Next Article in Journal
Challenges in Total Hip Arthroplasty with Prior Spinal Arthrodesis: A Comprehensive Review of Biomechanics, Complications, and Surgical Strategies
Previous Article in Journal
Sleep Bruxism and Sleep Structure in Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) Syndrome: A Polysomnographic Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 13
Issue 11
10.3390/jcm13113153
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Posterior Tibial Artery Blood Flow Velocity Is Increased in Patients with Plantar Heel Pain

by
Fumiya Kaneko
1,2,3,
Sho Katayama
2 and
Shintarou Kudo
1,3,*
1
Inclusive Medical Science Research Institute, 1-26-16 Nankokita, Suminoe Ward, Osaka 559-8611, Japan
2
Department of Rehabilitation, Meidaimae Orthopedic Clinic, 1-38-25, Matsubara Setagaya Ward, Tokyo 156-0043, Japan
3
AR-Ex Medical Research Center, 4-13-1, Todoroki Setagaya, Tokyo 158-0082, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(11), 3153; https://doi.org/10.3390/jcm13113153
Submission received: 15 May 2024 / Revised: 25 May 2024 / Accepted: 26 May 2024 / Published: 28 May 2024
(This article belongs to the Special Issue Advances in the Prevention, Management, and Rehabilitation of Sports Injuries)
Browse Figures
Versions Notes

Abstract

:
Background/Objectives: This study aimed to investigate the relationship between posterior tibial artery blood flow velocity and plantar heel pain (PHP). Methods: The PHP group comprised patients diagnosed with plantar fasciitis with plantar heel pain during gait, and the control group comprised healthy participants without plantar heel pain. The peak systolic velocity of the posterior tibial artery was measured using ultrasonography; it was measured three times on each side, and the mean value was calculated. Receiver operating characteristic curve analysis was performed to calculate the peak systolic velocity cutoff value for plantar heel pain. Results: 23 patients (age 58.0 ± 16.5 years; 13 males and 10 females) and 23 healthy participants (age 51.3 ± 17.3 years; 10 males and 13 females) formed the PHP and control groups, respectively. Peak systolic velocity on the affected side was significantly greater in the PHP group (44.1 ± 13.1 cm/s) than in the control group (32.7 ± 5.9 cm/s). No significant difference was observed between the left and right sides in the PHP (7.1 ± 9.8 cm/s) and control (3.7 ± 3.0 cm/s) groups. A cutoff value of 38.2 cm/s was observed on the affected side. Conclusions: We quantified the increase in posterior tibial artery blood flow velocity in patients with plantar heel pain. Peak systolic velocity measurements can aid in quantitatively evaluating these patients. This study was registered as a clinical trial (UMIN000046875) on 1 October 2021.

Graphical Abstract

1. Introduction

Plantar heel pain (PHP) is a common chronic foot disease reported to be intractable, with symptoms lasting 725 days, a 10-year persistence rate of approximately 45.6%, and a relapse rate of approximately 52.9% [1]. Furthermore, PHP is one of the most common injuries in runners [2]. The symptoms of plantar fasciitis, including PHP, are reportedly worse in the morning and after long periods of rest [3]. It has become increasingly apparent that the pathological basis of tendinopathy pain is associated with elevated intratendinous resting pressure and heightened intratendinous dynamic pressure [4]. However, the precise cause of tendon pathology remains unclear. Therefore, investigating the cause of the PHP crisis is critical and will provide useful information for evaluation and treatment.
Image evaluation is essential for understanding the disease state of PHP. In a review of imaging findings [5], thickening of the plantar aponeurosis, hypoechoic and fluid accumulation in the plantar aponeurosis, thickening of the subcalcaneal fat pad, and presence of calcaneal spurs were associated with PHP. However, a thinning of the plantar aponeurosis does not significantly change the pain score [6]. Therefore, quantitative assessments that reflect the degree of pain and symptoms require further investigation.
Recently, blood flow velocity was related to pain in the lower back [7], as well as shoulder [8] and knee joints [9], discovered through ultrasound diagnostic imaging, which is a non-invasive method of examining the body internally. When tissue damage occurs, the body increases its blood flow rate, increasing blood flow to the injured area and promoting tissue healing. Thus, by assessing the blood flow velocity, the healing response at the site of pain can be confirmed.
Ultrasonography evaluation in PHP research is being increasingly used [10]. Patients with PHP develop hypoechoic areas or collections of fluid around the plantar aponeurosis [11] and have abnormal blood flow [12]. Thus, when PHP is generated, the blood flow to the sole of the foot increases, and fluid component storage may occur. The posterior tibial artery (PTA) is the most common vessel that supplies blood to the plantar area. However, the relationship between PHP and the PTA blood flow velocity is not yet understood. This study aimed to determine the blood flow velocity of the PTA in patients with plantar tendinitis and PHP and to investigate the relationship between them. The hypothesis of this study was that the PTA blood flow velocity in the PHP was significantly higher than that in the healthy foot.

