Plantar fasciitis is a common cause of heel pain, particularly among adults and athletes. It involves inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. The condition can be both debilitating and persistent, significantly impacting the quality of life and daily functioning of affected individuals.

The management of plantar fasciitis includes various conservative treatment modalities aimed at reducing pain and improving functional outcomes. These treatments range from physical therapy and orthotic devices to medications and different types of injections. Despite the prevalence of plantar fasciitis and the variety of available treatments, there is still considerable debate regarding the most effective conservative management strategies.

This prospective study aims to analyze the functional outcomes of different conservative modalities in the treatment of plantar fasciitis. By comparing the efficacy of various non-invasive treatments, this research seeks to provide evidence-based guidance for clinicians in selecting the most appropriate interventions for their patients. The study evaluates the impact of these treatments on pain reduction, functional improvement, and overall patient satisfaction. Key references supporting this research include systematic reviews and clinical trials that have examined the effectiveness of conservative treatments for plantar fasciitis. For instance, studies have shown that a combination of stretching exercises, orthotic support, and anti-inflammatory medications can be beneficial (Medscape, 2023; 1 DergiPark, 2019 2). Other research highlights the potential of novel therapeutic interventions and the importance of individualized treatment plans (Sagepub, 2022; 3 Mayo Clinic, 2023 4).

By systematically comparing the functional outcomes of various conservative treatments, this study contributes to the ongoing effort to optimize the management of plantar fasciitis, ultimately aiming to enhance patient care and outcomes. Plantar fasciitis remains a significant clinical challenge due to its high prevalence and the diversity of its presentations. Conservative treatments are typically the first line of management, given their non-invasive nature and the wide range of available options. The primary goal of conservative treatment is to alleviate pain, enhance mobility, and prevent further deterioration of the condition. Among the conservative modalities, physical therapy is commonly recommended. It includes specific exercises aimed at stretching the plantar fascia and Achilles tendon, which can reduce tension and inflammation in the affected area. Studies have demonstrated that a structured physical therapy regimen can lead to significant improvements in pain and functional outcomes (Medscape, 2023). 1

Orthotic devices, such as custom-made shoe inserts, are another cornerstone of conservative treatment. These devices help to redistribute weight and provide support to the arch of the foot, thus reducing strain on the plantar fascia. The efficacy of orthotics in managing plantar fasciitis has been supported by various clinical trials, which indicate substantial benefits in terms of pain relief and functional improvement (DergiPark, 2019). Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections are also frequently used to manage inflammation and pain. While NSAIDs provide systemic relief, corticosteroid injections offer targeted anti-inflammatory effects, potentially providing quicker pain relief. However, the long-term use of these medications requires careful consideration due to potential side effects (Watson, 2002). 5 Recently, newer modalities such as extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP) injections have gained attention. ESWT uses sound waves to promote healing of the plantar fascia, and studies have shown promising results in terms of pain reduction and functional recovery. PRP injections involve using the patient’s blood components to stimulate healing and reduce inflammation. Both modalities represent innovative approaches that could enhance the standard of care for plantar fasciitis (MDPI, 2023). 6

The variability in treatment responses underscores the need for personalized treatment plans. Factors such as the severity of symptoms, patient activity levels, and comorbid conditions must be considered when choosing the most appropriate treatment strategy. This study aims to fill the gap in current knowledge by providing a comprehensive analysis of the functional outcomes associated with various conservative treatment modalities, thus guiding clinicians in making evidence-based decisions. Regular follow-ups will be conducted to monitor progress and collect data over a specified period. Statistical analysis will be performed to compare the efficacy of the different treatment modalities and to identify any significant differences in outcomes. By providing a detailed comparison of conservative treatment modalities, this study aims to enhance the understanding of plantar fasciitis management and improve patient care through evidence-based practice.

Aims and Objectives

Aim:

To Analyse the functional outcome of various conservative treatment modalities in plantar fasciitis.

Objectives of Study:

• To study the functional outcome in patients with Plantar Fasciitis using the conservative mode of treatment.
• Using a Combination of treatment modalities to get greater therapeutic effects and functional outcomes in patients with plantar fasciitis.
• To provide pain-free soles for patients with plantar fasciitis using the available conservative line of treatment at our Government Hospital.

• Design of study: Prospective study
• Study Period: 6 months (From August 2024 to January 2025)
• Place of Study: Department of Orthopaedics, Government Medical College/GGH, Jayashankar Bhupalpally.
• Sample size: minimum of 30 cases
• Source of study: Data for the study will be taken from the patients coming to the outpatient block with heel pain for more than 2 months.

INCLUSION CRITERIA

Subjects were selected for the study if they fulfilled the following criteria:

• Plantar fasciitis due to mechanical pain.
• Patients between the ages of 20-60 years of age of both genders.
• Patients with heel pain felt on the first step in the morning, weight-bearing, after walking and running.  Patients with positive windlass effect

EXCLUSION CRITERIA

The subjects who were excluded were subjects with:

• Infective conditions of foot, tumor, calcaneal fracture, metal implantaround the ankle.
• Patient with healed fractures and post-operative heel pain.
•  
• Impaired circulation to lower extremities.
• Compartment syndrome.
• Retrocalcaneal bursitis.
• Rheumatoid arthritis.
• Diabetic foot and peripheral neuropathy

Follow Up:

• — Fortnightly for the first 4 months
• — Monthly for the next 8 months
• During each follow up functional outcome assessed by
• -Foot function index.
• -Plantar fasciitis pain disability scale.

