Objective: To compare the outcome of conventional versus interventional method of treatments in patients presented with plantar fasciitis.
Study Design : Descriptive comparative study
Place and Duration of Study : This study was conducted at Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences from November 1 2006 to April 30 2009.
Subjects and Methods: A total number of 276 patients diagnosed as having plantar fasciitis were included in this study. They were divided into two groups of equal number. Group A was controlled group managed by conventional method i.e. non-steroidal anti inflammatory drugs (NSAIDs), foam heel pad, exercises and extracorporeal shock wave therapy (ESWT). Group B was managed by interventional method in which a steroid (Methylprednisolone) injection was used in addition to conventional method.
Results: In Group A, out of 138 patients, 83 patients had still pain on weight bearing and pain after rest and 55 patients had remission in symptoms after treatment. Similarly, in Group B, 29 patients had pain while 109 patients were relieved after treatment.Conclusion: Interventional treatment method using steroids along with conventional modalities have significant benefit as compared to conventional treatment alone. If the approach and expertise are proper we can expect the best results.
Key Words: Plantar fasciitis, Methylprednisolone injection, ESWT, NSAIDS

Introduction

Plantar fasciitis, inflammation of the plantar fascia at its origin is one of the most common causes of the heel pain. Predisposing factors of plantar fasciitis are obesity, prolong standing, nature of job, limited ankle flexion and acute or chronic injury to the heel from repeated overload stress. In runners, it appears to be associated with over use, improper or excessively worn footwear resulting into microtrauma to the plantar fascia at a rate that exceeds the body ability to recover.¹ In sedentary adults, it is often attributable to poor intrinsic muscle strength and poor force attenuation secondary to acquired pes planus and compounded by a decrease in the body healing capacity.2 This over use syndrome has been recognized for almost two hundred years. In 1812, Wood described this condition which has been referred by various synonyms including heel pain syndrome, subcalcaneal bursitis, periostitis, neuritis, heel spur syndrome, runner's heel and policeman's heel. The plantar fasciitis is a very common painful disorder of foot and for understanding its cause, it is essential to know the basic anatomy and physiology of the plantar aspect of the foot.During takeoff phase of the gait, the dorsiflexion of the toes tightens the plantar fascia and tensile forces generated in the Tendo Achilles increases the tensile strain in the plantar fascia. These repeated stresses result into microtrauma which induces inflammatory process in the proximal part of the plantar fascia and surrounding structures.³ Spontaneous rupture of all or part of the fascia may occur in extremely high load situations and the natural healing of torn fascia often is complicated by painful scar formation.

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