Plantar fasciitis is characterized by a sharp pain in the medial surface of the longitudinal arch and the heel bone [1], which worsens in the morning or during the first few steps. As the gait progresses, the plantar fascia stretches and metabolites are dispersed and decrease in concentration [2]. Although the etiology of plantar fasciitis is unclear, it is thought to involve changes in the thickness of the plantar fascia. This is because of repetitive and excessive stretching load on the plantar fascia that cause inflammatory changes, resulting in the destruction of collagen fibers, abnormal fibroblasts, and blood vessels. Other diagnoses that need to be distinguished from plantar fasciitis include acute injured plantar fasciitis, calcaneal fatigue fracture, and subcutaneous fat layer atrophy or bruise [3].

Conservative treatment is performed within 6 weeks of onset of symptoms, and rapid recovery may be possible. However, if the condition/disease becomes chronic, it is difficult to predict the therapeutic outcome [4]. Widely used extracorporeal shock wave therapy (ESWT) or stretching exercises for the plantar fascia can be performed, before proceeding with administration of anti-inflammatory agents. When conservative treatment fails, surgery is an option [5].

X-ray imaging is a technique for diagnosing plantar fasciitis, but must be used in conjunction with other methods because X-ray images may sometimes indicate plantar fasciitis in people without plantar fasciitis [6]. Ultrasound can be used to treat and diagnose plantar fasciitis. If the plantar is greater than about 3.5 to 4 mm thick at the calcaneal attachment on the long-axis image of the ultrasound, it can be diagnosed as plantar fasciitis. The sensitivity and specificity were reported to be 88.5% compared with 80% via magnetic resonance imaging. Plantar fasciitis causes thickening in a fusiform shape at the calcaneal attachment, exhibiting overall hyporeflexia [7,8]. Some studies showed a significant difference in plantar hypertrophy on ultrasound [9,10] and other studies compared the thickness of before and after treatment [11,12].

There have been many studies in Korean medicine treatment which depended on patient statements such as the visual analogue scale, numeric rating scale (NRS), and patellofemoral pain syndrome as evaluation [13] but no studies of using radiology as diagnosis. In addition, there has been no case of evaluating the treatment of plantar fasciitis using Korean-Western cooperative medicine in Korea.

There were 50 patients whose data was retrospectively analyzed. The average age of the patients was 58.9 (± 10.69) years (Table 2). The most common treatment period was 13 to 16 weeks. The average number of PDRN injections was 8.04 (± 2.85) and the average number of ESWT treatment was 3.48 (± 1.89; Table 3). The mean plantar fascia thickness before treatment was measured as 4.87 mm (± 1.08), and after treatment it was 4.11 mm (± 0.94). The mean NRS score before treatment was 5.84 (± 0.93) and after treatment it was 3.74 (± 1.40). Before treatment, the average plantar fascia thickness of males was 4.99 mm (± 0.92) and of females was 4.72 mm (± 0.87). After treatment, the average plantar fascia thickness for males was 4.31 mm (± 0.87) and for females it was 3.86 mm (± 0.92). Before treatment, the average NRS score of males was 5.89 (± 0.89) and of females was 5.78 (± 1.00). After treatment, the average NRS score of males was 3.96 (± 1.63) and for the females it was 3.48 (± 1.04). There was no significant correlation between ultrasound thickness and NRS score before treatment (|r| = 0.266), and after treatment (|r| = 0.239; Table 4.).

Korean-Western cooperative medicine treatment improved the level of pain and showed improvement in ultrasound imaging in both male and female patients diagnosed with plantar fasciitis. Gol-gwan and Mok-gwan are Dong-si of the acupuncture point and the EX-LE10 is empirically used for muscle pain and is effective for plantar fasciitis. KI2, KI3, KI4, KI5, KI5, BL60 are acupoints commonly used for foot pain. The acupuncture treatment may take effect by directly entering the cells through a certain route of the meridian system, local tissues, blood and lymph, and affecting the activities of tissues and organs [14]. Pharmacopuncture [15,16] and herbal medicine [17] is effective for plantar fasciitis (classified as a degenerative condition/disease). Injection with PDRN [18] and ESWT [19] is effective for plantar fasciitis. However, ESWT sometimes does not improve symptoms long-term [20]. This study is meaningful because it is the first study published in Korea, evaluating Korean-Western cooperative treatment for plantar fasciitis. In addition, the treatment efficacy was evaluated for 50 patients and significance was observed. As an evaluation index, ultrasound diagnosis and the NRS are objective. However, this study has limitations. This was a retrospective study of only outpatients who had received more than 7 weeks of treatment, ultrasound was used rather than magnetic resonance imaging which offers superior accuracy and sensitivity, and the difference in NRS values compared with previous studies, is considered to be due to large individual differences.