2. Materials and Methods

2.1. Participants

Patients with PHP during gait and who were diagnosed with plantar fasciitis between September 2022 and June 2023 were recruited to participate and included in the PHP group. The inclusion and exclusion criteria were as follows:
Inclusion criteria
1. Having PHP when walking;
2. Pain on the first step in the morning;
3. Patients must have subjective symptoms for at least 3 months;
4. Positive heel tenderness, windlass test, dorsiflexion/abduction test, or Tinel signs.
Exclusion criteria
1. PHP less than 3 months;
2. Diabetes mellitus;
3. Gout;
4. Rheumatoid arthritis;
5. History of foot fracture or surgery.
Participants without PHP were included in the control group. The control group was recruited by age, matching those who came to the orthopedics clinic with upper limb diseases. Data on age, height, weight, body mass index, brachial systolic blood pressure, and duration of illness were obtained from their medical records. Patient-based outcome assessments included the numeric rating scale (NRS) during walking, the Foot and Ankle Ability Measure (FAAM) questionnaire—where the FAAM assessed the ADL and the Sports subscales—and PTA flow velocity. These evaluations were conducted to compare the PHP group and control group and to validate the effects of pre- and post-treatment. In the PHP group, these assessments were performed at the start of treatment and 1 month later. The institutional review board of the Morinomiya University of Health Sciences Ethics Review Committee approved this study (UMIN000046875, 2021-095) on 10 February 2022. Written informed consent was obtained from all participants.

2.2. Settings of the Measuring Equipment

The Noblus ultrasound system (Hitachi Medical Corporation, Tokyo, Japan) was used to obtain measurements according to a previously published method [9]. Measurements were obtained using the brightness mode (B-mode), color Doppler, and pulse Doppler methods and a 4–8-MHz linear probe. One examiner, a physical therapist with more than 2 years of experience in echography, performed the measurements.

2.3. Measuring PTA Blood Flow Velocity

The PTA blood flow velocity was measured with the participant in a supine position on the bed, and the inside and outside malleolus of the foot juxtaposed approximately 5 cm from the edge of the bed. During imaging, the PTA was identified using the power Doppler method in the short-axis image at a position where the medial malleolus was visible in the B-mode. The peak systolic velocity (PSV) of the PTA was measured using the pulse Doppler method at a slant angle of 20° and an incidence angle of 60° in the blood flow direction relative to the direction of the ultrasound beam (Figure 1). The PSV was measured three times, and the average value was calculated. Measurements were performed bilaterally.
To determine intra-rater reliability, one examiner (with over 2 years of echography test experience) performed the measurements on five healthy adults. The examiner performed the measurements with sufficient practice. The intraclass correlation coefficient (1.3) was 0.91 (minimum detectable difference with 95% confidence, 2.23). In this study, according to the classification of Landis and Koch [13], the intra-rater reliability of the measurement of PSV was good.

2.4. Interventions

After being diagnosed with PHP, patients in the PHP group received various treatment regimens once a week for 40 min. The interventions for the PHP group included selected conservative therapies that have been shown to be effective for PHP in previous reports. Specifically, physiotherapy consisted of stretching the plantar fascia [14], training the plantar intrinsic muscles [15,16], strength training the plantar flexor ankle musculature [17,18], taping [19,20], and ultrasound therapy [21]. Extracorporeal shock wave therapy was also administered to patients who desired it. No oral medication or steroid injections were administered. Extracorporeal shock wave therapy has been shown to be highly effective [22], so the therapists encouraged patients to receive it. However, upon request, the patient was allowed to decide whether to undergo extracorporeal shock wave therapy. Although PRP therapy has been shown to be effective for the treatment of PHP [23], it was not used in this study. The control group did not receive ankle joint intervention, nor was there a one-month follow-up.

2.5. Follow-Up Investigations

Patients in the PHP group were followed up for 1 month after diagnosis; the PSV, FAAM ADL, FAAM Sports, and NRS scores were the final assessments.