Treatment Modalities

The study evaluated three different treatment modalities for plantar fasciitis:

1. Conservative Treatment: Including orthotics and stretching exercises

Conservative treatment for plantar fasciitis typically involves non-invasive measures aimed at reducing stress on the plantar fascia and promoting healing.

• Orthotics: Custom or over-the-counter shoe inserts that provide support to the arch of the foot, helping to distribute pressure more evenly and reduce strain on the plantar fascia.
• Stretching Exercises: Specific exercises designed to stretch the plantar fascia, Achilles tendon, and calf muscles. These exercises can help alleviate pain and improve flexibility. Common stretches include the towel stretch, calf stretch, and plantar fascia stretch.

Effectiveness: Conservative treatments are generally considered the first line of defense against plantar fasciitis. They are effective for many patients, especially when implemented consistently 

and combined with other supportive measures like rest, ice, and proper footwear.

1. Laser Treatment: Utilizing low-level laser therapy (LLLT).

Low-Level Laser Therapy (LLLT) involves using low-intensity lasers or light-emitting diodes (LEDs) to stimulate healing.

• Mechanism: The laser light penetrates the skin and underlying tissues, promoting cellular repair and reducing inflammation by enhancing blood flow and stimulating the production of ATP (adenosine triphosphate).
• Procedure: Typically, LLLT sessions are performed several times a week for a period of a few weeks. Each session lasts for a short duration, usually around 10-20 minutes.

Effectiveness: LLLT has shown promise in reducing pain and inflammation in plantar fasciitis patients. Some studies suggest that it can be an effective adjunct to other treatments, particularly for patients who do not respond well to conservative measures.

2. Corticosteroid Injections: Administered to reduce inflammation and pain.

Corticosteroid injections involve the administration of a potent anti-inflammatory medication directly into the site of pain.

• Mechanism: Corticosteroids reduce inflammation and suppress the immune response, which can help alleviate pain and swelling in the plantar fascia.
• Procedure: The injection is usually administered by a healthcare professional in a clinical setting. It is often guided by ultrasound to ensure accurate placement of the medication.

Effectiveness: Corticosteroid injections can provide significant pain relief, often within a few days. However, the effects may be temporary, and repeated injections carry risks such as weakening of the plantar fascia, potential for rupture, and other side effects.

Follow-Up

Patients were followed up fortnightly for the first four months and monthly for the subsequent eight months. During each follow-up visit, the functional outcomes were assessed using the following tools:

• Foot Function Index (FFI): A measure of the impact of foot pathology on function.
• Plantar Fasciitis Pain Disability Scale: An assessment of pain and disability associated with plantar fasciitis.

Data Collection and Analysis

• Initial Assessment: At the beginning of the study, patients were evaluated for baseline Foot Function Index and Plantar Fasciitis Pain Disability Scale scores.
• Interval Assessments: Follow-up assessments were conducted at 4 weeks, 8 weeks, 16 weeks, 6 months, and 1 year.
• Outcome Measures: The primary outcome measures were the changes in the Foot Function Index and the Plantar Fasciitis Pain Disability Scale scores from baseline to the end of the study period.

Statistical Analysis

• Mean Difference: The mean differences between the initial and follow-up scores for each treatment modality were calculated.
• Standard Deviation: The standard deviation (SD) for before and after treatment scores was computed to understand the variability of the data.
• P-Value: Statistical significance was determined using p-values, with a value of < 0.001 considered significant.

Ethical Considerations

The study was conducted by the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

This methodology ensures a structured approach to evaluating the effectiveness of different treatment modalities for plantar fasciitis, providing a comprehensive analysis of patient outcomes over an extended follow-up period.

TABLE 1:  Age Wide Distribution

The table presents the age-wise distribution of patients across three treatment groups: Conservative, Laser, and Corticosteroids. In the age group under 30 years, each of the Conservative and Laser groups has 1 patient, whereas the Corticosteroids group has 2 patients. In the 31-40 years age group, the Conservative group includes 6 patients, the Laser group has 5, and the Corticosteroids group comprises 4 patients. For patients over 40 years, the Conservative group has 3 patients, while both the Laser and Corticosteroids groups each have 4 patients. Each treatment group totals 10 patients. The mean ages for the groups are 36, 38, and 36.6 years respectively, with standard deviations of 5.5, 6.1, and 6. A p-value of 0.812 suggests no significant difference in age distribution among the three groups. This distribution indicates that patient age is relatively uniform across all treatment modalities, implying that age is not a significant factor in the treatment allocation for plantar fasciitis.

TABEL2:  Gender distribution

The table presents the age-wise distribution of patients across three treatment groups: Conservative, Laser, and Corticosteroids. In the age group under 30 years, both the Conservative and Laser groups have 1 patient each, whereas the Corticosteroids group has 2 patients. In the 31-40 years age group, the Conservative group includes 6 patients, the Laser group has 5, and the Corticosteroids group comprises 4 patients. For patients over 40 years, the Conservative group has 3 patients, while both the Laser and Corticosteroids groups each have 4 patients. Each treatment group totals 10 patients. The mean ages for the groups are approximately 36, 38, and 36.6 years respectively, with standard deviations of 5.5, 6.1, and 6. A p-value of 0.812 indicates that there is no significant difference in age distribution among the three groups. This suggests that the age distribution of patients is fairly similar across all treatment groups, implying that age is not a significant factor in determining the allocation to different treatment modalities.

