PAIN FROM PLANTAR FASCIITIS

Abstract

Introduction: Fasciitis of the foot is an inflammatory condition characterized by pain in the medial, central and lateral sectors of the sole accompanied by stiffness. The aim of this study was to examine and interpret the features of the pain focus in this condition from a clinical and esthesiological point of view and in relation to the objective findings of a biomechanical evaluation. Material and Method: Twenty-two subjects (17males, 5 females), aged 19-51 years were examined who practised sport regularly; all presented pain in the sole of the foot. Each subject underwent a clinical and esthesiological examination with measurement of pain thresholds to electrical stimulation of the skin, subcutaneous tissue and muscle in the trigger point zone and unaffected controlateral area and also an evaluation of biomechanical parameters related to function by means of an analysis of the foot-ground reaction and peak force revealed by isokinetic dynamometer. The patient were then fitted with a corrective insole and re-subjected to the above examinations after 30 and 60 days. Results: The subjects were divided into 3 groups on the basis of the TrP site and area of referred pain, as follows:Group A (12 cases) had fascial pain in the calcaneum attachment. The objective examination showed an active TrP determining referred pain in the median part of the sole of the foot. Group B ( 8 cases) had pain localized in the middle third of the medial part of the fascia. The objective examination showed an active TrP causing pain radiating disto-proxiamlly to the attachment of the peroneus muscle at the base of the V metatarsus. The esthesiological evaluation of these groups showed lowered pain thresholds in the skin and muscle compared with the controlateral areas. The isokinetic examination revealed a significant decrease in the peak force in concentric contraction and peak force in eccentric contraction. The foot-ground reaction were abnormal for same spatial and temporal components. A significant reduction of the painful symptoms was observed in these subjects after 30 days with corrective insole, together with a normalization of locomotion. After 60 days, the pain had disappeared and there was an objective reduction of the irritability of the TrPs and absence of the target zone. The esthesiological examination of the pain threshold to electrical stimulation of the skin and muscle showed a further increase with respect to the previous control. All components of the foot-ground reaction were improved. Conclusion: These results show that pain from fasciitis of the sole of the foot is due to an abnormality of movement which gives rise to an imbalance of the force and flexibility of the flexor muscle in this area. The improvement of the ground-foot reaction brings about a gradual disappearance of the painful symptoms.