2.6. Statistical Analysis

A sample size test using G*Power (version 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; http://www.gpower.hhu.de/ (accessed on 27 May 2024)) was conducted before the study. The sample size required to apply the Student’s t-test, which was calculated to be at least 21 patients in each group when α = 0.05, power = 0.8, and the effect size = 0.8. The figures for each factor regarding this pre-test are shown to be valid [24]. The Shapiro–Wilk test was performed to determine the normality of the results for patient information (including age, height, weight, and body mass index), as well as the PSV and scores for the NRS during walking and FAAM. The Student’s t-test was performed to identify the group differences in patient information (including age, height, weight, and body mass index) and the difference between the right and left sides of the PSV; the chi-square test for independence was performed for sex. Analysis of variance with the Games–Howell post hoc test was used to compare the PSV between the PHP and control groups and the differences in PSVs within the same group. When the PSV was compared between the PHP and control groups, the PSV of the right foot in the control group was used as a representative value. Correlations between the PSV and NRS score, FAAM score, and blood pressure were examined using Pearson’s correlation coefficient. Receiver operating characteristic curve analysis was performed to calculate the PSV cutoff value for PHP. The significance level was set at 5%. All statistical analyses were conducted using R4.0.2 (CRAN, freeware).

3. Results

3.1. Participants’ Information

Between September 2022 and June 2023, 23 patients were diagnosed with plantar fasciitis with PHP during gait and recruited to our study for the PHP group. Twenty-three healthy people were recruited for the control group. Table 1 shows the physical characteristics of the PHP and control groups. The mean duration of disease in the PHP group was 27.1 ± 31.4 weeks.

3.2. Comparison of PSV between Groups and Differences between the Left and Right Sides

The affected-side PSV in the PHP group was significantly higher than that in the control group (affected side: 44.1 ± 13.1 cm/s; control group: 32.7 ± 5.9 cm/s; p < 0.05, effect size: 0.50). No significant difference was observed between the two groups regarding the left–right difference (PHP group: 7.1 ± 9.8 cm/s; control group: 3.7 ± 3.3 cm/s; p = 0.12, effect size: 0.29) (Figure 2).

3.3. Correlation between PSV and Other Factors

Table 2 shows the correlations between the PSV and each factor in PHP. In PHP, no significant correlations between the PSV and NRS, FAAM ADL, FAAM Sports scores, or systolic blood pressure were observed.
Table 3 shows the numerical values and amount of change in scores before and after the 1-month follow-up. The PHP group’s improvements after one month of treatment are summarized for the PSV, NRS Score, FAAM ADL score, and FAAM Sports score. The values and modifications in each index before and after the intervention are detailed. Table 4 shows the correlation between the change in the PSV and the change in each factor after 1 month of treatment in the PHP group. The correlation between the change in PSV and the change in NRS score, FAAM ADL score, and FAAM Sports score is depicted in this table. A total of 18 individuals were successfully tracked in the 1-month follow-up survey. Five patients withdrew and were not available for follow-up. A significant moderate positive correlation was observed between the change in PSV and the change in the NRS score.

3.4. Cutoff Value of the PSV

The unilateral cutoff value was 38.2 cm/s (area under the receiver operating characteristic curve = 0.74, sensitivity = 65.2%, and specificity = 82.6%).