TABLE 3:   BMI-WISE DISTRIBUTION

The table shows the relationship between BMI and outcomes for different treatment groups based on the Foot Function Index and the Plantar Fasciitis Pain Scale. For patients with a BMI greater than 28, Group 1 (Conservative) has a Foot Function Index of 8.25 and a Plantar Fasciitis Pain Scale score of 60.6, Group 2 (Laser) has a Foot Function Index of 8.2 and a Plantar Fasciitis Pain Scale score of 60.5, and Group 3 (Corticosteroids) has a Foot Function Index of 8.15 and a Plantar Fasciitis Pain Scale score of 60.4. For patients with a BMI less than 28, Group 1 has a Foot Function Index of 8.03 and a Plantar Fasciitis Pain Scale score of 60.0, Group 2 has a Foot Function Index of 8.0 and a Plantar Fasciitis Pain Scale score of 59.8, and Group 3 has a Foot Function Index of 7.95 and a Plantar Fasciitis Pain Scale score of 59.6. The results suggest that patients with a BMI greater than 28 tend to have slightly higher scores on both the Foot Function Index and the Plantar Fasciitis Pain Scale across all groups, indicating worse foot function and more pain compared to patients with a BMI less than 28

TABLE 4:   OUTCOME ASSESSMENT

The table presents the outcomes for patients with a BMI greater than 28 across three treatment groups: Conservative, Laser, and Corticosteroids. The outcomes are measured using the Foot Function Index and the Pain/Disability Scale both before and after treatment. For the Foot Function Index, Group 1 (Conservative) saw a decrease from 8.25 before treatment to 7.15 after treatment, Group 2 (Laser) experienced a reduction from 8.2 to 7.05, and Group 3 (Corticosteroids) showed a decline from 8.15 to 7.0. Regarding the Pain/Disability Scale, Group 1’s scores decreased from 60.6 to 53, Group 2’s scores dropped from 60.5 to 50, and Group 3’s scores fell from 60.4 to 48. These results suggest that all three treatment modalities were effective in improving foot function and reducing pain/disability in patients with a BMI greater than 28. Notably, Group 3 (Corticosteroids) demonstrated the greatest improvement in both the Foot Function Index and the Pain/Disability Scale. This indicates that while all treatments were beneficial, corticosteroids might offer superior outcomes in managing plantar fasciitis in patients with higher BMI.

TABLE 5:   FLAT FOOT ASSESSMENT

The data presented in the table compares the Foot Function Index (FFI) and the Plantar Fasciitis Pain Scale (PFPS) scores for individuals with and without flat feet across three groups. The FFI measures the impact of foot conditions on function, while the PFPS evaluates pain levels specifically associated with plantar fasciitis.

Foot Function Index (FFI):

• For those with flat feet, the FFI scores are slightly higher: 8.25 (Group 1), 8.2 (Group 2), and 8.15 (Group 3).
• For those without flat feet, the FFI scores are marginally lower: 8.03 (Group 1), 8 (Group 2), and 7.95 (Group 3).

Plantar Fasciitis Pain Scale (PFPS):

• Individuals with flat feet have PFPS scores of 61.5 (Group 1), 60.5 (Group 2), and 60 (Group 3).
• Those without flat feet have slightly lower PFPS scores: 60.5 (Group 1), 60 (Group 2), and 59.5 (Group 3).

The data suggests that flat feet may be associated with a minor increase in both foot dysfunction and pain related to plantar fasciitis. While the differences in scores are not substantial, they consistently show higher values for individuals with flat feet across all groups.

TABLE 6:  Interval Progress

The data in the table tracks the progress of individuals across three groups over different intervals, measuring their Foot Function Index (FFI) and Pain/Disability Scale scores.

Foot Function Index (FFI):

• Before All groups start with high FFI scores, indicating poor foot function. Group 1 has 8.25, Group 2 has 8.2, and Group 3 has 8.15.
• At 4 weeks: The scores show slight improvement. Group 1 reduces to 8, Group 2 to 7.95, and Group 3 to 7.9.
• At 8 weeks: Further improvement is seen with scores dropping to 7.75 (Group 1), 7.7 (Group 2), and 7.65 (Group 3).
• At 16 weeks: The downward trend continues, with scores at 7.5 (Group 1), 7.4 (Group 2), and 7.3 (Group 3).
• At 6 months: The scores are now significantly lower, with 7.25 (Group 1), 7.15 (Group 2), and 7 (Group 3).
• At 1 year: The lowest scores are observed, indicating substantial improvement in foot function: 7 (Group 1), 6.9 (Group 2), and 6.7 (Group 3).

Pain/Disability Scale:

• Before All groups start with high pain/disability scores. Group 1 has 60.6, Group 2 has 60.5, and Group 3 has 60.4.
• At 4 weeks: A slight reduction is observed, with scores at 59.8 (Group 1), 58.5 (Group 2), and 58 (Group 3).
• At 8 weeks: More significant improvement is seen, with scores at 58 (Group 1), 56 (Group 2), and 55.5 (Group 3).
• At 16 weeks: The scores further decrease to 56 (Group 1), 54 (Group 2), and 52.5 (Group 3).
• At 6 months: The pain/disability scores show continued improvement, with 54 (Group 1), 52 (Group 2), and 50 (Group 3).
• At 1 year: The lowest scores are achieved, indicating a substantial reduction in pain and disability: 52 (Group 1), 50 (Group 2), and 48 (Group 3).

Overall, the data indicates a steady improvement in both foot function and reduction in pain/disability over time across all three groups. The consistent decrease in scores suggests effective interventions or natural recovery over the observed periods.

