A fasciite plantar é considerada a terceira doença mais comum em corredores. Apesar dessa alta prevalência, sua patogênese ainda é inconclusiva. Na literatura desalinhamento do retropé, mudanças na conformação do arco longitudinal plantar e um aumento da carga mecânica sobre os pés, têm sido embasados como fatores de risco para o desenvolvimento da fasciite plantar. No entanto, há uma escassez de estudos que investigaram estes fatores, durante a corrida. A maior parte da literatura investigou, especificamente, a marcha e os resultados apresentam-se controversos e ainda não claros, principalmente, em relação ao efeito da dor associada à doença. Para alívio da dor, a maioria dos tratamentos baseia-se na inserção de palmilhas, porém, há longo prazo, elas não impedem as recidivas dos sintomas. Isso pode ser justificado pela carência de bases científicas que melhor descrevam as características posturais do complexo tornozelo-pé e os padrões dinâmicos da carga plantar, durante a corrida, para que possam perpetuar uma maior eficácia deste tipo de tratamento. Assim, o objetivo geral desse estudo foi verificar a influência da fasciite plantar com e sem dor sobre o alinhamento do retropé e o arco longitudinal medial na postura ortostática bipodal, bem como a análise da distribuição da pressão plantar durante a corrida. Foram estudados 105 corredores adultos de ambos os sexos entre 20 a 55 anos. Destes 45 apresentavam fasciite plantar (30 com dor - FPS e 15 sem dor - FPA) e 60 eram corredores controles - GC. Para responder as questões científicas específicas foram realizados dois experimentos. O experimento um teve como objetivo específico avaliar a influência da fasciite plantar sintomática e assintomática sobre o alinhamento do retropé e o arco longitudinal medial durante a postura ortostática bipodal de corredores recreacionais. Para tanto, foram avaliadas, por meio da fotogrametria digital, duas medidas clínicas: ângulo do retropé e o arco longitudinal medial. O experimento dois teve como objetivo específico investigar e comparar a distribuição da pressão plantar de corredores com fasciite plantar sintomática e assintomática e corredores sem a presença da doença, durante a corrida. Para tanto, a distribuição da pressão plantar foi avaliada por meio de palmilhas capacitivas (Pedar X System) durante uma corrida de 40m a uma velocidade de 12km/h, utilizando um calçado esportivo padrão. A dor foi mensurada pela escala visual analógica. Para análise das variáveis biomecânicas da pressão o pé foi dividido em seis áreas: retropé lateral, central e medial, mediopé e antepé lateral e medial. Os principais resultados desse estudo mostraram que a fasciite plantar sintomática e assintomática não apresentou diferenças significativas no alinhamento em valgo do retropé, mas a condição de fasciite plantar influenciou no arco longitudinal medial, onde ambos os grupos com fasciite plantar (com e sem dor) apresentaram um arco mais elevado em relação ao controle. Já em relação às cargas plantares, durante a corrida, não houve diferença significativa nas variáveis: pico de pressão (p = 0,609), área de contato (p = 0,383), tempo de contato (p = 0,908) e integral da pressão (p = 0,504). Conclui-se que a fasciite plantar sintomática e assintomática não altera o alinhamento do retropé na postura ortostática bipodal e a distribuição da pressão plantar, durante a corrida. No entanto, a condição fasciite plantar, independente do sintoma de dor, associa-se com um aumento do arco longitudinal medial na população de corredores / The plantar fasciitis has been the third most common disease in runners. Despite this high prevalence, its pathogenesis is still inconclusive. In literature, the rearfoot misalignment, changes in the conformation of longitudinal plantar arch and increased mechanical load on the feet, have been described as risk factors for developing of plantar fasciitis. However, there are few studies investigating these factors during the running. The most of the literature investigated the gait and the results are still controversial and unclear, mainly on the effect of pain associated with disease. For pain relief, most of the treatments are based on use of the insoles, however, they do not have long-term beneficial effects. This can be explained by the lack of scientific evidence that describe the characteristics of postural ankle-foot complex and dynamic load patterns on plantar surface during the running, thus, improve effectiveness this type of treatment. The general purpose of this study was to investigate the influence of plantar fasciitis with and without pain on the rearfoot alignment, longitudinal medial plantar arch in bipedal standing posture and on the plantar pressure distribution during the running. One hundred and five adult recreational runners of both sexes between 20 to 55 years old were studied. Of these, 45 had plantar fasciitis (symptomatic 30 SPF and asymptomatic 15 APF) and 60 controls runners CG. Two experiments were realized in order to respond the specific scientific questions. The first experiment had the specific purpose of verify the influence of plantar fasciitis symptomatic (with pain) and asymptomatic (without pain) on the rearfoot alignment and on the longitudinal medial plantar arch during bipedal standing posture of runners. Therefore, were evaluated by mean of digital photogrammetry, two clinical measures: the rearfoot angle and arch index. The experiment two aimed specifically to investigate and comparing the plantar pressure distribution in runners with plantar fasciitis symptomatic and asymptomatic and runners without plantar fasciitis during the running. Therefore, the plantar pressure distribution was measured by capacitive insoles (Pedar System X) during a running of 40 m at a speed of 12km/h, using a standard sport shoes. Pain was measured by visual analogue scale. For analysis of the pressure variables, the foot was divided into six areas: rearfoot lateral, central and medial; midfoot and forefoot medial and lateral. The principal results of this study showed that the symptomatic and asymptomatic plantar fasciitis do not show significant difference in the valgus rearfoot misalignment, but the condition of plantar fasciitis (symptomatic and asymptomatic) caused an increase of the longitudinal medial plantar arch compared to CG. In relation to the plantar loads during the running, there was no significant difference on pressure peak (p = 0.609), contact area (p = 0.383), contact time (p = 0.908) and pressure integral (p = 0.504). We concluded that the symptomatic and asymptomatic plantar fasciitis does not change the valgus rearfoot alignment during bipedal standing posture and the plantar pressure distribution during the running. However, the condition of symptomatic and asymptomatic plantar fasciitis showed an increase in the longitudinal medial plantar arch of recreational runners

