***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Technological change in general orthopaedics and its multiple subspecialisations is continual . These changes are regulated , to varying degrees , by delegated authorities within appropriately m and ated concepts . One relatively recent technology , since approximately 1990 , has been the revision of treating relatively deep seated urolithiasis , whether in the renal parenchyma or the ureter , to more superficial musculoskeletal indications . Although originally conceived to dissipate calcifications in rotator cuff tendinopathy and to alter osseous biology , the technology rapidly spread to other common disorders that affect the musculoskeletal system . Unfortunately many of these applications were not tested through appropriate r and omised clinical trials or practical clinical trials , which could adequately assess clinical efficacy and significant modification of the natural history of a given musculoskeletal disorder . Such studies are obviously in dem and by clinicians and healthcare provider organisations to justify the application of both a given treatment modality and the efficiency of a new drug or device to accomplish an end result that is personally satisfactory to the patient and doctor and economically justifiable to the healthcare insurer/provider . Background Plantar heel pain is one of the most common musculoskeletal disorders of the foot and ankle . Treatment of the condition is usually conservative , however the effectiveness of many treatments frequently used in clinical practice , including stretching , has not been established . We performed a participant-blinded r and omised trial to assess the effectiveness of calf muscle stretching , a commonly used short-term treatment for plantar heel pain . Methods Ninety-two participants with plantar heel pain were recruited from the general public between April and June 2005 . Participants were r and omly allocated to an intervention group that were prescribed calf muscle stretches and sham ultrasound ( n = 46 ) or a control group who received sham ultrasound alone ( n = 46 ) . The intervention period was two weeks . No participants were lost to follow-up . Primary outcome measures were ' first-step ' pain ( measured on a 100 mm Visual Analogue Scale ) and the Foot Health Status Question naire domains of foot pain , foot function and general foot health . Results Both treatment groups improved over the two week period of follow-up but there were no statistically significant differences in improvement between groups for any of the measured outcomes . For example , the mean improvement for ' first-step ' pain ( 0–100 mm ) was -19.8 mm in the stretching group and -13.2 mm in the control group ( adjusted mean difference between groups -7.9 mm ; 95 % CI -18.3 to 2.6 ) . For foot function ( 0–100 scale ) , the stretching group improved 16.2 points and the control group improved 8.3 points ( adjusted mean difference between groups 7.3 ; 95 % CI -0.1 to 14.8 ) . Ten participants in the stretching group experienced an adverse event , however most events were mild to moderate and short-lived . Conclusion When used for the short-term treatment of plantar heel pain , a two-week stretching program provides no statistically significant benefit in ' first-step ' pain , foot pain , foot function or general foot health compared to not stretching Plantar fasciitis is one of the most common causes of foot pain in adults . In this prospect i ve study , the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared . Patients were r and omly assigned to either the tenoxicam or corticosteroid group . The tenoxicam group ( n=31 ) was treated using a local injection of 1 mL of tenoxicam ( 20 mg/2 mL ) and 1 mL of 2 % lidocaine , whereas the steroid  group ( n=30 ) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2 % lidocaine . Clinical evaluations , which were performed before the injection and 6 and 12 months after the injection , consisted of patient-assessed pain using a visual analog scale . In addition , patient satisfaction was measured using the Roles and Maudsley score . Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups ( P<.05 ) . Furthermore , no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection ( P>.05 ) . The tenoxicam injection was not significantly more effective than the corticosteroid injection . However , both methods were effective and successful in treating patients with plantar fasciitis .  Tenoxicam therapy appears to provide pain relief , but its effectiveness in the long term should be explored in additional studies Background Plantar heel pain is a commonly occurring foot complaint . Stretching is frequently utilised as a treatment , yet a systematic review focusing only on its effectiveness has not been published . This review aim ed to assess the effectiveness of stretching on pain and function in people with plantar heel pain . Methods Medline , EMBASE , CINAHL , AMED , and The Cochrane Library were search ed from inception to July 2010 . Studies fulfilling the inclusion criteria were independently assessed , and their quality evaluated using the modified PEDro scale . Results Six studies including 365 symptomatic participants were included . Two compared stretching with a control , one study compared stretching to an alternative intervention , one study compared stretching to both alternative and control interventions , and two compared different stretching techniques and duration s. Quality rating on the modified Pedro scale varied from two to eight out of a maximum of ten points . The method ologies and interventions varied significantly between studies , making meta- analysis inappropriate . Most participants improved over the course of the studies , but when stretching was compared to alternative or control interventions , the changes only reached statistical significance in one study that used a combination of calf muscle stretches and plantar fascia stretches in their stretching programme . Another study comparing different stretching techniques , showed a statistically significant reduction in some aspects of pain in favour of plantar fascia stretching over calf stretches in the short term . Conclusions There were too few studies to assess whether stretching is effective compared to control or other interventions , for either pain or function . However , there is some evidence that plantar fascia stretching may be more effective than Achilles tendon stretching alone in the short-term . Appropriately powered r and omised controlled trials , utilizing vali date d outcome measures , blinded assessors and long-term follow up are needed to assess the efficacy of stretching Plantar fasciitis is a common cause of heel pain . It is a disabling disease in its chronic form . It is a degenerative tissue condition of the plantar fascia rather than an inflammation . Various treatment options are available , including nonsteroidal anti-inflammatory drugs , corticosteroid injections , orthosis , and physiotherapy . This study compared the effects of local platelet-rich plasma , corticosteroid , and placebo injections in the treatment of chronic plantar fasciitis . In this double-blind study , patients were divided r and omly into 3 groups .  