Long-Term Prognosis of Plantar Fasciitis

A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination

Liselotte Hansen*, Thøger Persson Krogh, Torkell Ellingsen, Lars Bolvig, Ulrich Fredberg

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Background: Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown.

Purpose: Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad.

Study Design: Cohort study; Level of evidence, 3.

Methods: From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model.

Results: In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women ( P < .01) and patients with bilateral pain ( P < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups ( P < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. Fascia thickness ( P = .49) and presence of a heel spur ( P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been given an injection ( P = .66).

Conclusion: The risk of having PF in this study was 45.6% at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us to determine the efficacy of different treatment strategies.

Original languageEnglish
Article number2325967118757983
JournalOrthopaedic Journal of Sports Medicine
Volume6
Issue number3
ISSN2325-9671
DOIs
Publication statusPublished - Mar 2018

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Fascia
Heel
Adipose Tissue
Adrenal Cortex Hormones
Sex Characteristics
Body Mass Index
Cohort Studies
Smoking
Regression Analysis
Interviews
Exercise
Population

Keywords

  • corticosteroid
  • heel fat pad
  • heel spur
  • human
  • long-term prognosis
  • plantar fasciitis
  • plantar heel pain
  • prognosis
  • ultrasound

Cite this

@article{9d88757204ed4fdb9697a412248f2600,
title = "Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination",
abstract = "Background: Plantar fasciitis (PF) affects 7{\%} to 10{\%} of the population. The long-term prognosis is unknown.Purpose: Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad.Study Design: Cohort study; Level of evidence, 3.Methods: From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model.Results: In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54{\%} of patients were asymptomatic (mean duration of symptoms, 725 days), and 46{\%} still had symptoms. The risk of having PF was 80.5{\%} after 1 year, 50.0{\%} after 5 years, 45.6{\%} after 10 years, and 44.0{\%} after 15 years from the onset of symptoms. The risk was significantly greater for women ( P < .01) and patients with bilateral pain ( P < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups ( P < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. Fascia thickness ( P = .49) and presence of a heel spur ( P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24{\%} of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been given an injection ( P = .66). Conclusion: The risk of having PF in this study was 45.6{\%} at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24{\%} of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us to determine the efficacy of different treatment strategies.",
keywords = "corticosteroid, heel fat pad, heel spur, human, long-term prognosis, plantar fasciitis, plantar heel pain, prognosis, ultrasound",
author = "Liselotte Hansen and Krogh, {Th{\o}ger Persson} and Torkell Ellingsen and Lars Bolvig and Ulrich Fredberg",
year = "2018",
month = "3",
doi = "10.1177/2325967118757983",
language = "English",
volume = "6",
journal = "Orthopaedic Journal of Sports Medicine",
issn = "2325-9671",
publisher = "SAGE Publications",
number = "3",

}

Long-Term Prognosis of Plantar Fasciitis : A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination. / Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell; Bolvig, Lars; Fredberg, Ulrich.

In: Orthopaedic Journal of Sports Medicine, Vol. 6, No. 3, 2325967118757983, 03.2018.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Long-Term Prognosis of Plantar Fasciitis

T2 - A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination

AU - Hansen, Liselotte

AU - Krogh, Thøger Persson

AU - Ellingsen, Torkell

AU - Bolvig, Lars

AU - Fredberg, Ulrich

PY - 2018/3

Y1 - 2018/3

N2 - Background: Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown.Purpose: Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad.Study Design: Cohort study; Level of evidence, 3.Methods: From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model.Results: In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women ( P < .01) and patients with bilateral pain ( P < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups ( P < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. Fascia thickness ( P = .49) and presence of a heel spur ( P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been given an injection ( P = .66). Conclusion: The risk of having PF in this study was 45.6% at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us to determine the efficacy of different treatment strategies.

AB - Background: Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown.Purpose: Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad.Study Design: Cohort study; Level of evidence, 3.Methods: From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model.Results: In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women ( P < .01) and patients with bilateral pain ( P < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups ( P < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. Fascia thickness ( P = .49) and presence of a heel spur ( P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been given an injection ( P = .66). Conclusion: The risk of having PF in this study was 45.6% at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us to determine the efficacy of different treatment strategies.

KW - corticosteroid

KW - heel fat pad

KW - heel spur

KW - human

KW - long-term prognosis

KW - plantar fasciitis

KW - plantar heel pain

KW - prognosis

KW - ultrasound

U2 - 10.1177/2325967118757983

DO - 10.1177/2325967118757983

M3 - Journal article

VL - 6

JO - Orthopaedic Journal of Sports Medicine

JF - Orthopaedic Journal of Sports Medicine

SN - 2325-9671

IS - 3

M1 - 2325967118757983

ER -