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Simental-Mendía M, Simental-Mendía LE, Sánchez-García A, Sahebkar A, Jamialahmadi T, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo C. Effect of extracorporeal shockwave therapy on plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05464-6. [PMID: 39023569 DOI: 10.1007/s00402-024-05464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Extracorporeal shockwave therapy (ESWT) has been used as a therapeutic option for plantar fasciitis. The objective was to investigate the effect of ESWT over the plantar fascia thickness. METHODS MEDLINE, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials evaluating the effect of ESWT in patients with plantar fasciitis, comparing ESWT with another treatment. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Meta-regression and subgroup analyses were also carried out. RESULTS A total of 14 studies (867 participants) were included. ESWT significantly decreased plantar fascia thickness (weighted mean difference [WMD], -0.21 mm [95% CI -0.39, -0.02]; p = 0.03). No significant improvement in pain was observed (WMD, -0.51 cm [95% CI -1.04, 0.01]; p = 0.06) compared with non-surgical interventions. CONCLUSIONS Our results suggest that plantar fascia thickness is significantly decreased after ESWT intervention in patients with plantar fasciitis. However, pain relief was not significantly improved compared to other non-surgical interventions.
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Affiliation(s)
- Mario Simental-Mendía
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Luis E Simental-Mendía
- Biomedical Research Unit, Delegación Durango, Instituto Mexicano del Seguro Social, Durango, Mexico
| | - Adriana Sánchez-García
- Endocrinology Division, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tannaz Jamialahmadi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Félix Vilchez-Cavazos
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Víctor M Peña-Martínez
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Carlos Acosta-Olivo
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico.
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Zare Bidoki M, Vafaeei Nasab MR, Khatibi Aghda A. Comparison of High-intensity Laser Therapy with Extracorporeal Shock Wave Therapy in the Treatment of Patients with Plantar Fasciitis: A Double-blind Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:147-155. [PMID: 38584653 PMCID: PMC10997849 DOI: 10.30476/ijms.2023.98042.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 05/18/2023] [Indexed: 04/09/2024]
Abstract
Background The most common cause of heel pain is plantar fasciitis (PF). Although conservative treatments relieve pain in more than 90% of patients, it may remain painful in some cases. This study aimed to compare High-intensity Laser Therapy (HILT) with Extracorporeal Shock Wave Therapy (ESWT) in patients with PF. Methods In this double-blinded randomized clinical trial (conducted in Yazd, Iran, from May 2020 to March 2021), patients were classified into two groups, including the ESWT and HILT, using online randomization. Nine sessions, three times a week for 3 weeks, were the treatment period in both groups. Visual Analogue Score (VAS), Heel Tenderness Index (HTI), and the SF36 questionnaire were compared and analyzed statistically at the beginning and 9 months after treatment. Results 38 patients (19 in each group) completed the study. Results showed that pain and patient satisfaction improved significantly 3 months after treatment. The VAS and HTI decreased 3 months after treatment in both groups, which was statistically significant (P<0.001). The SF36 score in both groups increased 3 months after treatment, and this increase was statistically significant (P<0.001). Although the two modalities were effective based on VAS, HTI, and SF36, a significant statistical difference was observed between them (P=0.03, P=0.006, P=0.002, respectively), and the HILT was more effective. Conclusion ESWT and HILT decrease pain and increase patient satisfaction in PF. Besides, both methods are non-invasive and safe. However, there is a significant difference between them, and HILT is more effective. Trial registration number: IRCT20210913052465N1.