OBJETIVOS: Comparar o tratamento por ondas de choque radiais com a fisioterapia convencional na fasciite plantar. MATERIAL E MÉTODOS: Foram tratados 40 pacientes com diagnóstico de fasciite plantar. Os pacientes foram divididos, de forma aleatória em dois grupos. Grupo 1 - constituído de 20 pacientes, que fizeram 10 sessões de fisioterapia com ultra-som, cinesioterapia e orientação domiciliar de alongamentos. Grupo 2 constituído de 20 pacientes, que fizeram três aplicações, uma vez por semana, com ondas de choque radial e orientação domiciliar de alongamentos. Todos os pacientes passaram por uma avaliação de dor e função antes, depois e após 3 meses do tratamento. A média de idade foi 49,6 ± 11,8 (25-68) anos, 85% gênero feminino, 88% estavam acima do peso, 63% tinham comprometimento bilateral e 83% usavam analgésicos regularmente. RESULTADOS: Os dois tratamentos foram eficazes na melhora da dor e função dos pacientes com fasciite plantar. O efeito das ondas de choque foi observado em tempo menor. CONCLUSÃO: O tratamento com ondas de choque não foi mais efetivo que o tratamento de fisioterapia convencional, quando avaliado três meses após o final do tratamento / OBJECTIVE: To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis. MATERIALS AND METHODS: Forty patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 - was composed of 20 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 - was composed of 20 patients who underwent three applications of radial shockwaves (once a week) and received instruction for stretching exercises at home. Pain and function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 49.6 ± 11.8 years (range 25-68); 85% were female, 88% were overweight, 63% had bilateral impairment, and 83% used analgesics regularly. RESULTS: Both treatments were effective for pain reduction and for improving the functional abilities of patients with plantar fasciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment. CONCLUSION: Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment

A fasciite plantar é considerada a terceira doença mais comum em corredores. Apesar dessa alta prevalência, sua patogênese ainda é inconclusiva. Na literatura desalinhamento do retropé, mudanças na conformação do arco longitudinal plantar e um aumento da carga mecânica sobre os pés, têm sido embasados como fatores de risco para o desenvolvimento da fasciite plantar. No entanto, há uma escassez de estudos que investigaram estes fatores, durante a corrida. A maior parte da literatura investigou, especificamente, a marcha e os resultados apresentam-se controversos e ainda não claros, principalmente, em relação ao efeito da dor associada à doença. Para alívio da dor, a maioria dos tratamentos baseia-se na inserção de palmilhas, porém, há longo prazo, elas não impedem as recidivas dos sintomas. Isso pode ser justificado pela carência de bases científicas que melhor descrevam as características posturais do complexo tornozelo-pé e os padrões dinâmicos da carga plantar, durante a corrida, para que possam perpetuar uma maior eficácia deste tipo de tratamento. Assim, o objetivo geral desse estudo foi verificar a influência da fasciite plantar com e sem dor sobre o alinhamento do retropé e o arco longitudinal medial na postura ortostática bipodal, bem como a análise da distribuição da pressão plantar durante a corrida. Foram estudados 105 corredores adultos de ambos os sexos entre 20 a 55 anos. Destes 45 apresentavam fasciite plantar (30 com dor - FPS e 15 sem dor - FPA) e 60 eram corredores controles - GC. Para responder as questões científicas específicas foram realizados dois experimentos. O experimento um teve como objetivo específico avaliar a influência da fasciite plantar sintomática e assintomática sobre o alinhamento do retropé e o arco longitudinal medial durante a postura ortostática bipodal de corredores recreacionais. Para tanto, foram avaliadas, por meio da fotogrametria digital, duas medidas clínicas: ângulo do retropé e o arco longitudinal medial. O experimento dois teve como objetivo específico investigar e comparar a distribuição da pressão plantar de corredores com fasciite plantar sintomática e assintomática e corredores sem a presença da doença, durante a corrida. Para tanto, a distribuição da pressão plantar foi avaliada por meio de palmilhas capacitivas (Pedar X System) durante uma corrida de 40m a uma velocidade de 12km/h, utilizando um calçado esportivo padrão. A dor foi mensurada pela escala visual analógica. Para análise das variáveis biomecânicas da pressão o pé foi dividido em seis áreas: retropé lateral, central e medial, mediopé e antepé lateral e medial. Os principais resultados desse estudo mostraram que a fasciite plantar sintomática e assintomática não apresentou diferenças significativas no alinhamento em valgo do retropé, mas a condição de fasciite plantar influenciou no arco longitudinal medial, onde ambos os grupos com fasciite plantar (com e sem dor) apresentaram um arco mais elevado em relação ao controle. Já em relação às cargas plantares, durante a corrida, não houve diferença significativa nas variáveis: pico de pressão (p = 0,609), área de contato (p = 0,383), tempo de contato (p = 0,908) e integral da pressão (p = 0,504). Conclui-se que a fasciite plantar sintomática e assintomática não altera o alinhamento do retropé na postura ortostática bipodal e a distribuição da pressão plantar, durante a corrida. No entanto, a condição fasciite plantar, independente do