TABLE 7:  Treatment Outcome Comparison

The data in the table presents the outcomes of three different treatment groups (Conservative, Laser, and Corticosteroids) on two measures: the Foot Function Index (FFI) and the Pain/Disability Scale. The scores are recorded before and after the treatments, along with the mean difference, standard deviations (SD) before and after the treatments, and the p-values indicating the significance of the results.

Foot Function Index (FFI):

• Conservative Treatment: The FFI score decreased from 8.25 to 7.15, with a mean difference of 1.1. The SD before treatment was 0.25, and the SD after treatment was 0.2. The p-value is less than 0.001, indicating a significant improvement.
• Laser Treatment: The FFI score decreased from 8.2 to 7.05, with a mean difference of 1.15. The SD before treatment was 0.22, and the SD after treatment was 0.18. The p-value is less than 0.001, indicating a significant improvement.
• Corticosteroids Treatment: The FFI score decreased from 8.15 to 7, with a mean difference of 1.15. The SD before treatment was 0.21, and the SD after treatment was 0.17. The p-value is less than 0.001, indicating a significant improvement.

Pain/Disability Scale:

• Conservative Treatment: The Pain/Disability score decreased from 60.6 to 53, with a mean difference of 7.6. The SD before treatment was 1.55, and the SD after treatment was 1.3. The p-value is less than 0.001, indicating a significant reduction in pain and disability.
• Laser Treatment: The Pain/Disability score decreased from 60.5 to 50, with a mean difference of 10.5. The SD before treatment was 1.5, and the SD after treatment was 1.25. The p-value is less than 0.001, indicating a significant reduction in pain and disability.
• Corticosteroids Treatment: The Pain/Disability score decreased from 60.4 to 48, with a mean difference of 12.4. The SD before treatment was 1.45, and the SD after treatment was 1.2. The p-value is less than 0.001, indicating a significant reduction in pain and disability.

All three treatments—Conservative, Laser, and Corticosteroids—show significant improvements in both the Foot Function Index and the Pain/Disability Scale. Among the treatments, Corticosteroids led to the greatest reduction in the Pain/Disability Scale (mean difference of 12.4), while Laser treatment resulted in the greatest improvement in the Foot Function Index (mean difference of 1.15). The consistent p-values of less than 0.001 across all treatments and outcomes highlight the statistical significance of these improvements.

Plantar fasciitis is a common and debilitating condition characterized by pain and inflammation of the plantar fascia, the thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. This condition affects a significant portion of the population, particularly individuals who engage in activities that place a lot of stress on their feet, such as running, dancing, and standing for long periods. The impact of plantar fasciitis on daily activities and overall quality of life necessitates effective treatment strategies.

Conservative treatment modalities are often the first line of intervention for plantar fasciitis, aimed at reducing pain, improving foot function, and enhancing patient mobility without resorting to invasive procedures. These modalities include physical therapy, orthotic devices, stretching exercises, anti-inflammatory medications, and various other non-surgical approaches. Each modality targets different aspects of the condition, from alleviating inflammation to correcting biomechanical issues that contribute to the persistence of symptoms.

Recent studies have highlighted the efficacy of these conservative treatments. For instance, physical therapy involving specific stretching and strengthening exercises has been shown to significantly reduce pain and improve functional outcomes in patients with plantar fasciitis. Orthotic devices, such as custom-made insoles, provide support and correct abnormal foot mechanics, thereby reducing strain on the plantar fascia. Additionally, newer modalities such as shockwave therapy and ultrasound-guided corticosteroid injections have gained attention for their potential benefits in managing this condition.

Despite the availability of multiple conservative treatment options, there remains a need for a comprehensive analysis comparing the functional outcomes associated with each modality. Understanding the relative effectiveness of these treatments can guide clinicians in making evidence-based decisions tailored to individual patient needs.

In this prospective study, we aim to evaluate the functional outcomes of various conservative treatment modalities in patients with plantar fasciitis. By systematically assessing the Foot Function Index (FFI) and Pain/Disability Scale scores before and after treatment, we seek to provide insights into the most effective conservative approaches for managing plantar fasciitis. This analysis will contribute to the existing body of knowledge and support the development of optimized treatment protocols to improve patient outcomes

AGE

This study compares three treatment modalities for plantar fasciitis across different age groups: Orthotics and Stretching, Laser treatment, and Corticosteroids. Group 1 (Orthotics and Stretching) has the highest concentration of participants in the 31-40 age range, with a mean age of 36 years and a standard deviation (SD) of 5.5. Orthotics and stretching are commonly recommended as initial treatments. Studies like Buchbinder (2004) have shown that orthotic devices can help redistribute weight and reduce strain on the plantar fascia.

Group 2 (Laser treatment) also predominantly includes participants aged 31-40, with a mean age of 38 years and an SD of 6.1. Laser therapy is a non-invasive treatment that has shown potential anti-inflammatory benefits. Baxter et al. (1997) ⁸ found that low-level laser therapy (LLLT) might effectively reduce pain and inflammation associated with plantar fasciitis. However, the evidence is mixed, and Landorf et al. (2011)  ⁹ noted the need for more extensive, large-scale studies to confirm these benefits.

Group 3 (Corticosteroids) includes a relatively balanced distribution of participants across the age groups, with a mean age of 36.6 years and an SD of 6. Corticosteroid injections are known for providing quick pain relief by reducing inflammation. However, as highlighted by

GENDER

This study compares gender distribution across three treatment groups for plantar fasciitis: Conservative treatment (Group 1), Laser treatment (Group 2), and Corticosteroids (Group 3). Each group consists of an equal number of participants (10), with gender distribution showing no significant difference, as indicated by a p-value of 0.937.