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Affiliation(s)
- Marzieh Zare Bidoki
- Department of Physical Medicine and Rehabilitation, School of Medicine. Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Reza Vafaeei Nasab
- Department of Physical Medicine and Rehabilitation, School of Medicine. Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amidodin Khatibi Aghda
- Department of Physical Medicine and Rehabilitation, School of Medicine. Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Thammajaree C, Theapthong M, Palee P, Pakpakorn P, Sitti T, Sakulsriprasert P, Bunprajun T, Thong-On S. Effects of radial extracorporeal shockwave therapy versus high intensity laser therapy in individuals with plantar fasciitis: A randomised clinical trial. Lasers Med Sci 2023; 38:127. [PMID: 37219650 DOI: 10.1007/s10103-023-03791-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023]
Abstract
This study aimed to compare the effects of radial extracorporeal shockwave therapy (rESWT) to the effects of high-intensity laser therapy (HILT) in the treatment of individuals with plantar fasciitis. Thirty-two individuals with unilateral plantar fasciitis were randomized into two groups: rESWT and HILT. In each group, the individuals underwent the intervention two sessions per week, for three weeks. Outcome measures included morning pain, resting pain, pain at 80 newtons (N) pressure, skin blood flow and temperature, plantar fascia (PF) and flexor digitorum brevis (FDB) thickness, and Foot Function Index (FFI). There was no significant difference in baseline characteristics of the individuals in both groups. All outcome measures, except skin blood flow and temperature, and FDB thickness, were significantly different (p < 0.05) over time. Skin blood flow was significantly different between groups at the end of the program. Either HILT or rESWT could alleviate pain in individuals with plantar fasciitis significantly. However, HILT was better at reducing FFI (functional limitation domain) rather than rESWT. This study was a randomized clinical trial and was approved by Mahidol University-Central Institutional Review Board (MU-CIRB) following the Declaration of Helsinki, COA no. MU_CIRB 2020/207.0412, the Thai Clinical Trials Registry (TDTR) numbered TCTR2021012500.
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Affiliation(s)
- Chutiporn Thammajaree
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Bangkok, 10700, Thailand
| | - Montartip Theapthong
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Phongsathon Palee
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Phrattaya Pakpakorn
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Tippawan Sitti
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Prasert Sakulsriprasert
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Tipwadee Bunprajun
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Suthasinee Thong-On
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
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Muacevic A, Adler JR, Khandelwal N, Reddy DC, Gupta TP. Intralesional Steroid Injection Versus Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Comparative, Prospective, Case Series Study. Cureus 2023; 15:e33593. [PMID: 36779116 PMCID: PMC9910225 DOI: 10.7759/cureus.33593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Background This study aimed to compare and evaluate the outcomes of intralesional steroid injections (ultrasound-guided) versus extracorporeal shockwave therapy in the treatment of plantar fasciitis. Methodology Between January 2021 and March 2022, 120 (84 male, 36 female) patients with a confirmed diagnosis of plantar fasciitis were identified. Subjective assessment was done using Mayo Clinical Score, and objective evaluation was done by measuring plantar fascia thickness using ultrasonography. For this study, two groups were made, wherein group A was administered a high dose of extracorporeal shockwave therapy, and group B was administered ultrasound-guided intralesional or local steroid injections. Results Plantar fascia thickness was considerably reduced after therapy in both groups; however, the difference in thickness reduction was not statistically significant between both groups. Mayo Clinic Scores showed statistically significant improvement in pain; however, the difference in pain reduction was not statistically significant between both groups. Conclusions A considerable clinical and radiological improvement was noted in both groups; however, we did not record statistically significant and superior results in either group. Intralesional steroid injections provided faster clinical improvement and better patient compliance.