sintoma de dor, associa-se com um aumento do arco longitudinal medial na população de corredores / The plantar fasciitis has been the third most common disease in runners. Despite this high prevalence, its pathogenesis is still inconclusive. In literature, the rearfoot misalignment, changes in the conformation of longitudinal plantar arch and increased mechanical load on the feet, have been described as risk factors for developing of plantar fasciitis. However, there are few studies investigating these factors during the running. The most of the literature investigated the gait and the results are still controversial and unclear, mainly on the effect of pain associated with disease. For pain relief, most of the treatments are based on use of the insoles, however, they do not have long-term beneficial effects. This can be explained by the lack of scientific evidence that describe the characteristics of postural ankle-foot complex and dynamic load patterns on plantar surface during the running, thus, improve effectiveness this type of treatment. The general purpose of this study was to investigate the influence of plantar fasciitis with and without pain on the rearfoot alignment, longitudinal medial plantar arch in bipedal standing posture and on the plantar pressure distribution during the running. One hundred and five adult recreational runners of both sexes between 20 to 55 years old were studied. Of these, 45 had plantar fasciitis (symptomatic 30 SPF and asymptomatic 15 APF) and 60 controls runners CG. Two experiments were realized in order to respond the specific scientific questions. The first experiment had the specific purpose of verify the influence of plantar fasciitis symptomatic (with pain) and asymptomatic (without pain) on the rearfoot alignment and on the longitudinal medial plantar arch during bipedal standing posture of runners. Therefore, were evaluated by mean of digital photogrammetry, two clinical measures: the rearfoot angle and arch index. The experiment two aimed specifically to investigate and comparing the plantar pressure distribution in runners with plantar fasciitis symptomatic and asymptomatic and runners without plantar fasciitis during the running. Therefore, the plantar pressure distribution was measured by capacitive insoles (Pedar System X) during a running of 40 m at a speed of 12km/h, using a standard sport shoes. Pain was measured by visual analogue scale. For analysis of the pressure variables, the foot was divided into six areas: rearfoot lateral, central and medial; midfoot and forefoot medial and lateral. The principal results of this study showed that the symptomatic and asymptomatic plantar fasciitis do not show significant difference in the valgus rearfoot misalignment, but the condition of plantar fasciitis (symptomatic and asymptomatic) caused an increase of the longitudinal medial plantar arch compared to CG. In relation to the plantar loads during the running, there was no significant difference on pressure peak (p = 0.609), contact area (p = 0.383), contact time (p = 0.908) and pressure integral (p = 0.504). We concluded that the symptomatic and asymptomatic plantar fasciitis does not change the valgus rearfoot alignment during bipedal standing posture and the plantar pressure distribution during the running. However, the condition of symptomatic and asymptomatic plantar fasciitis showed an increase in the longitudinal medial plantar arch of recreational runners

Abstract Background: Plantar fasciitis is the most common heel injury and is a long-term pain syndrom in the attachment of the plantar fascia to the calcaneus bone. The condition is treated mainly in primary care, but there is currently no treatment guideline for the treatment of plantar fasciitis in Sweden. The purpose of this study was to investigate which treatment that occurred in primary care in Dalarna, Gävleborg and Västmanland counties, which treatments that were most common alone and in combination with each other. The aim was also to investigate if the four most commonly used treatment methods as physical therapists said they had used were supported in the literature, and if there was any difference between county employees and private physical therapists in the choice of treatment method. Method: 100 physiotherapists in primary care in Dalarna, Gävleborg and Västmanland counties, received a questionnaire by mail. 80 of the 100 physiotherapists were county employees and 20 were private employees. They were asked about what treatment methods they used for plantar fasciitis, both individual treatments and combination treatments. A comparison was made between county employees and private employees' choice of treatments and the four individual most frequently used treatments were examined on the basis of recent research. Results: 65 physiotherapists answered the survey, of which 61 of them treated patients with plantar fasciitis. The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The first three treatments named above were also those most commonly used in combination with each other. This was true for physiotherapists in county as well as in private employment. There is some evidence that these three treatments relieve pain particularly in short term. Conclusion: The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The conclusion drawn from the evidence currently available to taping, stretch of the plantar fascia and insoles is that it should be a part of the treatment plan for patients with plantar fasciitis. Further research is needed where larger studies and follow-up studies over a longer time is made. Studies of the most common combination treatments should be made, to mimic how they are used in everyday clinical practice. / Sammanfattning Bakgrund: Plantar fasciit är den vanligaste hälskadan och är ett långvarigt smärttillstånd i plantaraponeurosens infästning i calcaneus. Tillståndet behandlas framförallt inom primärvården där det idag saknas en behandlingsriktlinje för behandling av plantar fasciit. Syftet med studien var att undersöka vilka behandlingsmetoder som förekom inom primärvården i Dalarnas-, Gävleborgs- och Västmanlands län, vilka behandlingar som var