barefoot. They have already been successfully implemented in older adults for the treatment of knee osteoarthritis. Minimal shoes are highly flexible and lack the support of conventional footwear. This places greater demand on the foot muscles which promotes strengthening. Stronger foot intrinsic foot muscles have been shown to reduce the strain on the plantar fascia with each step, thereby reducing the risk of developing plantar fasciitis. Long-term Goal: To improve treatment interventions for plantar fasciitis in aging adults. Specific Aims: 1. Compare pain and physical function between the minimal footwear (MF) and the foot orthotic (FO) groups at the 3 and 6 month follow-up, 2. Compare changes in intrinsic foot muscle size and strength between MF and FO groups at the 3 and 6 month follow-up, and 3. Compare the incidence of recurrence of plantar fascial pain between the MF and FO groups at the 12 month follow-up Methods: 120 participants with plantar fasciitis (>6 mos.) will be recruited from 2 sites. They will be randomized into a minimal footwear (MF) and foot orthotic (FO) group. Baseline measures of foot muscle size and strength, static and dynamic balance, 6 min. walk test and two functional outcome questionnaires will be obtained. The MF group will receive 2 pair of minimal shoes, and the FO group will receive 2 pair of supportive shoes and prefabricated foot orthoses. The MF group will be given a 4-week program of foot strengthening and flexibility exercises, while the FO group will only receive the flexibility exercises. Both groups will be given an 8-week footwear transition program based upon their individual baseline step counts. They will return to the laboratory to repeat the baseline measures at 3 and 6 mos. Plantar fascial pain and daily step counts will be monitored over the course of the year. Comparisons in outcome measures as well as plantar fasciitis recurrence will be compared between the groups.