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Nafees F, Fatima Z, Malik SS, Yousaf Q, Latif M, Farooq SMY. Ultrasound measurement of plantar fascia thickness: Is the current criterion for normality applicable to everyone? SONOGRAPHY 2022. [DOI: 10.1002/sono.12342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Fouad Nafees
- Radiology Research Section The University of Lahore Lahore Pakistan
| | - Zareen Fatima
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences The University of Lahore Lahore Pakistan
| | - Sajid Shaheen Malik
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences The University of Lahore Lahore Pakistan
| | - Qasim Yousaf
- Department of Radiology Government Kot Khawaja Saeed Teaching Hospital Lahore Pakistan
| | - Mahrukh Latif
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences The University of Lahore Lahore Pakistan
| | - Syed Muhammad Yousaf Farooq
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences The University of Lahore Lahore Pakistan
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Tognolo L, Giordani F, Biz C, Bernini A, Ruggieri P, Stecco C, Frigo AC, Masiero S. Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial. Eur J Phys Rehabil Med 2022; 58:85-93. [PMID: 34786906 PMCID: PMC9980534 DOI: 10.23736/s1973-9087.21.06814-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Plantar fasciitis (PF) is a common cause of heel pain. Among the several conservative treatment options, extracorporeal shock wave therapy (ESWT) is considered the standard treatment. However, recent studies suggest that PF may be sustained by a myofascial impairment proximal to the pain area with a biomechanical disequilibrium of the entire limb and pelvis. AIM By combining the concepts of fascial manipulation and ESWT, the purpose of this study was to evaluate the effectiveness of the ESWT on myofascial points in a sample of subjects with PF. DESIGN Open label randomized controlled clinical trial. SETTING Outpatient clinic. POPULATION Patients with PF were randomly assigned to an experimental treatment group (EG), treated with focused ESWT on myofascial points, and a control group (CG), treated with the focused ESWT traditional approach on the medial calcaneal tubercle. METHODS Every patient underwent a 3-session program and follow-up after 1 and 4 months. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and the Italian Foot Functional Index (17-iFFI). RESULTS Thirty patients were enrolled in the study. Four patients of the CG dropped out the study, therefore twenty-six patients were included in the final analysis. Improvement in 17-iFFI and FAOS scores was observed in both groups starting from the third treatment and confirmed at the 1-month and 4-month follow-ups, with earlier improvement in the score values observed in the EG. CONCLUSIONS Treatment of the myofascial points with ESWT in subjects suffering from plantar fasciitis could be an effective treatment option. It fosters the hypothesis that a global biomechanical re-equilibrium of the body would be necessary to completely solve the pathology. CLINICAL REHABILITATION IMPACT ESWT on myofascial points could provide an interesting alternative with better outcomes in terms of time needed for recovery compared to traditional ESWT for the conservative management of PF.
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Affiliation(s)
- Lucrezia Tognolo
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences, University of Padua, Padua, Italy -
| | - Federico Giordani
- School of Physical Medicine and Rehabilitation, University of Padua, Padua, Italy
| | - Carlo Biz
- Unit of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy
| | - Andrea Bernini
- School of Physical Medicine and Rehabilitation, University of Padua, Padua, Italy
| | - Pietro Ruggieri
- Unit of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Anna C Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefano Masiero
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences, University of Padua, Padua, Italy
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El Molla SS, Fahmy AM, Gamil AM, Ibrahim RA, Kamel MM. Evaluation of plantar fasciitis improvement after shock wave therapy in calcaneal spur patients by musculoskeletal ultrasonography. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00085-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Plantar fasciitis due to calcaneal spur is a common cause of heel pain and functional disability, and its management presents a huge challenge for clinicians which results sometimes in unpleasant clinical outcomes. The efficacy of extracorporeal shock wave therapy (ESWT) as an alternative therapeutic option to surgical management after failure of conservative treatment has been addressed. Our aim was to evaluate the efficacy of ESWT in the treatment of plantar fasciitis in calcaneal spur patients using ultrasonography.
Results
The mean plantar fascia (PF) thickness was statistically significantly higher in the calcaneal spur patient group (5.66 ± 1.14 mm) than in the healthy control group (2.40 ± 0.35 mm), (P = 0.001). Significant PF thickness reduction, visual analog scale (VAS), and Roles and Maudsley score (RMS) improvement were observed (P < 0.001) after 4 sessions of ESWT.
Conclusion
PF thickness increases significantly in calcaneal spur patients and responds to treatment. ESWT decreases the thickness of the PF and improves pain and function significantly.
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Król P, Franek A, Król T, Stanula A, Dolibog P, Durmała J, Polak A, Kuszewski M, Stania M. Ground reaction force analysis for assessing the efficacy of focused and radial shockwaves in the treatment of symptomatic plantar heel spur. J Back Musculoskelet Rehabil 2021; 34:279-287. [PMID: 33285624 DOI: 10.3233/bmr-191739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extracorporeal shock wave therapy is among the conservative treatments for symptomatic heel spur. OBJECTIVE The purpose of this trial is to evaluate and compare the therapeutic effects of radial shock wave (RSWT) and focused shock wave (FSWT) applied in the treatment of symptomatic heel spur. METHODS Fifty-five participants were randomly divided into two comparative groups that were administered FSWT and RSWT, respectively. The severity of dysfunction (Foot Function Index, FFI), ground reaction forces (GRF) and walking temporal parameters were measured in all patients at baseline and at weeks 1, 3, 6, 12 and 24 after treatment. RESULTS In both groups, a gradual decrease in the FFI values occurred after treatment. The percentage reduction in the FFI was comparable for both groups. Statistically significant changes were only noted between some measurements of GRF and walking temporal parameters. The percentage changes in the values of the force and temporal parameters were similar between the groups. CONCLUSIONS Both FSWT and RSWT are efficacious in the treatment of symptomatic heel spur and their therapeutic effects are comparable. Objective data registered by force platforms during walking are not useful for tracing the progress of treatment applied to patients with symptomatic heel spur between consecutive procedures.
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Affiliation(s)
- Piotr Król
- Academy of Physical Education, Institute of Sport Sciences, Katowice, Poland
| | - Andrzej Franek
- Chair and Department of Medical Biophysics, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Tomasz Król
- Department of Kinesitherapy and Special Methods, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Arkadiusz Stanula
- Academy of Physical Education, Institute of Sport Sciences, Katowice, Poland
| | - Paweł Dolibog
- Chair and Department of Medical Biophysics, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Jacek Durmała
- Department of Rehabilitation, School of Health Sciences, Medical University of Silesia, Katowice-Ochojec, Poland
| | - Anna Polak
- Academy of Physical Education, Institute of Sport Sciences, Katowice, Poland
| | - Michał Kuszewski
- Academy of Physical Education, Institute of Physiotherapy and Health Sciences, Katowice, Poland
| | - Magdalena Stania
- Academy of Physical Education, Institute of Sport Sciences, Katowice, Poland
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Ginés-Cespedosa A, Ugarte IW, Ares-Vidal J, Solano-Lopez A, Adames DB, Gamba C. Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211027323. [PMID: 35097465 PMCID: PMC8702947 DOI: 10.1177/24730114211027323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been used as a diagnostic and prognostic instrument to evaluate the results of conservative treatment for plantar fasciitis. However, there are scarce data available relative to changes in the plantar fascia after operative treatment. The primary objective of this study is to evaluate the imaging changes in patients with recalcitrant plantar fasciitis treated operatively by means of proximal medial gastrocnemius release. METHODS Thirteen patients with recalcitrant plantar fasciitis were studied with MRI preoperatively and 1 year after operative treatment. Quantitative (plantar fascia thickness) and qualitative variables (hyperintensity in the plantar fascia, insertional calcaneus bone edema, a plantar fascia tear, and the presence of perifascial collections) were assessed by 2 musculoskeletal radiologists. Clinical results were also measured with American Orthopaedic Ankle & Society (AOFAS), visual analog scale (VAS) pain, and 36-Item Short Form Health Survey (SF-36) scales. RESULTS The mean plantar fascia thickness was 6.59 mm preoperatively and 6.37 mm postoperatively (P = .972). No statistically significant differences were found in any of the qualitative variables on comparing the pre- and postoperative periods. Patients reported clinical improvements in pain VAS, AOFAS measurement, and the physical subdomains of the SF-36 scale. CONCLUSION Quantitative and qualitative variables assessed for the plantar fascia on MRI did not show any significant change after medial gastrocnemius release despite clear clinical improvement. LEVEL OF EVIDENCE Level II, perspective cohort study.