vanligast och vilka som förekom i kombination med varandra. Syftet var även att undersöka om de fyra vanligast använda behandlingsmetoderna som sjukgymnasterna uppgav sig använda hade stöd i litteraturen samt om det var någon skillnad mellan landstingsanställda och privata sjukgymnasters val av behandlingsmetod. Metod: 100 sjukgymnaster inom primärvåden i Dalarnas-, Gävleborgs- och Västmanlands län, 80 landstingsanställda och 20 privatanställda, fick en enkät per e-post. Där frågades de om vilka behandlingsmetoder som användes vid plantar fasciit, både enskilda behandlingar och kombinationsbehandlingar. En jämförelse gjordes mellan landstingsanställdas och privatanställdas val av behandlingsmetoder och de fyra enskilt mest frekvent använda behandlingarna granskades utifrån senaste forskningen. Resultat: 65 sjukgymnaster svarade på enkäten varav 61 av dem behandlade patienter med plantar fasciit. De fyra mest frekvent använda behandlingarna var tejpning, stretch av plantarfascian, råd om inlägg samt råd om byte av skor. De tre förstnämnda behandlingsmetoderna var även de som var vanligast i kombination med varandra och vanligast för både landstingsanställda och privatanställda sjukgymnaster. Det finns visst stöd i litteraturen för dessa tre behandlingsmetoder som smärtlindrande, framförallt på kort sikt. Konklusion: De fyra mest frekvent använda behandlingarna var tejpning, stretch av plantarfascian, råd om inlägg samt råd om byte av skor. Slutsatsen dras utifrån den evidens som för närvarande finns att tejpning, stretch av plantarfascian samt råd om inlägg i dagsläget rekommenderas ingå i behandlingen av plantar fasciit. Ytterligare forskning behövs dock där större studier samt uppföljningsstudier under längre tid görs. Även studier av de vanliga kombinationsbehandlingarna bör göras, för att efterlikna hur de används i den kliniska vardagen.

OBJETIVOS: Comparar o tratamento por ondas de choque radiais com a fisioterapia convencional na fasciite plantar. MATERIAL E MÉTODOS: Foram tratados 40 pacientes com diagnóstico de fasciite plantar. Os pacientes foram divididos, de forma aleatória em dois grupos. Grupo 1 - constituído de 20 pacientes, que fizeram 10 sessões de fisioterapia com ultra-som, cinesioterapia e orientação domiciliar de alongamentos. Grupo 2 constituído de 20 pacientes, que fizeram três aplicações, uma vez por semana, com ondas de choque radial e orientação domiciliar de alongamentos. Todos os pacientes passaram por uma avaliação de dor e função antes, depois e após 3 meses do tratamento. A média de idade foi 49,6 ± 11,8 (25-68) anos, 85% gênero feminino, 88% estavam acima do peso, 63% tinham comprometimento bilateral e 83% usavam analgésicos regularmente. RESULTADOS: Os dois tratamentos foram eficazes na melhora da dor e função dos pacientes com fasciite plantar. O efeito das ondas de choque foi observado em tempo menor. CONCLUSÃO: O tratamento com ondas de choque não foi mais efetivo que o tratamento de fisioterapia convencional, quando avaliado três meses após o final do tratamento / OBJECTIVE: To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis. MATERIALS AND METHODS: Forty patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 - was composed of 20 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 - was composed of 20 patients who underwent three applications of radial shockwaves (once a week) and received instruction for stretching exercises at home. Pain and function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 49.6 ± 11.8 years (range 25-68); 85% were female, 88% were overweight, 63% had bilateral impairment, and 83% used analgesics regularly. RESULTS: Both treatments were effective for pain reduction and for improving the functional abilities of patients with plantar fasciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment. CONCLUSION: Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment

M. Tech. / Plantar fasciitis is the most common cause of heel pain for which professional care is sought (Singh, 2008). Plantar fasciitis is a common injury, and one which is known to be stubborn to many forms of treatment. The aim of the study was to determine the most effective treatment for individuals suffering with plantar fasciitis comparing three protocols, i.e. mobilisation and manipulation of the foot and ankle with cross friction massage of the plantar fascia versus stretching of the gastroc-soleus complex with cross friction massage of the plantar fascia or a combination of the aforementioned treatments. Participants in the study were recruited from information pamphlets, the University of Johannesburg Chiropractic and Podiatry Day Clinics and running clubs. Only those participants that conformed to the selection criteria were allowed to participate in the study. A total of forty five participants were included. These participants were randomly placed into one of three groups of fifteen participants in each group. Group one received manipulation and mobilisation therapy to the foot and ankle with cross friction massage of the plantar fascia. Group two received cross friction massage of the plantar fascia and stretching of the gastroc-soleus muscle. Group three received a combination of the aforementioned therapies. Subjective data was collected using the Short Form McGill Pain Questionnaire (SF-MPQ) and the Foot Function Index (FFI). Objective data was collected using the algometer to test differences in pain at the plantar fascia as well as ankle range of motion in dorsiflexion and plantarflexion which was measured using a goniometer. The results of this study indicate that cross friction massage of the plantar fascia and stretching of the gastroc-soleus complex would appear to have shown the greatest overall improvement in terms of reducing the pain and disability and ankle dorsiflexion range of motion. Manipulation of the foot and ankle, cross friction massage of the plantar fascia and stretching of the gastroc-soleus complex proved to have shown the greatest overall improvement in plantarflexion only. Based on the results of the study, cross friction massage and gastroc-soleus stretching is the most effective treatment protocol for plantar fasciitis.