4. Discussion

The results of the current study showed that the PSV of the affected side of patients with PHP was significantly higher than that of the control group. After 1 month of treatment, a significant moderate positive correlation was observed between the changes in PSV and the NRS score. In contrast, no association was found between the PSV and FAAM ADL or FAAM Sports scores. The cutoff value for the PSV on the affected side was determined to be 38.2 cm/s.
According to the image evaluations of plantar fasciitis in patients with PHP, the plantar fascia thickens to ≥4 mm [25,26], the low echoic region or storage of the fluid component occurs around the plantar fasciitis [26], and abnormal blood flow occurs [12,27]. Abnormal angiogenesis occurs at the site of injury in chronic musculoskeletal diseases [28,29], and the blood flow velocity in the vessels in the area increases [8,9]. To the best of our knowledge, no research has evaluated the blood flow velocity of the PTA. Hence, the increase in blood flow velocity of the PTA in patients with PHP was quantitatively shown for the first time in this study.
The mechanism of increased blood flow velocity in plantar fasciitis and other tendon disorders is as follows. Tendon disorders, including plantar fasciitis, are commonly triggered by compressive overload [4]. This stress occurs at the tendon attachments and is exacerbated when tendons are subjected to tensile loading under compressive loading stress owing to bony prominences [30]. In addition, compressive loading stress causes the accumulation of glycosaminoglycans at the origin of the plantar fascia [31], which leads to tendon swelling and increased internal pressure [4]. At the origin of the plantar fasciitis in PHP, there is an increase in glycosaminoglycans, which promotes a neovascular response [31]. The vasculature of the lesioned tendon cells is composed of vessels with narrow inner diameters [32] and is in a constant state of hypoxia [33]. In addition, ultrasound imaging findings show increased blood flow in the microvasculature of the plantar tendon membrane in PHP [34]. Thus, neovascularization is produced in injured or diseased tendon tissue but is hypoxic. It is possible that blood flow velocity is increased to promote tissue healing in injured or diseased tendon tissue areas.
In this study, there was no correlation between the PSV and NRS or FAAM subscale scores at baseline (Table 2), and the degree of change in PSV was moderately positively correlated with the NRS score after one month (Table 4). The baseline scores showed no association with pain, but there was a correlation between the amount of change in pain and the amount of change in PSV with the intervention. This suggests that PSV may reflect the status of tissue healing in the PHP. As mentioned previously, blood flow velocity increases to contribute to tendon tissue healing [34]; therefore, it is likely that blood flow velocity would be reduced if pain was reduced. The PSV in the PHP can be used to infer the healing state of the tendon by examining the changes over time.
The correlation between the amount of change in PSV and the amount of change in the NRS at 1 month and the lack of correlation between the amount of change in PSV and the amount of change in the FAAM subscale has been demonstrated. It is possible that psychological factors also influence physiological factors. It has been suggested that chronic musculoskeletal pain should be addressed using a biopsychosocial approach [35]. The experience of pain can be influenced by psychological factors such as stress, depression, and catastrophic thinking [36]. Research suggests that women may be more affected by stress and depression than men [37]. Factors related to physical functioning, such as stress, depression, kinesiophobia, and catastrophization, have also been identified [36]. It is important to note that since the NRS assesses pain and the FAAM assesses function, the psychological factors affecting each score may vary. The longer the disease history, the more chronic and complex the pain [38]. Psychological factors influence chronic pain [39]. The patients who participated in the present study had a long history of the disease; therefore, their pain symptoms probably did not correlate with the blood flow measured in the tissue. PHP is a common overuse syndrome, and the symptoms are often observed in clinical practice. Therefore, developing treatments that combine subjective symptoms and objective data by quantitatively determining lesion repair conditions is desirable. The PSV cutoff value may be clinically useful in understanding tissue repair status.

5. Limitations

This study had some limitations. First, using a prospective design intervention to establish how the increase in PSV is altered as pain is relieved is necessary. Second, the association between PSV and imaging findings around the plantar aponeurosis was not evaluated. As mentioned above, imaging findings and pain are associated [25,40]. Therefore, future studies should compare PSV to other imaging findings. Third, the relationship between psychological factors and PSV has not yet been investigated. Psychological factors are associated with chronic pain [39], and investigating how they are related to PSV is necessary. Fourth, the relationship between BMI and blood flow velocity was not assessed because the control and PHP groups were matched for age and BMI. It has been reported that a high BMI is a risk factor for PHP [41]. Understanding the differences in blood flow velocity and pathology in people with a high BMI in PHP may help in understanding the development of PHP in the future. Fifth, the blood flow velocity in the large arteries was not measured. It is possible that this increase in PSV was caused by an increase in the blood flow velocity in the large arteries. However, since there was no correlation between the NRS and PSV in the PHP group (Table 2), we considered the possibility that a redistribution of blood flow due to tissue repair may have occurred.

6. Conclusions

In the present study, the PSV of PTA was measured in patients with PHP. The PSV value of the affected side was significantly higher in patients with PHP compared with that of healthy controls. The unilateral cutoff value was 38.2 cm/s. A significant moderate positive correlation was observed between the change in PSV and the change in the NRS score. Future studies are needed to examine changes in PSV over time with long-term interventions.

Author Contributions

F.K. contributed to the study design and data collection, and drafted the manuscript; S.K. (Sho Katayama) made critical revisions to the manuscript; S.K. (Shintarou Kudo) supervised the study, contributed to the analysis and interpretation of data, and made critical revisions to the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by research funds obtained through crowdfunding.

