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The hallmarks of necrotizing fasciitis are friable superficial fascia, gray exudate without pus, and widespread tissue destruction. The infection is either polymicrobial or monomicrobial. Early surgical débridement and appropriate antibiotics are crucial for recovery.

Objective To investigate the effectiveness of ultrasound guided corticosteroid injection in the treatment of plantar fasciitis.Design Randomised, investigator and participant blinded, placebo controlled trial.Setting University clinic in Melbourne, Australia.Participants 82 people with a clinical and ultrasound diagnosis of plantar fasciitis unrelated to systemic inflammatory disease.Interventions Participants were randomly allocated to ultrasound guided injection of the plantar fascia with either 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group) or 1 mL normal saline (placebo). Before injection the participants were given an ultrasound guided posterior tibial nerve block with 2% lidocaine (lignocaine).Main outcome measures Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasound at 4, 8, and 12 weeks.Results Reduction in pain at four weeks favoured the dexamethasone group by 10.9 points (95% confidence interval 1.4 to 20.4, P=0.03). Between group differences for pain scores at eight and 12 weeks were not statistically significant. Plantar fascia thickness measured at four weeks favoured the dexamethasone group by −0.35 mm (95% confidence interval −0.67 to −0.03, P=0.03). At eight and 12 weeks, between group differences for plantar fascia thickness also favoured dexamethasone, at −0.39 mm (−0.73 to −0.05, P=0.02) and −0.43 mm (−0.85 to −0.01, P=0.04), respectively. The number needed to treat with dexamethasone for one successful outcome for pain at four weeks was 2.93 (95% confidence interval 2.76 to 3.12). There were no reported adverse events associated with the intervention.Conclusion A single ultrasound guided dexamethasone injection is a safe and effective short term treatment for plantar fasciitis. It provides greater pain relief than placebo at four weeks and reduces abnormal swelling of the plantar fascia for up to three months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond four weeks.Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000239066.

Background Current management strategies for plantar fasciitis primarily involve conservative treatments. However, the overall effectiveness of extracorporeal shock wave therapy (ESWT) as a specific intervention for this condition has been a subject of ongoing debate in the medical community and its long term efficacy remains controversial. This study’s objective is to assess the effectiveness of extracorporeal radial shock wave therapy (rESWT) for treating plantar fasciitis treatment compared to physiotherapy combined with ultrasound sessions and to screen for foot disorders implementing baropodometry, in a Tunisian tertiary care rehabilitation department. Methods Patients who presented to the rehabilitation department between November 2022 and November 2023 with Plantar Fasciitis were randomly assigned to the rESWT and the Physiotherapy combined to ultrasound groups. The diagnosis of PF was confirmed by physical examination. X-ray radiography was used to exclude a fracture of the calcaneus. Results Our study included 129 patients diagnosed with plantar fasciitis (PF), who were randomly allocated into two groups: 66 participants received radial extracorporeal shockwave therapy (rESWT), and 63 received physiotherapy combined with ultrasound therapy. The average age of these patients was 50.33 years (SD 10). The majority of participants were female, accounting for 101 individuals (78%). The average Body Mass Index (BMI) across the study group was 29.2 kg/m2. Regarding lower limb conditions, pes cavus (high arches) was the most common, observed in 58 participants (45%), followed by pes planus (low arches) in 47 participants (36%).Both treatment groups showed a significant decrease in Visual Analogue Scale (VAS) scores across all follow-up periods (p<0.001). However, no significant difference was found in the mean VAS scores between the two groups at any point after treatment. Conclusion Both protocols (rESWT and physiotherapy combined to ultrasound) were effective for improving morning pain at short term and midterm follow-up periods. Foot disorders should be initially evaluated and considered while treating. Trial registration This trial is officially registered with the Pan African Clinical Trial Registry under the registration number PACTR202308802969500 first registered on (24/08/2023).