PF is one of the most common foot and ankle problems. People with PF experience mild to severe pain that interferes moderately with activities of daily living (ADL). Due to chronic pain that interferes with ADL, people with PF often use non-steroidal anti-inflammatory medications and/or acetaminophen. These medications alleviate pain but cannot eliminate it. Additionally, with chronic use, these medications can cause well-known adverse side effects. The purposes of this study were to investigate the effect of Korean Hand Therapy (KHT) in (1) treating the pain experienced in patients with plantar fasciitis (PF), (2) evaluating its impact on functionality, and (3) assessing participants' self-adherence to treatment. A pre-post mixed methods pilot study was conducted with 28 participants. Baseline measures included a demographic questionnaire, height and weight, a 10-point pain scale, the foot function index (FFI), and measurement of the plantar fascia via ultrasound. As a group, participants were taught about KHT and how to self-administer it. Participants then self-administered KHT for four weeks. Three weekly electronic surveys were sent asking participants about their pain and use of KHT. After four weeks, participants returned for final data collection, including a focus group. Baseline measures, except the demographic questionnaire and height and weight, were repeated. Thickness of PF was not correlated with pain at baseline (r = -0.14, p = 0.47). Compared to baseline, pain was significantly reduced after the initial KHT treatment on the first visit (4.875 vs 2.625, p < 0.00) and at the 4-week follow up (4.875 vs 2.528, p < 0.05). On average for all four weeks, participants reported 5.48 (SD 1.50) days of self-guided KHT per week. PF thickness was not significantly reduced at the follow up session at 4 weeks (t =1.16, p = 0.26). FFI scores were significantly improved between baseline and four weeks: Pain (t = 3.80, p < 0.00), Activity Limitation (t = 2.64, p = 0.02), and Disability (t = 4.74, p < 0.00) and overall FFI (t = 4.83, p < 0.00). Findings suggest KHT may reduce pain and increase functionality for people who experience PF. While the sample was small, KHT is low-risk, low-cost, and easily self-administered. Further investigation is needed on the long-term effects of KHT and its ability to generally alleviate all types of pain.

A fasciite plantar, terceira lesão mais comum em corredores, apresenta como principais fatores etiológicos o alinhamento do retropé, o arco longitudinal plantar e a carga mecânica dos pés. Os únicos dois estudos que investigaram estes fatores, durante a corrida, permanecem controversos e ainda não claros, principalmente, em relação ao efeito da dor. Outra questão importante é o suporte teórico da associação entre as medidas clinicas dos pés com a carga mecânica no calcâneo, porém sem evidência científica comprovada. A compreensão dos padrões dinâmicos da carga plantar e a sua associação com as medidas clínicas do pé poderão perpetuar uma maior efetividade de recursos terapêuticos como calçados e palmilhas direcionadas a essa população. Portanto, o objetivo geral desse estudo foi avaliar o padrão de carga plantar e impacto dos pés em contato com o solo durante a corrida de corredores com fasciite plantar aguda e crônica e sua associação com o arco longitudinal medial e ângulo do retropé. Foram estudados 75 corredores adultos de ambos os sexos entre 20 a 55 anos. Destes 45 apresentavam fasciite plantar (30 com dor - FPA e 15 sem dor - FPC) e 30 eram corredores controles - GC. Para responder a questões específicas foram realizados dois experimentos. O primeiro teve como objetivo analisar e comparar as taxas de impacto estimadas e as cargas em três regiões distintas dos pés de corredores com fasciite plantar na fase aguda e crônica e corredores controle. A pressão plantar foi avaliada por meio de palmilhas capacitivas (Pedar X System) durante uma corrida de 40m a uma velocidade de 12±5%km/h, utilizando um calçado esportivo padrão. A dor foi mensurada pela escala visual analógica. As taxas de impacto e a carga plantar em retropé, mediopé e antepé foram analisadas em série temporal. Os dados foram processados no Matlab e comparados por ANOVAs (p<0,05). Os principais resultados indicam que a força máxima e integral da força no retropé e as taxas de impacto (20-80%; 10-100%) apresentam-se maiores em corredores com fasciite plantar em relação aos corredores controle (p<0,01). Porém, corredores com fasciite plantar na fase aguda apresentaram menores taxas de impacto e cargas plantares no retropé em relação à fase crônica (p<0,01). O segundo experimento teve como objetivo investigar a relação entre o arco longitudinal medial, o alinhamento do retropé e a dinâmica da pressão plantar em corredores com fasciite plantar: aguda e crônica. O índice do arco plantar e o alinhamento do retropé foram calculados no AutoCAD por meio de imagem fotográfica digital. Para análise da pressão plantar foi utilizado os dados previamente coletados no experimento 1 pelo sistema de palmilhas capacitivas (Pedar X System) durante a corrida. Uma análise de regressão múltipla foi realizada (p<0,05). Os resultados indicam que o arco plantar elevado pode predizer a integral