Institutional Review Board Statement

This study was approved by the Morinomiya University of Health Sciences Ethics Review Committee (approval number 2021-095. Approval date: 19 November 2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets relevant to the present study are available on request to the corresponding author.

Acknowledgments

The authors thank the patients and the clinic staff for their cooperation.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Hansen, L.; Krogh, T.P.; Ellingsen, T.; Bolvig, L.; Fredberg, U. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients with Ultrasound Examination. Orthop. J. Sports Med. 2018, 6, 2325967118757983. [Google Scholar] [CrossRef] [PubMed]
  2. Petraglia, F.; Ramazzina, I.; Costantino, C. Plantar Fasciitis in Athletes: Diagnostic and Treatment Strategies. A Systematic Review. Muscles Ligaments Tendons J. 2017, 7, 107–118. [Google Scholar] [CrossRef]
  3. Koc, T.A.; Bise, C.G.; Neville, C.; Carreira, D.; Martin, R.L.; McDonough, C.M. Heel PainPlantar Fasciitis: Revision 2023. J. Orthop. Sports Phys. Ther. 2023, 53, CPG1–CPG39. [Google Scholar] [CrossRef]
  4. Pringels, L.; Cook, J.L.; Witvrouw, E.; Burssens, A.; Vanden Bossche, L.; Wezenbeek, E. Exploring the Role of Intratendinous Pressure in the Pathogenesis of Tendon Pathology: A Narrative Review and Conceptual Framework. Br. J. Sports Med. 2022, 57, 1042–1048. [Google Scholar] [CrossRef]
  5. van Leeuwen, K.D.B.; Rogers, J.; Winzenberg, T.; van Middelkoop, M. Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: Systematic review and meta-analysis of various clinical and imaging risk factors. Br. J. Sports Med. 2016, 50, 972–981. [Google Scholar] [CrossRef]
  6. McMillan, A.M.; Landorf, K.B.; Gilheany, M.F.; Bird, A.R.; Morrow, A.D.; Menz, H.B. Ultrasound guided corticosteroid injection for plantar fasciitis: Randomised controlled trial. BMJ 2012, 344, e3260. [Google Scholar] [CrossRef] [PubMed]
  7. Espahbodi, S.; Doré, C.J.; Humphries, K.N.; Hughes, S.P.F. Color Doppler ultrasonography of lumbar artery blood flow in patients with low back pain. Spine 2013, 38, E230–E236. [Google Scholar] [CrossRef]
  8. Terabayashi, N.; Watanabe, T.; Matsumoto, K.; Takigami, I.; Ito, Y.; Fukuta, M.; Akiyama, H.; Shimizu, K. Increased blood flow in the anterior humeral circumflex artery correlates with night pain in patients with rotator cuff tear. J. Orthop. Sci. 2014, 19, 744–749. [Google Scholar] [CrossRef] [PubMed]
  9. Fukumoto, Y.; Miyashita, T.; Kitano, M.; Okuno, Y.; Kudo, S. Characteristics of the descending genicular artery blood flow velocity in patients with knee osteoarthritis. Knee 2021, 33, 143–149. [Google Scholar] [CrossRef]
  10. Mohseni-Bandpei, M.A.; Nakhaee, M.; Mousavi, M.E.; Shakourirad, A.; Safari, M.R.; Vahab Kashani, R. Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: A systematic review. Ultrasound Med. Biol. 2014, 40, 1737–1754. [Google Scholar] [CrossRef]
  11. Khammas, A.S.A.; Mahmud, R.; Hassan, H.A.; Ibrahim, I.; Mohammed, S.S. An Assessment of Plantar Fascia with Ultrasound Findings in Patients with Plantar Fasciitis: A Systematic Review. J. Ultrasound 2023, 26, 13–38. [Google Scholar] [CrossRef]
  12. McMillan, A.M.; Landorf, K.B.; Gregg, J.M.; De Luca, J.; Cotchett, M.P.; Menz, H.B. Hyperemia in plantar fasciitis determined by power doppler ultrasound. J. Orthop. Sports Phys. Ther. 2013, 43, 875–880. [Google Scholar] [CrossRef] [PubMed]
  13. Landis, J.R.; Koch, G.G. The measurement of observer agreement for categorical data. Biometrics 1977, 33, 159–174. [Google Scholar] [CrossRef]