Local injections of platelet-rich plasma , corticosteroid , or normal saline were given . Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle and Hindfoot score before injection , at 3 weeks , and at 3-month follow-up . Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up , respectively . Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up , respectively . There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up . There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study . The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis . Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis Dear Editor-in-ChiefThe treatment of Plantar Fasciitis ( PF ) is primarily conservative , initially with rest and icing to give pain relief . In about 10 % of the cases who do not respond to such treatments , surgical intervention is suggested . An alternative to the surgical treatment of PF is Extracorporeal Shockwave Therapy - ESWT ( 1 , 2 ) . The aim of the study was to compare analgesic effects of ESWT and P-ESWT in males with chronic PF.Thirty patients were included in the study from September 2012 to October 2014 . The study was conducted in Military Hospital in Busko-Zdroj . Exclusion criteria were local soft-tissue infection , skin ulcerations , malignant disease , pacemaker , epileptic disorders , local arthritis , rheumatoid arthritis , ankylosing spondylitis , and Reiter syndrome , previous operation on the heel , patients who had received local corticosteroid injection within 12 weeks , age under 18 years . Patients were r and omized into the ESWT or PESWT group . R and omization was done before the first treatment by means of a computer-generated r and omization list ( MedCalc 11.4.3.0 , Kielce ) . In the ESWT group , patients received either 1000 or 2000 shock waves per treatment of energy levels varying between 0.02 mJ/mm2 and 0.33 mJ/mm2 , pulse frequency gradually increased to 240 per minute . In the P-ESWT , treatment consisted of 100 shock waves per treatment , energy level of 0.02 mJ/mm2 , frequency 60 per minute . Both groups took a series of 5 ESWT . Apparatus used for the treatment was BTL-5000 SWT . The procedure was performed in the area of most intense pain - calcaneal tubercle . The basic method of research was to evaluate pain after normal daily activity according to VAS . The patients of the two groups were tested pretreatment , and 12 months post treatment . In various combinations , the value of the function t was observed . The statistical significant of differences in the intensity of pain assessed was noticed ( PCalculations were performed at the Department of Computer Science at Holy Cross College in Kielce with the use of MedCalc software - version 11.4.3.0 . The research project was authorized by the Bioethics Committee at Holy Cross College in Kielce - resolutions of 1/10/KB on 20.06.2012.In the ESWT group and P-ESWT group , a significant decrease of VAS was seen 12 months post treatment after normal daily activity ( Table 1 ) . The analgesic efficacy of ESWT was confirmed by the analysis of differences in the frequency of occurrence of pain intensity between groups 12 months post treatment ( Table 2).Metzner et al. ( 3 ) used  ESWT in patients with chronic PF.Each patient received 1000 impulses of shock wave ; the density of energy stream was 0.35 mJ/mm2 . It turned out that pain was reduced in 81 % of patients after 6 weeks , in 88 % of patients - after 16 months , and in 96 % of patients - after 72 months post ESWT . Objective : To investigate the effectiveness of a physiotherapy-based exercise program versus dexamethasone injection for chronic plantar fasciopathy in workers st and ing for prolonged periods of time . Design : A parallel group nonblinded r and omized controlled trial with 12-week follow-up . Setting : An outpatient sports medicine clinic in Vancouver , British Columbia , Canada . Participants : Fifty-six workers required to st and for greater than 5 h/d with chronic plantar fasciopathy took part . Diagnosis from a physiotherapist must include signs of structural changes to the plantar fascia seen on ultrasound . Interventions : The PHYSIO group included 7 physiotherapy-led exercises performed daily over a 12-week period . The INJECTION group received 1 palpation-guided dexamethasone injection followed by a daily routine of calf stretching . Main Outcome Measures : The Foot and Ankle Disability Index ( FADI ) scores 12-weeks postintervention and ultrasound-based measures of ligament appearance . Results : At follow-up , both groups reported significant improvements in FADI and visual analog scales for pain at work and with activities of daily living at 6 and 12 weeks compared with baseline scores ( P < 0.001 ) . There were no significant between-group differences . There were no significant changes to plantar fascia thickness reported at the 6- and 12-week follow-up point . Both the number of cases with focal anechoic areas and the size of these anechoic areas improved significantly in the PHYSIO ( P = 0.003 ) and INJECTION ( P < 0.001 ) groups at 12-week follow-up . Conclusions : Workers st and ing for prolonged periods experienced the same short-term therapeutic effectiveness with a physiotherapy-led exercise program compared with an injection of corticosteroid with stretching OBJECTIVE To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis . METHODS The prospect i ve study was conducted at Department of Orhopaedic , Regional Hospital , Limerick , Irel and from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs , heel cup , orthoses and /or shoe modifications , local steroid injections had failed , and they were treated with low energy extracorporeal shock wave therapy . Patients were review ed at 6 , 12 and 24 weeks post treatment . RES 
    Output:
    
There was no evidence of inconsistency detected between direct and indirect treatment comparisons in the networks , but sparse data led to frequently wide CIs .
Available evidence does not suggest that any of the commonly used treatments for the management of PHP are better than any other , although corticosteroid injections , alone or in combination with exercise , and ESWT were ranked most likely to be effective for the management of short-term , medium-term and long-term pain or function ;  placebo/sham/control appeared least likely to be effective ; and exercise appeared to only be beneficial for long-term pain or function .
Conclusions Current evidence is equivocal regarding which treatment is the most effective for the management of PHP .