da força (R=0,35, R2=0,15) e a força máxima (R=0,59, R2=0,35) no antepé na fase aguda e crônica, respectivamente. O alinhamento valgo do retropé prediz a força máxima no retropé na fase aguda (R=0,42, R2=0,18) e crônica (R=0,67, R2=0,45), além de predizer o aumento das taxas de impacto do pé na fase crônica da fasciite plantar, 20-80% (R=0,44, R2=0,19) e 10-100% (R=0,63, R2=0,40). Conclui-se que corredores com fasciite plantar aguda e crônica apresentam maiores cargas plantares no retropé e aumento das taxas de impacto do pé no solo. No entanto, a condição fasciite plantar aguda mostrou-se com menores taxas e cargas plantares no retropé em relação à fase crônica, possivelmente, devido ao mecanismo de proteção a dor na região do calcâneo. Além disso, o arco plantar prediz as cargas plantares do antepé de corredores com fasciite plantar e o alinhamento em valgo do retropé demonstrou ser uma medida clínica de fundamental importância para avaliação de corredores com fasciite plantar, pois permitiu predizer tanto o aumento das cargas e taxas de impacto na região do calcâneo e com isso, prevenir os sintomas e a progressão da fasciite plantar / The plantar fasciitis, the third most common injury in runners, presents as the main etiological factors rearfoot alignment, the longitudinal arch and mechanical load on the feet. The only two studies have investigated these factors during running and the results remain controversial and still not clear, specifically regarding the pain symptoms. Another important question is the theoretical support of the association between clinical measurements of the feet with the mechanical load on the heel, but without proven scientific evidence. Understanding the dynamic patterns of plant load and its association with clinical measures of foot may perpetuate more effective therapeutic resources, such as footwear and insoles that target this population. Therefore, the general objective of this study was to evaluate the load pattern and impact of plantar foot in contact with the ground during running in runners with acute and chronic plantar fasciitis and its association with the medial longitudinal arch and rearfoot angle. We studied 75 adult runners of both sexes between 20 and 55 years. Of these 45 had plantar fasciitis (pain-APF 30 with and 15 without pain - CPF) and 30 controls were runners - CG. To answer specific questions two experiments were conducted. The first aimed to analyze and compare the estimated impact rates and the plantar loads in runners with both acute and chronic PF, compared to controls. Seventy-five runners with heel contact running patterns were evaluated and divided into three groups: Acute PF (n=30); chronic PF (n=15); and controls (n=30). Pain was assessed by the Visual Analogue Scale. The plantar pressures was measured by X Pedar system during 40-meter running sessions at speeds of 12±5% Km/h with standard sport footwear. The impact rates and the loads over the rearfoot, midfoot, and forefoot were analyzed based upon temporal series. The data were processed in Matlab and compared by ANOVAs (p <0.05). The main results indicate that the maximum force and integral force in the rearfoot and impact rates (20-80%, 10-100%) were higher in runners with plantar fasciitis when compared with control runners (p <0.01). However, runners with plantar fasciitis in the acute phase showed lower impact rates and loads plantar on rearfoot in relation to chronic phase (p <0.01). The second experiment aimed to investigate the relationship between the medial longitudinal arch, rearfoot alignment and dynamic plantar pressure in runners with plantar fasciitis: acute and chronic. The plantar arch index and rearfoot alignment were calculated in AutoCAD using digital photographic image. For analysis of plantar pressure was used previously collected data in experiment 1 by the system of capacitive insoles (Pedar X System) during the running. A multiple regression analysis was performed (p <0.05). The results indicate that high plantar arch can predict the increase: integral force (R = 0.35, R2 = 0.15) and maximum force (R = 0.59, R2 = 0.35) in the forefoot in acute and chronic phase, respectively. The alignment of the rearfoot valgus predict the maximum force on rearfoot in the acute phase (R = 0.42, R2 = 0.18) and chronic (R = 0.67, R2 = 0.45), and predict increased rates impact of the foot during the chronic plantar fasciitis, 20-80% (R = 0.44, R2 = 0.19) and 10-100% (R = 0.63, R2 = 0.40). We conclude that runners with plantar fasciitis acute and chronic have higher plantar loads on rearfoot and increased rates of impact of the foot on the ground. However, the condition plantar fasciitis acute proved loads with lower impact rates and plantar load on rearfoot in relation to chronic phase, possibly due to the protective mechanism pain in calcaneal region. Moreover, the plantar arch predicts loads plantar in forefoot of the runners with plantar fasciitis and alignment in valgus rearfoot proved to be a measure of fundamental importance for clinical evaluation of runners with plantar fasciitis because it can predict the increase of the plantar loads and impact rates of calcaneal region and thus prevents the symptoms and progression of plantar fasciitis.