  14. Siriphorn, A.; Eksakulkla, S. Calf Stretching and Plantar Fascia-Specific Stretching for Plantar Fasciitis: A Systematic Review and Meta-Analysis. J. Bodyw. Mov. Ther. 2020, 24, 222–232. [Google Scholar] [CrossRef]
  15. Cheung, R.T.H.; Sze, L.K.Y.; Mok, N.W.; Ng, G.Y.F. Intrinsic Foot Muscle Volume in Experienced Runners with and without Chronic Plantar Fasciitis. J. Sci. Med. Sport. 2016, 19, 713–715. [Google Scholar] [CrossRef]
  16. Huffer, D.; Hing, W.; Newton, R.; Clair, M. Strength Training for Plantar Fasciitis and the Intrinsic Foot Musculature: A Systematic Review. Phys. Ther. Sport 2017, 24, 44–52. [Google Scholar] [CrossRef] [PubMed]
  17. Rathleff, M.S.; Thorborg, K. “Load Me up, Scotty”: Mechanotherapy for Plantar Fasciopathy (Formerly Known as Plantar Fasciitis). Br. J. Sports Med. 2015, 49, 638–639. [Google Scholar] [CrossRef]
  18. Rathleff, M.S.; Mølgaard, C.M.; Fredberg, U.; Kaalund, S.; Andersen, K.B.; Jensen, T.T.; Aaskov, S.; Olesen, J.L. High-Load Strength Training Improves Outcome in Patients with Plantar Fasciitis: A Randomized Controlled Trial with 12-Month Follow-Up. Scand. J. Med. Sci. Sports 2015, 25, e292–e300. [Google Scholar] [CrossRef]
  19. García-Gomariz, C.; Hernández-Guillén, D.; Nieto-Gil, P.; Blasco-García, C.; Alcahuz-Griñán, M.; Blasco, J.-M. Effects of Kinesiotape versus Low-Dye Tape on Pain and Comfort Measures in Patients with Plantar Fasciitis: A Randomized Clinical Trial. Life 2024, 14, 249. [Google Scholar] [CrossRef]
  20. Bahar-Ozdemir, Y.; Atan, T. Effects of Adjuvant Low-Dye Kinesio Taping, Adjuvant Sham Taping, or Extracorporeal Shockwave Therapy Alone in Plantar Fasciitis: A Randomised Double-Blind Controlled Trial. Int. J. Clin. Pract. 2021, 75, e13993. [Google Scholar] [CrossRef]
  21. Alhakami, A.M.; Babkair, R.A.; Sahely, A.; Nuhmani, S. Effectiveness of Therapeutic Ultrasound on Reducing Pain Intensity and Functional Disability in Patients with Plantar Fasciitis: A Systematic Review of Randomised Controlled Trials. PeerJ 2024, 12, e17147. [Google Scholar] [CrossRef] [PubMed]
  22. Melese, H.; Alamer, A.; Getie, K.; Nigussie, F.; Ayhualem, S. Extracorporeal Shock Wave Therapy on Pain and Foot Functions in Subjects with Chronic Plantar Fasciitis: Systematic Review of Randomized Controlled Trials. Disabil. Rehabil. 2021, 44, 5007–5014. [Google Scholar] [CrossRef] [PubMed]
  23. Bildik, C.; Kaya, O. Platelet-Rich Plasma vs. Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial. Foot Ankle Int. 2022, 43, 1211–1218. [Google Scholar] [CrossRef] [PubMed]
  24. Kang, H. Sample Size Determination and Power Analysis Using the G*Power Software. J. Educ. Eval. Health Prof. 2021, 18, 17. [Google Scholar] [CrossRef]
  25. Aggarwal, P.; Jirankali, V.; Garg, S.K. Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis. Pol. J. Radiol. 2020, 85, e375–e380. [Google Scholar] [CrossRef] [PubMed]
  26. Drake, C.; Whittaker, G.A.; Kaminski, M.R.; Chen, J.; Keenan, A.-M.; Rathleff, M.S.; Robinson, P.; Landorf, K.B. Medical imaging for plantar heel pain: A systematic review and meta-analysis. J. Foot Ankle Res. 2022, 15, 4. [Google Scholar] [CrossRef] [PubMed]
  27. Walther, M.; Radke, S.; Kirschner, S.; Ettl, V.; Gohlke, F. Power Doppler findings in plantar fasciitis. Ultrasound Med. Biol. 2004, 30, 435–440. [Google Scholar] [CrossRef] [PubMed]
  28. Okuno, Y.; Korchi, A.M.; Shinjo, T.; Kato, S.; Kaneko, T. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J. Vasc. Interv. Radiol. 2017, 28, 995–1002. [Google Scholar] [CrossRef] [PubMed]