ObjectivesTo develop and validate a scoring system integrating MRI and laboratory findings to differentiate necrotizing fasciitis (NF) from non-necrotizing fasciitis (non-NF).MethodsThis retrospective study included 144 subjects who underwent surgery in one of three tertiary referral centers for NF or cellulitis with non-NF. The development cohort consisted of 96 subjects (NF = 47; non-NF = 49) from one center, and the validation cohort consisted of 48 subjects (NF = 23; cellulitis with non-NF = 25) from two different centers. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system and five MRI findings (thickening of the intermuscular deep fascia ≥ 3 mm, extensive involvement of the deep fascia, multi-compartmental involvement in one extremity, presence of gas, and contrast-enhancement pattern) were included in univariate and multivariate logistic regression analysis to identify independent predictors of NF. An additive scoring system was developed using the coefficients of the final regression model. Model performance was assessed for discrimination and calibration. The scoring system was externally validated.ResultThe final scoring system consisted of three variables: thickening of the deep fascia ≥ 3 mm, multi-compartmental involvement, and LRINEC score. The new predictive model showed improved performance (area under the receiver operating characteristic curve [AUC], 0.862; positive and negative predictive values, 82% and 79%, respectively), compared with the LRINEC score alone (0.814, 77% and 67%, respectively). The model also showed good discrimination with the external validation dataset (AUC, 0.933).ConclusionsDifferentiation of NF from severe cellulitis with non-NF can be achieved with the new predictive scoring system.Key Points• The new predictive scoring system integrating two MRI findings with the LRINEC score can help in the differentiation of necrotizing fasciitis from severe cellulitis with non-necrotizing fasciitis.• Thickening of the deep fascia ≥ 3 mm and multi-compartmental involvement were the most important MRI findings for the differentiation.

Purpose Plantar fasciitis is a frequent and painful condition with a lifetime incidence of 10%. Good results have been reported for operative treatment of plantar fasciitis refractory to non-surgical interventions in uncontrolled studies. The aim of this study was to compare the results of operative treatment (endoscopic debridement, removal of the heel spur and partial resection of the plantar fascia) with those of a controlled and supervised non-operative rehabilitation program. Methods Thirty consecutive patients with plantar fasciitis during more than 3 months were randomized to either (1) non-operative treatment with corticosteroid injections and a controlled strength training program or (2) an endoscopic 2-incision operation with partial fasciotomy and heel spur removal followed by the same strength training program. Patients were evaluated at entry and 3, 6, 12 and 24 months post-operatively with the foot function index (FFI) and pain score during activity on a 100 mm VAS scale (VAS activity). FFI at 6 and 12 months was defined a priori as primary endpoint. Results Both groups improved significantly over time. The FFI score was significantly better in the operated group compared to the non-surgically treated group 12 months post-operatively ( p  = 0.033), at 24 months this was, however, not significant ( p  = 0.06). VAS activity at 24 months was significantly ( p  = 0.001) in favor of the operative group. More patients returned to running and jumping in the operative group ( p  = 0.04). Conclusion This randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program. Level of evidence I.

Radial extracorporeal shock wave therapy (r-ESWT) is accepted as one of the most effective treatment modalities for plantar fasciitis (PF). Also kinesio taping (KT) applicationis effective for the treatment of PF. However, there is not enough evidence about the effectiveness of the combination of these two modalities in the treatment of PF. This prospective randomized clinical trial was planned to investigate the acute effects of KT application in addition to r-ESWT application on pain, foot function and flexibility. The study was performed on 42 patients with unilateral PF, that were randomly assigned into two groups receiving four sessions of either r-ESWT or r-ESWT+KT treatment once per week. All patients performed home exercises. Patients' pain levels were evaluated via the Visual Analogue Scale (VAS), and foot function via the Foot Function Index (FFI). Flexibility was evaluated through gastro-soleus and plantar fascia flexibility tests. The evaluations were done before and one week after the final treatment. Two Way Analysis of Variance with Repeated Measures and Generalized Estimating Equations (GEE) methods were used in statistical analyses. As a result, rest pain and activity pain decreased in both groups and there is no differences between the groups (respectively p: 0,831; p: 0.331). FFI pain and disability subscores decreased and were also similar between the groups (respectively p: 0.304; p: 0.978). FFI activity limitation subscore decreased in the r-ESWT group more than r-ESWT+KT group (p: 0.002). Night pain, gastro-soleus and plantar fascia flexibility did not change in both goups (respectively p: 0.713; p: 0.413; p: 0.475). Adding KT to r-ESWT application did not create an additional pain relieving effect, on the contrary, resulted in less improvement in activity limitation. This may be related to the fact that KT application to the sole and heel region creates a hard surface on the heel. r-ESWT application may be more beneficial in PF where activity limitation are prominent. The registration number: NCT06516393.