Plantar heel pain is commonly encountered by clinicians. Various conditions, such as plantar fasciopathy, myofascial syndrome and entrapment of the tibial, plantar and calcaneal nerves at the tarsal tunnel can cause plantar heel pain. This diversity in aetiology makes the diagnosis and treatment challenging. There are limited studies on pain mechanisms in patients with planter heel pain. There is no gold criterion standard for the diagnosis. Although various interventions have been reported, no specific treatment approach has yet been identified as being most effective. The first aim of this thesis was to critically appraise the literature on plantar heel pain of neural origin. Various databases were searched for peer-reviewed articles that predominantly focused on neurogenic plantar heel pain or that discussed relevant biomechanics of the tibial, plantar and calcaneal nerves. This review revealed inconsistency in the literature regarding the diagnosis and treatment of neurogenic plantar heel pain. There also was a lack of evidence for treatment approaches although the majority of patients with plantar heel pain are reported to improve with conservative treatment. The second aim of this thesis was to examine the biomechanical effects of clinical tests and combination of movements on various structures associated with plantar heel pain. This aim was achieved through cadaver studies (Study 1–3), in which strain in the plantar fascia and the nerves of the lower limb, and excursion of the nerves were measured during various movements and positions of the lower limb. Study 1 examined the Dorsiflexion-eversion test used to diagnose tarsal tunnel syndrome (TTS) and the Windlass test for plantar fasciopathy given the similarity between both tests. Both the Dorsiflexion-eversion and Windlass tests significantly increased strain in the structures that are commonly associated with plantar heel pain (the tibial and plantar nerves and plantar fascia). This suggests that the usefulness of the Dorsiflexion-eversion and Windlass tests in the differential diagnosis of plantar heel pain might be limited. Study 2 investigated the influence of different positions in adjacent joints on nerve biomechanics during ankle and toe movement. Increased strain in the tibial nerve at the ankle and plantar nerves associated with ankle and toe movement was significantly higher when the nervous system was pre-tensioned at a more proximal joint. Strain was even higher when the nerve bed was pre-tensioned at two joints. Study 3 examined a modified straight leg raising (SLR) test in which ankle dorsiflexion is performed before hip flexion. This test has been suggested to diagnose distal neuropathies such as TTS. During the modified SLR, the excursion and strain in the sciatic nerve associated with hip flexion were transmitted distally along the nerve from the hip to the foot. As a result, the strain in the nerves around the foot and ankle increased significantly during hip flexion. This movement did not affect plantar fascia strain. Consequently, the modified SLR may be a useful test to differentially diagnose plantar heel pain. This test warrants future research to evaluate its clinical use in patients with neurogenic plantar heel pain. The third aim of this thesis was to determine the reliability of high-resolution ultrasound for measuring the cross-sectional area of the tibial nerve at the tarsal tunnel and to compare the tibial nerve size between people with and without plantar heel pain. Study 4 investigated intra and intertester reliability in 10 participants without plantar heel pain by calculating intraclass correlation coefficients, measurement error and smallest detectable difference (SDD). Intra and intertester reliability were excellent, with very small measurement error and SDD. Tibial nerve enlargement in an individual patient by as little as 1.8 mm2 can be detected reliably with high-resolution ultrasound. The use of average value of three scans is recommended to compare between the involved and uninvolved side. Differences in the nerve size between 26 patients with plantar heel pain and 20 control participants were also analysed. There was no significant difference in tibial nerve size between both groups. Future research is needed to investigate the tibial nerve size in patients with proven TTS using ultrasonography. The fourth aim of this thesis was to investigate the characteristics of plantar heel pain through Study 5 for the same group of patients and control participants as in Study 4. Several self-report measures on pain and quality of life were used. Clinical tests and quantitative sensory tests (QST) were performed at local and remote sites on the involved and uninvolved side in the patients and on one side in the control participants. In the patients, mechanical hyperalgesia was the main finding as demonstrated by changes in palpation and pressure pain threshold. Other findings were changes in current thresholds, vibration threshold and thermal perception thresholds. These results suggest the existence of sensory changes that likely indicates change in peripheral and central pain processing. It is recommended to utilise a multidimensional pain assessment for patients with plantar heel pain. The findings in this thesis are important for the diagnosis and treatment of plantar heel pain. For future research, the results suggest to use fresh cadavers when investigating biomechanics of the clinical tests and nerve gliding exercises that are used for patients with plantar heel pain. It is also suggested to evaluate the cross-sectional area of the tibial nerve at the tarsal tunnel, the QSTs and all other diagnostic measurements in this thesis in patients with neurogenic plantar heel pain or patients with TTS.

A fasciite plantar, terceira lesão mais comum em corredores, apresenta como principais fatores etiológicos o alinhamento do retropé, o arco longitudinal plantar e a carga mecânica dos pés. Os únicos dois estudos que investigaram estes fatores, durante a corrida, permanecem controversos e ainda não claros, principalmente, em relação ao efeito da dor. Outra questão importante é o suporte teórico da associação entre as medidas clinicas dos pés com a carga mecânica no calcâneo, porém sem evidência científica comprovada. A compreensão dos padrões dinâmicos da carga plantar e a sua associação com as medidas clínicas do pé poderão perpetuar uma maior efetividade de recursos terapêuticos como calçados e palmilhas direcionadas a essa população. Portanto, o objetivo geral desse estudo foi avaliar o padrão de carga plantar e impacto dos pés em contato com o solo durante a corrida de corredores com fasciite plantar aguda e crônica e sua associação com o arco longitudinal medial e ângulo do retropé. Foram estudados 75 corredores adultos de ambos os sexos entre 20 a 55 anos. Destes 45 apresentavam fasciite plantar (30 com dor - FPA e 15 sem dor - FPC) e 30 eram corredores