  29. Shibuya, M.; Sugihara, E.; Miyazaki, K.; Fujiwara, K.; Sakugawa, T.; Okuno, Y. Intra-arterial infusion of temporary embolic material in a patient with plantar fasciitis: A case report. Cardiovasc. Interv. Radiol. 2021, 44, 1823–1826. [Google Scholar] [CrossRef]
  30. Cook, J.L.; Purdam, C. Is Compressive Load a Factor in the Development of Tendinopathy? Br. J. Sports Med. 2012, 46, 163–168. [Google Scholar] [CrossRef]
  31. Merkel, M.F.R.; Svensson, R.B.; Jakobsen, J.R.; Mackey, A.L.; Schjerling, P.; Herzog, R.B.; Magnusson, S.P.; Konradsen, L.; Krogsgaard, M.R.; Kjær, M.; et al. Widespread Vascularization and Correlation of Glycosaminoglycan Accumulation to Tendon Pain in Human Plantar Fascia Tendinopathy. Am. J. Sports Med. 2024, 3635465241246262. [Google Scholar] [CrossRef] [PubMed]
  32. Järvinen, T.A. Neovascularisation in Tendinopathy: From Eradication to Stabilisation? Br. J. Sports Med. 2020, 54, 1–2. [Google Scholar] [CrossRef] [PubMed]
  33. Alfredson, H.; Bjur, D.; Thorsen, K.; Lorentzon, R.; Sandström, P. High Intratendinous Lactate Levels in Painful Chronic Achilles Tendinosis. An Investigation Using Microdialysis Technique. J. Orthop. Res. 2002, 20, 934–938. [Google Scholar] [CrossRef] [PubMed]
  34. Broholm, R.; Pingel, J.; Simonsen, L.; Bülow, J.; Johannsen, F. Applicability of Contrast-Enhanced Ultrasound in the Diagnosis of Plantar Fasciitis. Scand. J. Med. Sci. Sports 2017, 27, 2048–2058. [Google Scholar] [CrossRef] [PubMed]
  35. Pomarensky, M.; Macedo, L.; Carlesso, L.C. Management of Chronic Musculoskeletal Pain through a Biopsychosocial Lens. J. Athl. Train. 2022, 57, 312–318. [Google Scholar] [CrossRef] [PubMed]
  36. Drake, C.; Mallows, A.; Littlewood, C. Psychosocial Variables and Presence, Severity and Prognosis of Plantar Heel Pain: A Systematic Review of Cross-Sectional and Prognostic Associations. Musculoskelet. Care 2018, 16, 329–338. [Google Scholar] [CrossRef] [PubMed]
  37. Cotchett, M.P.; Whittaker, G.; Erbas, B. Psychological Variables Associated with Foot Function and Foot Pain in Patients with Plantar Heel Pain. Clin. Rheumatol. 2015, 34, 957–964. [Google Scholar] [CrossRef] [PubMed]
  38. Jayaseelan, D.J.; Fernandez-de-las-Penas, C.; Blattenberger, T.; Bonneau, D. Altered central pain processing in patients with chronic plantar heel pain: A critically appraised topic. J. Sports Rehabil. 2021, 30, 812–817. [Google Scholar] [CrossRef] [PubMed]
  39. Cotchett, M.; Frescos, N.; Whittaker, G.A.; Bonanno, D.R. Psychological Factors Associated with Foot and Ankle Pain: A Mixed Methods Systematic Review. J. Foot Ankle Res. 2022, 15, 10. [Google Scholar] [CrossRef]
  40. Sconfienza, L.M.; Silvestri, E.; Orlandi, D.; Fabbro, E.; Ferrero, G.; Martini, C.; Sardanelli, F.; Cimmino, M.A. Real-time sonoelastography of the plantar fascia: Comparison between patients with plantar fasciitis and healthy control subjects. Radiology 2013, 267, 195–200. [Google Scholar] [CrossRef]
  41. Taş, S.; Bek, N.; Ruhi Onur, M.; Korkusuz, F. Effects of Body Mass Index on Mechanical Properties of the Plantar Fascia and Heel Pad in Asymptomatic Participants. Foot Ankle Int. 2017, 38, 779–784. [Google Scholar] [CrossRef] [PubMed]
Jcm 13 03153 g001
Figure 1. Peak systolic velocity measurement of the posterior tibial artery. Ultrasound images. Pulse Doppler sonograms of the posterior tibial artery confirmed that the blood flow had a three-phase waveform. The slant angle is adjusted manually.