The customized insole is widely recommended as an effective intervention for pain reduction and foot function improvement in plantar fasciitis persons. However, it is unclear whether the additional correction of medial wedges could change the kinematics from the only insole. The objectives of this study were thus to compare customized insoles with and without medial wedges on lower extremity kinematics during gait and to determine the short-term effects of the customized insole with medial wedges on pain intensity, foot function, and ultrasonographic findings in plantar fasciitis persons. A within-subject, randomized, crossover design within motion analysis research laboratory was conducted among 35 persons with plantar fasciitis. Main outcome measures included joint motions of the lower extremity and multi-segment foot, pain intensity, foot function, and ultrasonographic findings. The customized insole with medial wedges produced less knee motion in the transverse plane and hallux motion in all planes during the propulsive phase than that without medial wedges (all p < 0.05). After the 3-month follow-up, the insoles with medial wedges decreased pain intensity and increased foot function. Abnormal ultrasonographic findings also decreased significantly after the 3-month treatment of insoles with medial wedges. Customized insoles with medial wedges seem superior to those without medial wedges on both multi-segment foot motion and knee motion during propulsion. Positive outcomes from this study supported the use of customized insoles with medial wedges as an effective conservative treatment in patients with plantar fasciitis. Trial registration : TCTR20210928006 (28/09/2021).

Background Foot orthoses are routinely used to treat plantar fasciopathy in clinical practice. However, minimal evidence exists as to the effect of both truly custom designed foot orthoses, as well as that of the shoe the foot orthoses are placed into. This study investigated the effect of wearing custom foot orthoses and new athletic footwear on first-step pain, average 24-h pain and plantar fascia thickness in people with unilateral plantar fasciopathy over 12 weeks. Methods A parallel, three-arm randomised controlled trial with blinding of participants and assessors. 60 participants diagnosed with unilateral plantar fasciopathy were randomised to either custom foot orthoses and new shoes (orthoses group), a sham insole with a new shoes (shoe group) or a sham insole placed in the participant’s regular shoes (control group). Primary outcome was first-step pain. Secondary outcomes were average 24-h pain and plantar fascia thickness measured on ultrasound. Outcomes were assessed at baseline, 4 week and 12 week trial time-points. Results At 4 weeks, the orthoses group reported less first-step pain ( p  = 0.002) compared to the control group. At 12 weeks, the orthoses group reported less first-step pain compared to both the shoe ( p  = < 0.001) and sham ( p  = 0.01) groups. Both the orthoses ( p  = < 0.001) and shoe ( p  = 0.006) groups reported less average 24-h pain compared to the control group at 4 and 12 weeks. The orthoses group demonstrated reduced plantar fascia thickness on ultrasound compared to both the shoe ( p  = 0.032) and control groups ( p  = 0.011). Conclusions Custom foot orthoses in new shoes improve first-step pain and reduce plantar fascia thickness over a period of 12 weeks compared to new shoes alone or a sham intervention. Trial registration Australian New Zealand Clinical Trials Registry ( ACTRN 12613000446763 ). Submitted on the 10th of April 2013 and registered on the 18th of April 2013.

