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

足底筋膜炎是一种反复拉伤，是导致足部疼痛的最常见原因之一。10%的老龄化 成人会出现足底筋膜炎，50%的病例是残废的。足部疼痛可能会导致其他问题 例如行动不便、抑郁和处方药的使用，导致生活质量下降。 足部疼痛和虚弱、静态和动态平衡降低之间的关系已经确定， 老年人的行走速度也会减慢。足底筋膜炎的标准护理方法是用 足部矫形器和支撑鞋。然而，对牙弓的慢性支持已被证明会导致固有的 足部肌肉萎缩。由于足底筋膜炎与这种萎缩有关，因此采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 足底筋膜炎在10年后出现症状的老年人。 最小的鞋子被设计成让脚自然地发挥作用，就像赤脚一样。他们已经是 成功地在老年人中实施，用于治疗膝骨性关节炎。最小的鞋子是高度 灵活，缺乏传统鞋类的支持。这对足部肌肉提出了更大的需求， 促进发展壮大。更强壮的足部固有肌肉已被证明可以减少足部肌肉的紧张。 足底筋膜的每一步，从而降低了发生足底筋膜炎的风险。 长期目标：改进老年成人足底筋膜炎的治疗干预措施。 具体目标：1.比较最小鞋(MF)和足底矫形器的疼痛和身体功能 (FO)组在3个月和6个月随访时，2.比较足部固有肌肉大小和力量的变化 比较MF组和FO组在3个月和6个月的随访期和3个月的复发率。 足底筋膜疼痛在12个月随访期的比较 方法：120例足底筋膜炎患者。将从2个地点招聘。他们将会是 随机分为最小鞋类(MF)组和足部矫形器(FO)组。足部肌肉大小的基线测量 力量，静态和动态平衡，6分钟。步行测试和两份功能结果问卷将 获得。MF组将得到2双最小的鞋子，FO组将得到2双支持 鞋子和预制的足部矫形器。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。两组都将被给予 一项为期8周的鞋类过渡计划，基于他们各自的基线步数。他们将返回到 实验室在3个月和6个月重复基线测量。足底筋膜痛和每日步数 在这一年中一直受到监测。预后指标与足底筋膜炎的比较 复发率将在两组之间进行比较。

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.