EPIDEMIOLOGY AND TREATMENT OUTCOME IN PATIENTS PRESENTING WITH PLANTAR FASCIITIS AT THE KORLE BU TEACHING HOSPITAL

Abstract

Background Plantar fasciitis (PF) is a common cause of heel pad pain. The pain associated with this clinical condition can result in impairment of activities of daily living. Although the diagnosis of this condition is easy to clinch, the aetiology remains unclear with numerous treatment options, because no single treatment has strong scientific evidence to support its use to improve outcome. For most patients presenting with this condition at the Orthopaedic unit of Korle-Bu Teaching Hospital (KBTH), the main treatments offered are plantar fascia stretching exercises and corticosteroid injection if the former fails. The rationale of this study was to describe the epidemiology of this clinical condition, identify some of the risk factors common in patients presenting to the Orthopaedic unit of the Korle Bu Teaching Hospital and to determine baseline outcome of KBTH treatment protocol for PF and compare it to those reported in the literature.

Methods This was a longitudinal study on patients presenting with plantar fasciitis to the unit between September, 2014 and August, 2015. Those who met the inclusion criteria were recruited in this study. All newly diagnosed patients were offered plantar fascia stretching exercises; those who failed to respond to treatment based on the Visual Analogue Scale for pain and a modification of foot function index after a month or two were offered corticosteroid injection in addition to plantar fascia stretching exercise.

Results Forty four patients met the inclusion criteria for this study with an incidence of 2.75% of all new cases reporting at the Orthopaedic OPD of the KBTH over the study period. At the end of the 12th week, thirty seven patients were available for follow up. Majority of the patients seen were females (thirty eight), leading to a female to male preponderance of 6.3:1. Twenty three patients representing 52.5% belonged to the age group of 41-50%. The mean age was 47.9 years with a standard deviation of 9.7 years. All the patients seen responded ‘yes’ to morning pain marked after a few couple of steps and to pain after prolonged periods of inactivity. Twenty six patients (59.1%), admitted to be involved in occupations that involved prolonged weight bearing. No significant structural risk factors in terms of pes planus, pes cavus, and leg length discrepancy were detected. Ninety percent of the patients seen were either overweight, obese or morbidly obese. Thirty five patients (79.4%) had a heel spur on X-ray. At four weeks, out of the 42 patients available for follow up, only 5(11.9%) required steroid injection in addition to physiotherapy. At eight weeks, only one (2.56%) of the 39 patients available for follow up had steroid injection in addition to the physiotherapy. By the end of the 12 weeks, 37 patients were available for follow up. All the 37 patients had significant improvement in their VAS scores as well as their modified foot function index scores. The means and (standard deviations) for VAS scores at baseline, 4th week, 8th week and 12th week were, 7.05 (2.2); 5.05 (2.5); 3.15 (1.6); 1.9 (1.2) respectively. The means for the modified FFI at baseline, 4th week, 8th week and 12th week were, 16.0, 11.4, 6.8, 3.7 respectively, with corresponding standard deviations of 4.0, 5.6, 4.6, and 3.0 respectively. These results shows a trend in improvement of symptoms with time.

Conclusions Plantar Fasciitis was found to be common in females. Majority of the patients were middle aged 41 to 50 years with a mean age of 47.9 years and a standard deviation of 9.7 years. Early morning pain at the heel which is marked with few couple of steps is characteristic of plantar fasciitis. Not all patients with plantar fasciitis have a heel spur on X-ray. Structural risk factors in terms of pes cavus, pes planus, and leg length discrepancy were uncommon in this study. Elevated BMI, happened to be a major risk factor in this study; ninety percent of the patient were either overweight, obese or morbidly obese. Stretching exercises should be employed as the first line of treatment for patients presenting with plantar fasciitis