controles - GC. Para responder a questões específicas foram realizados dois experimentos. O primeiro teve como objetivo analisar e comparar as taxas de impacto estimadas e as cargas em três regiões distintas dos pés de corredores com fasciite plantar na fase aguda e crônica e corredores controle. A pressão plantar foi avaliada por meio de palmilhas capacitivas (Pedar X System) durante uma corrida de 40m a uma velocidade de 12±5%km/h, utilizando um calçado esportivo padrão. A dor foi mensurada pela escala visual analógica. As taxas de impacto e a carga plantar em retropé, mediopé e antepé foram analisadas em série temporal. Os dados foram processados no Matlab e comparados por ANOVAs (p<0,05). Os principais resultados indicam que a força máxima e integral da força no retropé e as taxas de impacto (20-80%; 10-100%) apresentam-se maiores em corredores com fasciite plantar em relação aos corredores controle (p<0,01). Porém, corredores com fasciite plantar na fase aguda apresentaram menores taxas de impacto e cargas plantares no retropé em relação à fase crônica (p<0,01). O segundo experimento teve como objetivo investigar a relação entre o arco longitudinal medial, o alinhamento do retropé e a dinâmica da pressão plantar em corredores com fasciite plantar: aguda e crônica. O índice do arco plantar e o alinhamento do retropé foram calculados no AutoCAD por meio de imagem fotográfica digital. Para análise da pressão plantar foi utilizado os dados previamente coletados no experimento 1 pelo sistema de palmilhas capacitivas (Pedar X System) durante a corrida. Uma análise de regressão múltipla foi realizada (p<0,05). Os resultados indicam que o arco plantar elevado pode predizer a integral da força (R=0,35, R2=0,15) e a força máxima (R=0,59, R2=0,35) no antepé na fase aguda e crônica, respectivamente. O alinhamento valgo do retropé prediz a força máxima no retropé na fase aguda (R=0,42, R2=0,18) e crônica (R=0,67, R2=0,45), além de predizer o aumento das taxas de impacto do pé na fase crônica da fasciite plantar, 20-80% (R=0,44, R2=0,19) e 10-100% (R=0,63, R2=0,40). Conclui-se que corredores com fasciite plantar aguda e crônica apresentam maiores cargas plantares no retropé e aumento das taxas de impacto do pé no solo. No entanto, a condição fasciite plantar aguda mostrou-se com menores taxas e cargas plantares no retropé em relação à fase crônica, possivelmente, devido ao mecanismo de proteção a dor na região do calcâneo. Além disso, o arco plantar prediz as cargas plantares do antepé de corredores com fasciite plantar e o alinhamento em valgo do retropé demonstrou ser uma medida clínica de fundamental importância para avaliação de corredores com fasciite plantar, pois permitiu predizer tanto o aumento das cargas e taxas de impacto na região do calcâneo e com isso, prevenir os sintomas e a progressão da fasciite plantar / The plantar fasciitis, the third most common injury in runners, presents as the main etiological factors rearfoot alignment, the longitudinal arch and mechanical load on the feet. The only two studies have investigated these factors during running and the results remain controversial and still not clear, specifically regarding the pain symptoms. Another important question is the theoretical support of the association between clinical measurements of the feet with the mechanical load on the heel, but without proven scientific evidence. Understanding the dynamic patterns of plant load and its association with clinical measures of foot may perpetuate more effective therapeutic resources, such as footwear and insoles that target this population. Therefore, the general objective of this study was to evaluate the load pattern and impact of plantar foot in contact with the ground during running in runners with acute and chronic plantar fasciitis and its association with the medial longitudinal arch and rearfoot angle. We studied 75 adult runners of both sexes between 20 and 55 years. Of these 45 had plantar fasciitis (pain-APF 30 with and 15 without pain - CPF) and 30 controls were runners - CG. To answer specific questions two experiments were conducted. The first aimed to analyze and compare the estimated impact rates and the plantar loads in runners with both acute and chronic PF, compared to controls. Seventy-five runners with heel contact running patterns were evaluated and divided into three groups: Acute PF (n=30); chronic PF (n=15); and controls (n=30). Pain was assessed by the Visual Analogue Scale. The plantar pressures was measured by X Pedar system during 40-meter running sessions at speeds of 12±5% Km/h with standard sport footwear. The impact rates and the loads over the rearfoot, midfoot, and forefoot were analyzed based upon temporal series. The data were processed in Matlab and compared by ANOVAs (p <0.05). The main results indicate that the maximum force and integral force in the rearfoot and impact rates (20-80%, 10-100%) were higher in runners with plantar fasciitis when compared with control runners (p <0.01). However, runners with plantar fasciitis in the acute phase showed lower impact rates and loads plantar on rearfoot in relation to chronic phase (p <0.01). The second experiment aimed to investigate the relationship between the medial longitudinal arch, rearfoot alignment and dynamic plantar pressure in runners with plantar fasciitis: acute and chronic. The plantar arch index and rearfoot alignment were calculated in AutoCAD using digital photographic image. For analysis of plantar pressure was used previously collected data in experiment 1 by the system of capacitive insoles (Pedar X System) during the running. A multiple regression analysis was performed (p <0.05). The results indicate that high plantar arch can predict the increase: integral force (R = 0.35, R2 = 0.15) and maximum force (R = 0.59, R2 = 0.35) in the forefoot in acute and chronic phase, respectively. The alignment of the rearfoot valgus predict the maximum force on rearfoot in the acute phase (R = 0.42, R2 = 0.18) and chronic (R = 0.67, R2 = 0.45), and predict increased rates impact of the foot during the chronic plantar fasciitis, 20-80% (R = 0.44, R2 = 0.19) and 10-100% (R = 0.63, R2 = 0.40). We conclude that runners with plantar fasciitis acute and chronic have higher plantar loads on rearfoot and increased rates of impact of the foot on the ground. However, the condition plantar fasciitis acute proved loads with lower impact rates and plantar load on rearfoot in relation to chronic phase, possibly due to the protective mechanism pain in calcaneal region. Moreover, the plantar arch predicts loads plantar in forefoot of the runners with plantar fasciitis and alignment in valgus rearfoot proved to be a measure of fundamental importance for clinical evaluation of runners with plantar fasciitis because it can predict the increase of the plantar loads and impact rates of calcaneal region and thus prevents the symptoms and progression of plantar fasciitis.