Background Although nodular fasciimmon and can occur in various anatomical locations, its occurrence within a nerve is extremely rare. Nodular fasciitis usually resolves spontaneously after partial resection. However, it often presents diagnostic challenges due to its resemblance to malignant diseases, resulting in excessive treatments such as extended nerve excision and nerve transplantation. Case presentation We report two cases of intraneural nodular fasciitis. A 37-year-old woman presented with left upper limb numbness and pain, without trauma history. Preoperative ultrasound was performed. Subtotal resection of the mass in the superficial branch of the radial nerve was conducted. Postoperative pathology and immunohistochemistry confirmed intraneural nodular fasciitis. At 9-month follow-up, symptoms resolved with no recurrence of the mass. A 15-year-old female presented with progressive right lower limb numbness, later accompanied by pain, distal muscle weakness, and difficulty in lifting the foot. Preoperative ultrasound and magnetic resonance imaging were performed. The mass within the sciatic nerve was completely removed. Postoperative pathology and immunohistochemistry confirmed intraneural nodular fasciitis. At 3-month follow-up, symptoms resolved with no recurrence of the mass. Conclusions Accurate diagnosis of intraneural nodular fasciitis is crucial to prevent unnecessary treatment. Its ultrasound and magnetic resonance imaging features lack specificity. Preoperative biopsy using ultrasound or computed tomography guidance may be considered if necessary and safe. The histopathological features for intraneural nodular fasciitis exhibits spindle cells in a tissue-culture-like pattern within a richly myxoid matrix, abundant capillaries, inflammatory cell infiltration, frequent mitotic figures without atypia, and infiltrative margins. Immunohistochemically, intraneural nodular fasciitis is characterized by SMA(+) and S100(-). Surgical excision of the lesion is necessary to prevent neurological deficits. And the vast majority of intraneural nodular fasciitis cases spontaneously regress after subtotal resection. A comprehensive diagnostic approach is recommended when intraneural nodular fasciitis is suspected. This article analyzes the diagnostic workup and pathogenesis of all 13 reported intraneural nodular fasciitis cases (including our two), aiming to aid clinicians in achieving precise diagnosis and avoiding overtreatment.

Background Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy. Methods We conducted a protocol-based systematic review to identify specific features of necrotising fasciitis in children aged one month to 17 years. We searched ’PubMed’, ’Web of Science’ and ’SCOPUS’ for relevant literature. Primary outcomes were incidence and case fatality rates in population-based studies, and skin symptoms on presentation. We also assessed signs of systemic illness, causative organisms, predisposing factors, and reconstructive procedures as secondary outcomes. Results We included five studies reporting incidence and case fatality rates, two case-control studies, and 298 cases from 195 reports. Incidence rates varied between 0.022 and 0.843 per 100,000 children per year with a case-fatality rate ranging from 0% to 14.3%. The most frequent skin symptoms were erythema (58.7%; 175/298) and swelling (48%; 143/298), whereas all other symptoms occurred in less than 50% of cases. The majority of cases had fever (76.7%; 188/245), but other signs of systemic illness were present in less than half of the cohort. Group-A streptococci accounted for 44.8% (132/298) followed by Gram-negative rods in 29.8% (88/295), while polymicrobial infections occurred in 17.3% (51/295). Extremities were affected in 45.6% (136/298), of which 73.5% (100/136) occurred in the lower extremities. Skin grafts were necessary in 51.6% (84/162) of the pooled cases, while flaps were seldom used (10.5%; 17/162). The vast majority of included reports originate from developed countries. Conclusions Clinical suspicion remains the key to diagnose necrotising fasciitis. A combination of swelling, pain, erythema, and a systemic inflammatory response syndrome might indicate necrotising fasciitis. Incidence and case-fatality rates in children are much smaller than in adults, although there seems to be a relevant risk of morbidity indicated by the high percentage of skin grafts. Systematic multi-institutional research efforts are necessary to improve early diagnosis on necrotising fasciits.