Plantar Fasciitis, Operation or Conservative Treatment

NCT ID: NCT02448316

Last Updated: 2018-07-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-01

Study Completion Date

2017-11-01

Brief Summary

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The purpose of this study is to compare in a randomized controlled trial the effect of endoscopic operation with the standard conservative treatmentprotocol with training supplemented with 1-3 injections of glucocorticoids in patients with chronic plantar fasciopathia.

Detailed Description

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Plantars fasciitis (PF) is a frequently diagnosed condition, defined as pain at the medial tubercle of the calcaneus, and 10% of the population will at some points in their life experience this condition. Accumulated loading of the plantar fascia seems to relate to development of PF, as it is commonly seen in runners and those who are overweight, and number of daily steps or simply time of standing has been shown to be a predisposing factor for PF development ( Orthosis and glucocorticoid injections are 2 widely used treatments and in most clinics the standard treatment, despite the fact that a recent Cochrane review found limited evidence for treatment of plantar heelpain.

Once the condition gets chronic the response to several kinds of treatment is less predictable. However it has been demonstrated that endoscopic surgery for plantar fasciitis using a deep-fascial approach was successful in individuals with an active sports anamnesis, and all patients returned with this treatment to full athletic activities within 8-15 weeks. This high succesrate is not seen in conservative treatment with decrease in activity, training and injections of glucocorticosteroid, eventhough they had shorter disease duration. Therefore the investigators think it would be interesting to offer this minimal invasive operation to patients much earlier in the disease, especially as there is no reported severe sideeffects .

However, surgery is very seldom compared with results of other treatment modalities, and no randomized studies exist on the effect of operation vs the normal conservative standard-treatment.

The purpose of this study is to compare in a randomized controlled trial the effect of endoscopic operation with the standard conservative treatmentprotocol with training supplemented with 1-3 injections of glucocorticoids in patients with chronic plantar fasciopathia.

Conditions

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Plantar Fasciitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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endoscopic surgery

Endoscopic operation through 2 portals profound for the fascia plantaris

Group Type ACTIVE_COMPARATOR

endoscopic surgery

Intervention Type PROCEDURE

Through 2 portals profound for the fascia plantaris (deep-fascial) lateral and medial a heel-spur will be resected and the medial half of the fascia is released from its attachment to the calcaneus.

A mikroskopic X-ray sensitive pearle (Tantalum-pearle) will be inserted in the fascia in the proximal end of the distal part of the remaining fascia for measuring distance (resorbtion).

Three weeks after operation, the patients are instructed to start a specific training program. Training is supervised every third week by a physiotherapist (week 3,6,9,12 after operation), and daily training is carried out at home. Sutures are removed after 10 days,

conservative treatment

The standard treatment here acting as controle treatment . All patients are informed to decrease activity level, use shoes with good shock absorption and are recommended to use insoles (standard orthoses) for increased shock absorption. Training is supervised every third week by a physiotherapist (week 1,3,6,9), and daily training is carried out at home. Glucocorticoid injections of 1 ml Glucocorticosteroid (methylprednisolon 40 mg) and 1 ml of Lidokaine 5mg/ml from the medial side profound to the thickened part of the fascia plantaris are given every month until the fascia thickness is below 4 mm (max 3 injections).

Group Type ACTIVE_COMPARATOR

methylprednisolon

Intervention Type DRUG

1ml methylprednisolon is mixed with 1ml of Lidocain and injected underneath the plantar fascia as close to the medial attachment on calcaneus as possible

lidokaine

Intervention Type DRUG

1ml methylprednisolon is mixed with 1ml of Lidocain and injected underneath the plantar fascia as close to the medial attachment on calcaneus as possible

Training

Intervention Type BEHAVIORAL

the patient is instructed in reduction in impact. strength training 3 times weekly and stretching exercises daily are recommended.

Interventions

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endoscopic surgery

Through 2 portals profound for the fascia plantaris (deep-fascial) lateral and medial a heel-spur will be resected and the medial half of the fascia is released from its attachment to the calcaneus.

A mikroskopic X-ray sensitive pearle (Tantalum-pearle) will be inserted in the fascia in the proximal end of the distal part of the remaining fascia for measuring distance (resorbtion).

Three weeks after operation, the patients are instructed to start a specific training program. Training is supervised every third week by a physiotherapist (week 3,6,9,12 after operation), and daily training is carried out at home. Sutures are removed after 10 days,

Intervention Type PROCEDURE

methylprednisolon

1ml methylprednisolon is mixed with 1ml of Lidocain and injected underneath the plantar fascia as close to the medial attachment on calcaneus as possible

Intervention Type DRUG

lidokaine

1ml methylprednisolon is mixed with 1ml of Lidocain and injected underneath the plantar fascia as close to the medial attachment on calcaneus as possible

Intervention Type DRUG

Training

the patient is instructed in reduction in impact. strength training 3 times weekly and stretching exercises daily are recommended.

Intervention Type BEHAVIORAL

Other Intervention Names

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Fascial release Heel spur resection Training Depo-medrol Glucocorticosteroid injection Xylocain strength training stretching

Eligibility Criteria

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Inclusion Criteria

* pain at the medial attachment of fascia plantaris
* first step pain in the morning
* symptoms for at least 3 months
* ultrasound scanning at the first visit shows thickness of the proximal fascia above 4 mm
* patient can read and understand danish

Exclusion Criteria

* known arthritis inflammatory bowl disease, psoriasis or clinical signs of any of these.
* leg ulcerations
* long lasting oedema of the leg and foot
* palpatory decreased puls in the foot
* diabetes
* reduced sensibility in the foot
* infections in the foot
* daily use of pain killers
* pregnancy or planning to become pregnant
* earlier operations on the foot, that is judged to complicate training.
* patients assessed not to be able to participate in the training for other reasons
* Glucocorticosteroid injection to the diseased plantar fascia within the last 6 months
Minimum Eligible Age

20 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Danish Rheumatism Association

OTHER

Sponsor Role collaborator

Bispebjerg Hospital

OTHER

Sponsor Role lead

Responsible Party

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Finn Elkjær Johannsen

chief physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Finn MD Johannsen, MD

Role: PRINCIPAL_INVESTIGATOR

Institute of Sports Medicine Copenhagen, Bispebjerg Hospital Copenhagen, Denmark

Locations

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Institute of Sports Medicine Copenhagen, Bispebjerg Hospital

Copenhagen, , Denmark

Site Status

Countries

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Denmark

References

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Baldassin V, Gomes CR, Beraldo PS. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial. Arch Phys Med Rehabil. 2009 Apr;90(4):701-6. doi: 10.1016/j.apmr.2008.11.002.

Reference Type BACKGROUND
PMID: 19345789 (View on PubMed)

Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;(3):CD000416. doi: 10.1002/14651858.CD000416.

Reference Type BACKGROUND
PMID: 12917892 (View on PubMed)

Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 2008 Jun;16(6):338-46. doi: 10.5435/00124635-200806000-00006.

Reference Type BACKGROUND
PMID: 18524985 (View on PubMed)

Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ. Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance. J Clin Ultrasound. 2006 Jan;34(1):12-6. doi: 10.1002/jcu.20177.

Reference Type BACKGROUND
PMID: 16353228 (View on PubMed)

Uden H, Boesch E, Kumar S. Plantar fasciitis - to jab or to support? A systematic review of the current best evidence. J Multidiscip Healthc. 2011;4:155-64. doi: 10.2147/JMDH.S20053. Epub 2011 May 24.

Reference Type BACKGROUND
PMID: 21655342 (View on PubMed)

Komatsu F, Takao M, Innami K, Miyamoto W, Matsushita T. Endoscopic surgery for plantar fasciitis: application of a deep-fascial approach. Arthroscopy. 2011 Aug;27(8):1105-9. doi: 10.1016/j.arthro.2011.02.037. Epub 2011 Jun 24.

Reference Type BACKGROUND
PMID: 21704466 (View on PubMed)

Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot Ankle Int. 2007 May;28(5):549-56. doi: 10.3113/FAI.2007.0549.

Reference Type BACKGROUND
PMID: 17559761 (View on PubMed)

Jerosch J, Schunck J, Liebsch D, Filler T. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF). Knee Surg Sports Traumatol Arthrosc. 2004 Sep;12(5):471-7. doi: 10.1007/s00167-004-0496-6. Epub 2004 Apr 14.

Reference Type BACKGROUND
PMID: 15088083 (View on PubMed)

Kalaci A, Cakici H, Hapa O, Yanat AN, Dogramaci Y, Sevinc TT. Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial. J Am Podiatr Med Assoc. 2009 Mar-Apr;99(2):108-13. doi: 10.7547/0980108.

Reference Type BACKGROUND
PMID: 19299346 (View on PubMed)

Other Identifiers

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H-2-2012-151

Identifier Type: -

Identifier Source: org_study_id

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