Figure 1. Peak systolic velocity measurement of the posterior tibial artery. Ultrasound images. Pulse Doppler sonograms of the posterior tibial artery confirmed that the blood flow had a three-phase waveform. The slant angle is adjusted manually.
Jcm 13 03153 g001
Jcm 13 03153 g002
Figure 2. Comparison of PSV between groups and differences between the left and right sides.
Figure 2. Comparison of PSV between groups and differences between the left and right sides.
Jcm 13 03153 g002
Table 1. Characteristics of the participants in each group.
Table 1. Characteristics of the participants in each group.
PHP GroupControl Groupp-Value
Number2323
Age (years)58.0 ± 16.551.3 ± 17.30.12
SexMale13 (28.3%)10 (21.7%)0.37
Female10 (21.7%)13 (28.3%)
Height (m)1.6 ± 0.11.6 ± 0.10.75
Weight (kg)59.9 ± 11.559.1 ± 11.30.84
BMI (kg/m2)22.7 ± 3.322.2 ± 3.00.87
Blood pressure (mmHg)128.2 ± 12.4121.2 ± 24.60.23
FAAM ADL score79.9 ± 16.597.5 ± 5.3<0.001
FAAM Sports score61.6 ± 27.291.8 ± 14.4<0.001
Data other than Number are presented as mean ± standard deviation. ADL, activities of daily living; BMI, body mass index; FAAM, Foot and Ankle Ability Measure questionnaire; PHP, plantar heel pain.
Table 2. Correlation between the peak systolic velocity of the posterior tibial artery and other factors in plantar heel pain.
Table 2. Correlation between the peak systolic velocity of the posterior tibial artery and other factors in plantar heel pain.
FactorRp-Value
NRS score0.120.58
FAAM ADL score0.210.35
FAAM Sports score0.100.67
Blood pressure0.160.43
ADL, activities of daily living; FAAM, Foot and Ankle Ability Measure questionnaire; NRS, Numerical Rating Scale.
Table 3. The numerical values and the amount of change in scores before and after the 1-month follow-up in the PHP group (n = 18).
Table 3. The numerical values and the amount of change in scores before and after the 1-month follow-up in the PHP group (n = 18).
FactorBefore TreatmentAfter TreatmentAmount of Change
PSV (cm/s)45.0 ± 13.439.3 ± 9.1−5.8 ± 14.5
NRS score6.5 ± 2.03.6 ± 2.1−2.9 ± 2.8
FAAM ADL score80.6 ± 17.090.0 ± 10.99.4 ± 14.1
FAAM Sports score63.4 ± 25.479.7 ± 19.116.3 ± 21.9
Data are presented as mean ± standard deviation. ADL, activities of daily living; FAAM, Foot and Ankle Ability Measure questionnaire; NRS, Numerical Rating Scale; PHP, plantar heel pain; PSV, peak systolic velocity.
Table 4. The correlation between the change in peak systolic velocity and the change in each factor in the PHP group after 1 month of treatment (n = 18).
Table 4. The correlation between the change in peak systolic velocity and the change in each factor in the PHP group after 1 month of treatment (n = 18).
FactorRp Value
NRS score0.47<0.05
FAAM ADL score−0.240.31
FAAM Sports score0.020.92
ADL, activities of daily living; FAAM, Foot and Ankle Ability Measure questionnaire; NRS, numeric rating scale; PHP, plantar heel pain.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Kaneko, F.; Katayama, S.; Kudo, S. Posterior Tibial Artery Blood Flow Velocity Is Increased in Patients with Plantar Heel Pain. J. Clin. Med. 2024, 13, 3153. https://doi.org/10.3390/jcm13113153

AMA Style

Kaneko F, Katayama S, Kudo S. Posterior Tibial Artery Blood Flow Velocity Is Increased in Patients with Plantar Heel Pain. Journal of Clinical Medicine. 2024; 13(11):3153. https://doi.org/10.3390/jcm13113153

Chicago/Turabian Style

Kaneko, Fumiya, Sho Katayama, and Shintarou Kudo. 2024. "Posterior Tibial Artery Blood Flow Velocity Is Increased in Patients with Plantar Heel Pain" Journal of Clinical Medicine 13, no. 11: 3153. https://doi.org/10.3390/jcm13113153

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop