Reumatología Clínica Reumatología Clínica
Reumatol Clin.2007;3:159-65 - Vol. 3 Núm.4 DOI: 10.1016/S1699-258X(07)73614-8
Originales
Fascitis plantar: revisión del tratamiento basado en la evidencia
Plantar Fascitis: Evidence-Based Review of Treatment
Ana Lafuente Guijosa, , Isabel O’mullony Muñoz, Maruxa Escribá de La Fuente, Paula Cura-Ituarte
Unidad de Rehabilitación. Fundación Hospital Alcorcón. Alcorcón. Madrid. España
Recibido 28 diciembre 2006, Aceptado 22 marzo 2007
Resumen
Objetivos

Analizar la eficacia de los tratamientos utilizados en la fascitis plantar.

Material y método

Se ha consultado los principales buscadores y bases de datos biomédicas: MEDLINE, Evidence Based Medicine, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, EMBASE y PEDRO (Physiotherapy Evidence Database). Se seleccionó los estudios de mayor calidad científica: metaanálisis, revisiones sistemáticas, revisiones y ensayos clínicos controlados y/o aleatorizados de una o varias intervenciones para tratar el dolor plantar del talón.

Resultados

Tras realizar una revisión bibliográfica actualizada sobre el tratamiento de las fascitis plantar, se encontró que existen múltiples opciones terapéuticas, pero su eficacia es variable y no hay evidencia fuerte del beneficio de ninguna modalidad de tratamiento.

Únicamente se encontró limitada evidencia de beneficio con la utilización de taloneras blandas, junto con la realización de cinesiterapia, principalmente ejercicios específicos de estiramiento de la fascia plantar. Con las infiltraciones y la iontoforesis con corticoides también se ha demostrado beneficio, aunque limitado y a corto plazo. Con el resto de los tratamientos no se ha hallado suficiente evidencia de beneficio.

Conclusiones

Según el análisis de la evidencia científica, ante una fascitis plantar debemos recomendar primero la utilización de medidas conservadoras, sencillas y de bajo coste, como taloneras blandas y ejercicios específicos de estiramiento de la fascia plantar. Si lo anterior no es eficaz, se puede administrar corticoides locales mediante infiltraciones o iontoforesis, aunque su efecto es transitorio.

Resumen
Objetive

To analyze the effectiveness of the interventions in the management of plantar fasciitis.

Material and method

The main medical and biomedical databases have been used: MedLine, Evidence Based Medicine, Cochrane Database of Systematic Review, Cochrane Register of Controlled Trials, EMBASE and PEDRO (Physiotherapy Evidence Database). Meta-analysis, systematic reviews, reviews, and controlled or randomized clinical trials of interventions for heel pain have been selected.

Results

After an updated review of the treatment of plantar fascitis, we have found several therapy options to treat this problem, but their efficacy is variable, and none show strong evidence of benefit. The use of plantar insoles and stretching exercises focused on plantar fascia have demonstrated limited evidence of benefit. Corticosteroid injections and iontophoresis with steroids have also demonstrated evidence of benefit, although limited and during a short time. The rest of interventions have not demonstrated enough evidence of benefit.

Conclusions

An evidence-based review of treatments of plantar fasciitis suggests that we must first recommend the use of conservative measures, easy to perform and of low cost, such as plantar soft insoles, plus specific stretching plantar fascia exercises. Limited evidence suggest that steroid injection or iontophoresis may be useful, but of transient effect, when conservative options fail.

Key words
Plantar fasciitis, Heel pain, Painful heel syndrome, Review, Treatment, Clinical trial
Palabras clave
Fascitis plantar, Dolor en la parte inferior del talón, Talalgia, Revisión, Tratamiento, Ensayo clínico
El Texto completo solo esta disponible en PDF
Bibliografía
1.
D. Singh,J. Angel,G. Bentley,S.G. Trevino
Fortnightly review. Plantar fasciitis
BMJ, 315 (1997), pp. 172-175
2.
M. Wolgin,C. Cook,C. Grahan,D. Mauldin
Conservative treatment of plantar heel pain: long-term follow-up
Foot Ankle Int, 15 (1994), pp. 97-102
3.
M.W. Cornwall,T.G. MCPoil
Plantar fasciitis: Etiology and treatment
J Orthop Sports Phys Ther, 29 (1999), pp. 756-760
4.
N. Sabir,S. Demirlenk,B. Yagci,N. Karabulut,S. Cubukcu
Clinical utility fo sonography in diagnosing plantar fasciitis
J Ultrasound Med, 24 (2005), pp. 1041-1048
5.
J.F. Berkowitz,R. Kier,S. Rudicel
Plantar fasciitis: MR imaging
Radiology, 179 (1991), pp. 665-667
6.
D.L. Sackett,S.E. Straus,W.S. Richardson,W. Rosemberg,R.B. Haynes
Evidence-Based-Medicine. How to practice an teach MBE, 2.a ed.,
7.
M. Van Tulder,A. Furlan,C. Bombardier,L. Bouter
Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group
Spine, 28 (2003), pp. 1290-1299
8.
M. Powell,W.R. Post,J. Keener,S. Wearden
Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study
Foot Ankle Int, 19 (1998), pp. 10-18
9.
J.E. Martin,J.C. Hosch,W.P. Goforth,R.T. Murff,D.M. Lynch,R.D. Odom
Mechanical treatment of plantar fasciitis: a prospective study
J Am Pod Med Assoc, 91 (2001), pp. 55-62
10.
R.A. Probe,M. Baca,R. Adams,C. Preece
Nigth splint treatment for plantar fasciitis: a prospective randomized study
Clin Orthop Relat Res, 368 (1999), pp. 190-195
11.
M.E. Batt,J.L. Tanji,N. Skattum
Plantar fasciitis: a prospective randomized clinical trial of the tension night splint
Clin J Sports Med, 6 (1996), pp. 158-162
12.
F. Crawford,C. Thomson
Interventions for treating plantar heel pain
Cochrane Database Syst Rev, 3 (2003),
13.
A.J. Black
A preliminary study of the comparative effectos of steroid injection versus orthosis (Viscoheel sofspot) on plantar fasciitis
Quenn’s University, (1996)
14.
G.B. Pfeffer,P. Bacchetti,J. Deland,A. Lewis,R. Anderson,W. Davis
Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis
Foot Ankle Int, 20 (1999), pp. 214-221
15.
P.F. Davis,E. Severud,D.E. Baxter
Painful heel syndrome: results of nonooperative treatment
Foot Ankle Int, 15 (1994), pp. 531-535
16.
C.C. Young,D.S. Rutherford,M.W. Niedfeldt
Treatment of plantar fascitis
Am Fam Phys, 63 (2001), pp. 467-474
17.
D. Porter,E. Barrill,K. Oneacr,B.D. May
The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, controlled study
Foot Ankle Int, 23 (2002), pp. 619-624
18.
B.F. DiGiovanni,D.A. Nawoczenski,M.C. Lintal,E.A. Moore,J.C. Murray,G.E. Wilding
Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain
J Bone Joint Surg (Am), 85 (2003), pp. 1270-1727
19.
B.F. DiGiovanni,D.A. Nawoczenski,D.P. Malay,P.A. Graci,T.T. Williams,G.E. Wilding
Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis
J Bone Joint Surg 28 (Am), 88 (2006), pp. 1775-1781
20.
F. Crawford,D. Atkins,P. Young,J. Edwards
Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial
Rheumatology (Oxford), 38 (1999), pp. 974-977
21.
S. Kriss
Heel pain: an investigation into its etiology and management [tesis]
University of Westminster, (1990)
22.
D.M. Lynch,W.P. Gogorth,J.E. Martin,R.D. Odom,C.K. Preece,M.W. Kotter
Conservative treatment of plantar fasciitis. A prospective study
J Am Pod Med Assoc, 88 (1998), pp. 375-380
23.
A.F. Tallia,D.A. Cardone
Diagnostic and therapeutic injection of the ankle and foot
Am Fam Phys, 68 (2003), pp. 1356-1362
24.
J.I. Acevedo,J.L. Baskin
Complications of plantar fascia rupture associated with corticosteroid injection
Foot Ankle Int, 19 (1998), pp. 91-97
25.
S.D. Gudeman,S.A. Eisele,R.S. Heidt,A.J. Colosimo,A.L. Stroupe
Treatment of plantar fascitis by iontophoresis at 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study
Am J Sports Med, 25 (1997), pp. 312-326
26.
F. Crawford,M. Snaith
How effective is ultrasound in the treatment of heel pain?
Ann Rheum Dis, 55 (1996), pp. 265-267
27.
J.R. Basford,G.A. Malanga,D.A. Krause,P.T. William,M.S. Harmsen
A randomised controlled evaluation of low-intensity laser therapy: Plantar fascitis
Arch Phys Med Rehabil, 79 (1998), pp. 249-254
28.
M.A. Caselli,N. Clark,S. Lazarus,Z. Velez,L. Venegas
Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain
J Am Podiatr Med Assoc, 87 (1997), pp. 11-16
29.
C.E. Thomson,F. Crawford,G.D. Murray
The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis
BMC Musculoskelet Disord, 22 (2005), pp. 19
30.
R.E. Leach,M.S. Seavey,D.K. Salter
Results of surgery in athletes with plantar fasciitis
Foot Ankle, 7 (1986), pp. 156-161
31.
P.J. Daly,H.B. Kitaoka,Y.S. Chao
Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation
Foot Ankle, 13 (1992), pp. 188-195
32.
W. Benton-Weil,A.H. Borreelli,L.S. Weil,L.S. Weil
Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis
J Foot Ankle Surg, 37 (1998), pp. 269-272
Correspondencia: Dra. A. Lafuente Guijosa. Baños de Montemayor, 5 portal 2-7.° A. 28005 Madrid. España.
Copyright © 2007. Elsevier España S.L Barcelona
Reumatol Clin.2007;3:159-65 - Vol. 3 Núm.4 DOI: 10.1016/S1699-258X(07)73614-8