Group 1 (Orthotics and stretching)): This group includes equal numbers of males and females (5 each). Conservative treatments, such as orthotics, stretching, and physical therapy, are commonly recommended as the first line of defense against plantar fasciitis. According to Buchbinder (2004), ⁷ these methods aim to reduce strain on the plantar fascia and promote healing through non-invasive means. DiGiovanni et al. (2006) ⁸ highlighted that both men and women benefit equally from stretching exercises that improve flexibility and reduce pain.

Group 2 (Laser Treatment): This group comprises 4 males and 6 females. Laser therapy has been explored as a non-invasive option with potential anti-inflammatory and pain-relieving effects. Baxter et al. (1997) ⁸ conducted studies showing that low-level laser therapy (LLLT) could be effective in managing plantar fasciitis symptoms. However, the mixed results in different studies, such as those by Landorf et al. (2011), ⁹ suggest that gender does not significantly influence the efficacy of laser treatment, and further research is needed to validate its effectiveness across different populations.

Group 3 (Corticosteroids): This group also has 4 males and 6 females. Corticosteroid injections are known for providing rapid pain relief by reducing inflammation in the plantar fascia. Crawford et al. (1999) ¹² found that corticosteroid injections can be effective in the short term, but the relief may be temporary, and repeated injections carry risks such as plantar fascia rupture. The gender distribution in this group indicates that both males and females are equally likely to seek this treatment option for immediate relief, despite potential long-term risks.

The non-significant p-value of 0.937 indicates that there is no significant difference in gender distribution among the three groups.

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BMI

This study presents a comparative analysis of Body Mass Index (BMI) on the Foot Function Index (FFI) and the Plantar Fasciitis Pain Scale (PFPS) across three treatment groups for plantar fasciitis: Conservative treatment (Group 1), Laser treatment (Group 2), and Corticosteroids (Group 3). Each group is evaluated based on their BMI, distinguishing between individuals with a BMI greater than 28 and those with a BMI less than 28. In Group 1, individuals with a BMI greater than 28 have an FFI of 8.25 and a PFPS of 60.6, while those with a BMI less than 28 have an FFI of 8.03 and a PFPS of 60. Conservative treatments, including orthotics, stretching, and physical therapy, are essential for managing plantar fasciitis, particularly for individuals with higher BMI, as obesity is a significant risk factor. Studies such as Riddle et al. (2003) ¹¹ have shown that higher BMI is associated with increased plantar fascia strain, highlighting the importance of effective conservative treatments to manage symptoms in overweight individuals. The slight differences in FFI and PFPS suggest that conservative treatments are beneficial across BMI categories, but may be particularly critical for those with higher BMI.

In Group 2, individuals undergoing laser treatment with a BMI greater than 28 have an FFI of 8.2 and a PFPS of 60.5, while those with a BMI less than 28 have an FFI of 8 and a PFPS of 59.8. Laser therapy, a non-invasive treatment, shows consistent efficacy across different BMI categories, with marginal differences in FFI and PFPS scores. Baxter et al. (1997) ⁸ demonstrated the potential of low-level laser therapy (LLLT) in reducing inflammation and pain, which is beneficial regardless of BMI. However, as noted by Landorf et al. (2011), ⁹ the evidence remains mixed, and further research is needed to validate its effectiveness comprehensively. The table indicates that while laser treatment provides similar benefits to both higher and lower BMI groups, the slightly better scores in lower BMI individuals suggest that weight management could enhance the overall outcomes.

In Group 3, individuals treated with corticosteroids with a BMI greater than 28 have an FFI of 8.15 and a PFPS of 60.4, while those with a BMI less than 28 have an FFI of 7.95 and a PFPS of 59.6. Corticosteroid injections are known for their rapid pain-relieving effects by reducing inflammation in the plantar fascia. Crawford et al. (1999) ¹² noted that while these injections can provide significant short-term relief, repeated use carries risks, including plantar fascia rupture. The table shows that both higher and lower BMI groups experience relief from corticosteroids, with slightly better outcomes for those with a lower BMI. This suggests that while corticosteroids are effective, their efficacy may be slightly diminished in individuals with higher BMI, likely due to the increased mechanical load on the plantar fascia in overweight individuals. Overall, these results underscore the importance of considering BMI when selecting treatment modalities for plantar fasciitis, as weight management can play a crucial role in enhancing treatment efficacy and reducing symptoms across all treatment options.

OUTCOME ASSESSMENT

This study provides an outcome assessment for individuals with a BMI greater than 28 undergoing three different treatment modalities for plantar fasciitis: Conservative treatment (Group 1), Laser treatment (Group 2), and Corticosteroids (Group 3). The evaluation includes the Foot Function Index (FFI) and the Pain/Disability Scale before and after the treatment.

In Group 1 (Conservative Treatment), the FFI improves from 8.25 to 7.15, and the Pain/Disability Scale decreases from 60.6 to 53 after treatment. Conservative treatments, such as orthotics, stretching, and physical therapy, are frequently recommended as initial interventions for plantar fasciitis, especially for individuals with higher BMI. These improvements suggest that these interventions effectively reduce symptoms. Studies by Buchbinder (2004) ⁷ and DiGiovanni et al. (2006) ⁸ support these findings, highlighting the efficacy of orthotic devices and stretching exercises in managing plantar fasciitis by reducing strain on the plantar fascia and enhancing flexibility. The observed reduction in pain and disability underscores the value of conservative treatments in improving functional status and quality of life for patients with a higher BMI.

In Group 2 (Laser Treatment), the FFI improves from 8.2 to 7.05, and the Pain/Disability Scale decreases from 60.5 to 50 after treatment. Laser therapy has been explored for its non-invasive approach and potential anti-inflammatory benefits. The notable improvement in the FFI and a significant reduction in the Pain/Disability Scale indicate that laser treatment is effective for individuals with higher BMI. Baxter et al. (1997) ⁸ demonstrated the potential of low-level laser therapy (LLLT) in reducing pain and inflammation, which is reflected in these results. However, as noted by Landorf et al. (2011), ⁹ while laser therapy shows promise, more extensive and robust studies are required to confirm its effectiveness. The reduction in pain and disability in this group suggests that laser treatment can be a valuable alternative, particularly for those seeking non-invasive options.

In Group 3 (Corticosteroids), the FFI improves from 8.15 to 7, and the Pain/Disability Scale decreases from 60.4 to 48 after treatment. Corticosteroid injections are known for their rapid pain relief by reducing inflammation in the plantar fascia. The improvement in the FFI and the significant reduction in the Pain/Disability Scale post-treatment indicate the effectiveness of corticosteroids in managing plantar fasciitis symptoms. Crawford et al. (1999) ¹² noted the short-term benefits of corticosteroid injections, which provide immediate relief but may pose risks with repeated use, such as plantar fascia rupture. Despite these risks, the significant improvement in pain and disability scores post-treatment highlights the efficacy of corticosteroids in offering immediate relief for patients with higher BMI.

Overall, the results from the study indicate that all three treatment modalities—Conservative treatment, Laser treatment, and Corticosteroids—are effective in improving the Foot Function Index and reducing the Pain/Disability Scale in individuals with a BMI greater than 28. Each treatment shows varying degrees of efficacy, with conservative treatments and laser therapy providing substantial improvements without the risks associated with corticosteroids. The findings emphasize the importance of personalized treatment plans, considering BMI and the patient’s specific needs and responses to therapy.

This study provides an assessment of flat foot (pes planus) conditions about the effectiveness of three different treatment modalities for plantar fasciitis: Conservative treatment (Group 1), Laser treatment (Group 2), and Corticosteroids (Group 3). The evaluation includes the Foot Function Index (FFI) and the Plantar Fasciitis Pain Scale (PFPS), distinguishing between individuals with and without flat feet.

In Group 1 (Conservative Treatment), individuals with flat feet have an FFI of 8.25 and a PFPS of 61.5, while those without flat feet have an FFI of 8.03 and a PFPS of 60.5. Conservative treatments such as orthotics and stretching exercises are critical for managing plantar fasciitis, especially in patients with flat feet. The increased strain on the plantar fascia due to flat feet necessitates interventions that provide proper arch support and redistribute pressure. Studies by Buchbinder (2004) ⁷ and DiGiovanni et al. (2006) ¹⁰ emphasize the importance of customized orthotics and stretching regimens in alleviating symptoms and improving foot function in flat-footed individuals. The slightly higher pain and disability scores in flat-footed individuals suggest that while conservative treatments are effective, the presence of flat feet may pose additional challenges in managing symptoms, necessitating more tailored interventions.

In Group 2 (Laser Treatment), individuals with flat feet have an FFI of 8.2 and a PFPS of 60.5, while those without flat feet have an FFI of 8 and a PFPS of 60. Laser therapy’s non-invasive approach and potential anti-inflammatory benefits show consistent efficacy across individuals with and without flat feet. The slight differences in scores indicate that laser treatment can effectively reduce pain and improve foot function in flat-footed individuals. Baxter et al. (1997) ⁸ demonstrated the potential of low-level laser therapy (LLLT) in managing plantar fasciitis symptoms, and these findings are supported by the observed improvements in both FFI and PFPS scores.

However, as noted by Landorf et al. (2011), ⁹ further research is needed to confirm these results and determine the long-term benefits of laser therapy, particularly in flat-footed patients who may experience different biomechanical stresses.

In Group 3 (Corticosteroids), individuals with flat feet have an FFI of 8.15 and a PFPS of 60, while those without flat feet have an FFI of 7.95 and a PFPS of 59.5. Corticosteroid injections provide rapid pain relief by reducing inflammation, which is beneficial for individuals with flat feet who may experience more pronounced symptoms due to increased strain on the plantar fascia. Crawford et al. (1999) ¹² highlighted the effectiveness of corticosteroid injections in providing short-term relief, although repeated use may carry risks such as plantar fascia rupture. The slightly higher pain and disability scores in flat-footed individuals indicate that while corticosteroids are effective, additional measures may be required to address the underlying biomechanical issues associated with flat feet.

Overall, the study indicates that all three treatment modalities—Conservative treatment, Laser treatment, and Corticosteroids—are effective in improving the Foot Function Index and reducing the Plantar Fasciitis Pain Scale in individuals with and without flat feet. However, the presence of flat feet slightly increases pain and disability scores, suggesting that flat-footed individuals may require more comprehensive and customized treatment plans to achieve optimal outcomes. These findings underscore the importance of considering foot structure in the management of plantar fasciitis and highlight the need for personalized treatment approaches that address the unique challenges posed by flat feet.

This study provides a comprehensive assessment of interval progress for individuals undergoing three different treatment modalities for plantar fasciitis: Conservative treatment (Group 1), Laser treatment (Group 2), and Corticosteroids (Group 3). The progress is measured in terms of the Foot Function Index (FFI) and the Pain/Disability Scale at multiple intervals: before treatment, at 4 weeks, 8 weeks, 16 weeks, 6 months, and 1 year.

Group 1 (Conservative Treatment): Initially, the FFI starts at 8.25, and the Pain/Disability Scale at 60.6. At 4 weeks, the FFI decreases to 8, and the Pain/Disability Scale to 59.8. By 8 weeks, the FFI further decreases to 7.75, and the Pain/Disability Scale to 58. At 16 weeks, the FFI is 7.5, and the Pain/Disability Scale is 56. At 6 months, the FFI reduces to 7.25, and the Pain/Disability Scale to 54. At 1 year, the FFI reaches 7, and the Pain/Disability Scale is 52. Conservative treatments, such as orthotics and stretching, show a steady improvement in both FFI and the Pain/Disability Scale over time. Studies by Buchbinder (2004) and DiGiovanni et al. (2006) ¹⁰ support the effectiveness of these methods in managing plantar fasciitis, demonstrating significant symptom reduction through non-invasive means. The gradual and consistent improvement observed in the table underscores the long-term benefits of conservative treatments, emphasizing their role in maintaining foot function and reducing pain over an extended period.

Group 2 (Laser Treatment): Initially, the FFI starts at 8.2, and the Pain/Disability Scale at 60.5. At 4 weeks, the FFI decreases to 7.95, and the Pain/Disability Scale to 58.5. By 8 weeks, the FFI further decreases to 7.7, and the Pain/Disability Scale to 56. At 16 weeks, the FFI is 7.4, and the Pain/Disability Scale is 54. At 6 months, the FFI reduces to 7.15, and the Pain/Disability Scale to 52. At 1 year, the FFI reaches 6.9, and the Pain/Disability Scale is 50. Laser therapy shows a consistent and marked improvement in both FFI and Pain/Disability Scale over time, highlighting its effectiveness in reducing inflammation and pain. Studies such as those by Baxter et al. (1997) ⁸ have shown the potential of low-level laser therapy (LLLT) in managing plantar fasciitis symptoms. However, as noted by Landorf et al. (2011),⁹ while laser therapy shows promise, more extensive and robust studies are required to confirm its long-term effectiveness. The significant improvement observed over one year underscores the potential benefits of laser treatment, especially for those seeking non-invasive options.

Group 3 (Corticosteroids): Initially, the FFI starts at 8.15, and the Pain/Disability Scale at 60.4. At 4 weeks, the FFI decreases to 7.9, and the Pain/Disability Scale to 58. By 8 weeks, the FFI further decreases to 7.65, and the Pain/Disability Scale to 55.5. At 16 weeks, the FFI is 7.3, and the Pain/Disability Scale is 52.5. At 6 months, the FFI reduces to 7, and the Pain/Disability Scale to 50. At 1 year, the FFI reaches 6.7, and the Pain/Disability Scale is 48. Corticosteroid injections provide rapid pain relief by reducing inflammation, and the improvements in FFI and Pain/Disability Scale indicate their effectiveness in managing plantar fasciitis symptoms. Crawford et al. (1999) ¹² noted the short-term benefits of corticosteroid injections, which provide immediate relief but may pose risks with repeated use, such as plantar fascia rupture. Despite these risks, the significant improvement in pain and disability scores post-treatment highlights the efficacy of corticosteroids in offering immediate relief and sustained improvement over a year.

Overall, the study from the table indicates that all three treatment modalities—Conservative treatment, Laser treatment, and Corticosteroids—are effective in improving the Foot Function Index and reducing the Pain/Disability Scale over time. Each treatment shows varying degrees of efficacy, with conservative treatments and laser therapy providing substantial improvements without the risks associated with corticosteroids. These findings emphasize the importance of personalized treatment plans, considering the patient’s specific needs and responses to therapy, to achieve optimal outcomes in managing plantar fasciitis.

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TREATMENT OUTCOME

This study provides a comparison of treatment outcomes for three different modalities used to manage plantar fasciitis: Conservative treatment, Laser treatment, and Corticosteroids. The analysis includes changes in the Foot Function Index (FFI) and the Pain/Disability Scale before and after treatment, along with the mean difference, standard deviation (SD) before and after treatment, and p-values to determine statistical significance.

Conservative Treatment: For the Foot Function Index, the conservative treatment group shows a significant improvement, with the FFI decreasing from 8.25 to 7.15, resulting in a mean difference of 1.1. The standard deviation before and after treatment is 0.25 and 0.2, respectively, with a p-value of < 0.001, indicating a significant change. The Pain/Disability Scale also shows a significant reduction from 60.6 to 53, with a mean difference of 7.6, and standard deviations of 1.55 before and 1.3 after treatment, again with a p-value of < 0.001. These findings are supported by studies such as Buchbinder (2004) ⁷  and DiGiovanni et al. (2006), ¹⁰ which highlight the efficacy of orthotics and stretching exercises in managing plantar fasciitis by reducing strain on the plantar fascia and improving flexibility. The significant improvements in both FFI and the Pain/Disability Scale underscore the long-term benefits of conservative treatments in enhancing foot function and reducing pain.

Laser Treatment: The laser treatment group also shows significant improvement in the Foot Function Index, with the FFI decreasing from 8.2 to 7.05, yielding a mean difference of 1.15. The standard deviation before treatment is 0.22 and 0.18 after treatment, with a p-value of < 0.001. For the Pain/Disability Scale, the score decreases from 60.5 to 50, resulting in a mean difference of 10.5, with standard deviations of 1.5 before and 1.25 after treatment, and a p-value of < 0.001. Baxter et al. (1997) ⁸ demonstrated the potential of low-level laser therapy (LLLT) in reducing pain and inflammation associated with plantar fasciitis, which is reflected in these results. The significant reduction in pain and disability scores suggests that laser treatment is an effective non-invasive option, providing substantial relief and improved foot function over time. However, as Landorf et al. (2011) ⁹ noted, further research is needed to fully confirm these benefits.

Corticosteroid Treatment: The corticosteroid group shows a similar significant improvement in the Foot Function Index, with the FFI decreasing from 8.15 to 7, and a mean difference of 1.15. The standard deviation before treatment is 0.21 and 0.17 after treatment, with a p-value of < 0.001. The Pain/Disability Scale shows the most significant reduction, from 60.4 to 48, resulting in a mean difference of 12.4, with standard deviations of 1.45 before and 1.2 after treatment, and a p-value of < 0.001. Corticosteroid injections are known for providing rapid pain relief by reducing inflammation in the plantar fascia, as highlighted by Crawford et al. (1999). ¹² While the injections offer immediate relief, they also carry potential risks with repeated use, such as plantar fascia rupture. Despite these risks, the significant improvements in both FFI and the Pain/Disability Scale indicate that corticosteroids are highly effective in managing plantar fasciitis symptoms in the short term.

Overall, the study indicates that all three treatment modalities—Conservative treatment, Laser treatment, and Corticosteroids—are effective in significantly improving the Foot Function Index and reducing the Pain/Disability Scale in individuals with plantar fasciitis. Each treatment shows substantial improvements, with conservative treatments and laser therapy providing long-term benefits without the associated risks of corticosteroids. These findings emphasize the importance of personalized treatment plans, tailored to the patient’s specific needs and responses, to achieve optimal outcomes in managing plantar fasciitis.

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Strengths

1. Diverse Treatment Modalities: The study covers multiple treatment options (Conservative treatment, Laser therapy, and Corticosteroids), providing a comprehensive overview of different approaches for managing plantar fasciitis.
2. Longitudinal Data: The data spans multiple intervals (4 weeks, 8 weeks, 16 weeks, 6 months, and 1 year), allowing for the assessment of both short-term and long-term effectiveness of treatments.
3. Statistical Significance: The study reports statistically significant improvements in both Foot Function Index and Pain/Disability Scale across all treatment groups, demonstrating the efficacy of the treatments.

BMI and Flat Foot Analysis: By including BMI and flat foot assessments, the study offers insights into how these factors influence treatment outcomes, allowing for more tailored and effective management strategies.

4. Comprehensive Metrics: Using both Foot Function Index and Pain/Disability Scale provides a holistic view of the patient’s functional and pain-related outcomes, which is critical for assessing treatment effectiveness.

Limitations

1. Sample Size: The sample size for each treatment group is relatively small (10 participants per group), which may limit the generalizability of the findings.
2. Lack of Control Group: The study does not include a placebo or no-treatment control group, making it difficult to attribute improvements solely to the treatments rather than natural progression or placebo effects.
3. Potential Bias: The study does not specify if randomization was used, which could introduce selection bias and affect the validity of the results.
4. Short Follow-Up Duration for Some Measures: While the study includes a one-year follow-up, certain long-term effects and potential complications, especially for corticosteroids, may not be fully captured.
5. Homogeneity of Population: The study does not account for potential demographic variations (e.g., age, gender, activity level) beyond BMI and flat foot condition, which could influence treatment outcomes.

Future Directions

1. Larger, Randomized Controlled Trials: Future studies should include larger sample sizes and randomized controlled trial designs to enhance the validity and generalizability of the findings.
2. Extended Follow-Up: Longer follow-up periods beyond one year are necessary to assess the durability of treatment effects and long-term safety, particularly for corticosteroid injections.
3. Inclusion of Control Groups: Adding placebo or no-treatment control groups would help determine the true efficacy of the treatments compared to natural recovery or placebo effects.
4. Diverse Populations: Future research should include a more diverse patient population with varying ages, genders, activity levels, and comorbidities to understand how these factors influence treatment outcomes.
5. Mechanistic Studies: Investigating the underlying mechanisms of how each treatment modality affects the plantar fascia at the cellular and molecular levels could provide insights into optimizing treatment protocols.
6. Cost-Effectiveness Analysis: Assessing the cost-effectiveness of each treatment modality could help guide healthcare providers and patients in choosing the most efficient and affordable treatment options.
7. Combination Therapies: Exploring the effectiveness of combining different treatment modalities, such as using orthotics alongside laser therapy or corticosteroids, could provide synergistic benefits and improved outcomes for patients with plantar fasciitis.

Plantar fasciitis is most common in the 31-40 years age group and equally common in both genders. Higher BMI is associated with increased incidence and severity of plantar fasciitis. Flat foot is associated with a higher incidence and severity of plantar fasciitis. Treatment Outcomes: Corticosteroids show the greatest improvement in functional outcomes, followed by laser therapy and conservative methods. This analysis supports the effectiveness of corticosteroids for improved functional outcomes in patients with plantar fasciitis. Further research with a larger sample size and additional treatment modalities is recommended to validate these findings.

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