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Affiliation(s)
- Alberto Ginés-Cespedosa
- Orthopaedics Department, Hospital del Mar, UAB–Universitat Autonoma Barcelona, Barcelona, Spain
| | | | - Jesus Ares-Vidal
- Department of Radiology and Radiodiagnostic, Hospital del Mar, Barcelona, Spain
| | | | - Daniel Bianco Adames
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
| | - Carlo Gamba
- Orthopaedic Department, Hospital de la Santa Creu I Sant Pau, Universitat Autonoma Barcelona, Barcelona, Spain
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10
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Heinen EH, Lima KMME, Correia R, Diefenthaeler F, de Brito Fontana H. Reliability in ultrasound measurements of plantar aponeurosis thickness. Foot (Edinb) 2021; 46:101749. [PMID: 33285494 DOI: 10.1016/j.foot.2020.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/21/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Given the increasing research interest in ultrasound plantar aponeurosis (PA) thickness measurements, this study aimed to analyze the inter and intra-rater reliability of independent sonograms and to identify the error related to the image analysis procedure. METHODS Twenty-one healthy men participated in this study. Imaging of PA consisted of two independent sonograms per subject. Two raters (R1 and R2) evaluated each sonogram twice using standardized steps. Precision of the image analysis procedure was analyzed using the Bland and Altman plot and Intraclass Correlation Coefficient (ICC). Agreement estimates and ICC were used to assess absolute and relative inter and intra-rater reliability. RESULTS Reliability of PA thickness was found to depend strongly on the number of images acquired per subject. Intra-rater agreement for single measurements were 0.696 (R1) and 0.495 (R2), whereas average measurements yielded values of 0.821 (R1) and 0.662 (R2), respectively. Precision within a sonogram varied from ICC values of 0.873 to 0.960 (intra-rater) and 0.670 to 0.822 (inter-rater). CONCLUSION Most part of the error in PA thickness measurements seems to be related to the sonogram acquisition process and not to the visual inspection of the image. To minimize error, average values of a minimum of two images per subject should be used. The moderate agreement between raters found in this study ratifies the need of all measurements being made by the same rater or group of raters. If a single rater evaluates all subjects, performing multiple measurements over one image does not seem to affect ICC as much as acquiring multiple images.
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Affiliation(s)
- Eduarda Heydt Heinen
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, 88.040-900, Brazil.
| | - Kelly Mônica Marinho E Lima
- Health Sciences Department, School of Science, Technology and Health, Federal University of Santa Catarina, Araranguá, 88.906-072, Brazil.
| | - Raissa Correia
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, 88.040-900, Brazil.
| | - Fernando Diefenthaeler
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, 88.040-900, Brazil; Physical Eduaction Department, School of Sports, Federal University of Santa Catarina, Florianópolis, 88.040-900, Brazil.
| | - Heiliane de Brito Fontana
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, 88.040-900, Brazil; Morphological Sciences Department, School of Biological Sciences, Federal University of Santa Catarina, Florianópolis, 88.040-900, Brazil.
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11
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Narin S, Unver B, Demirkıran ND, Erduran M. Comparison of Radial Extracorporeal Shock Wave Therapy in Plantar Fasciitis Treatment Using Two Different Frequencies. Cureus 2020; 12:e8284. [PMID: 32601560 PMCID: PMC7317142 DOI: 10.7759/cureus.8284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To compare results of two different frequencies and densities of radial extracorporeal shock wave therapy (rESWT) after 10 sessions. Methods A total of 41 patients with plantar fasciitis were included in this study. Patients were randomly divided into two groups. Both groups were administered 10 sessions of treatment consisting of 15 Hz frequency, 3.0 Bar density and 2000 impulses/ session for the 1st group, and 10 Hz frequency, 2.0 Bar density and 2000 impulses/ session for the 2nd group. Visual analog scale (VAS) and a modification of the clinical rating system of the American Orthopedic Foot and Ankle Society (AOFAS) were used for outcome measurement. The patients were assessed before treatment and followed up four weeks, and 12 weeks after end of treatment. Results Mean VAS scores were reduced after rESWT from 7.52 ± 2.34 (mean ± SEM) at baseline to 0.57 ± 0.68 at 12 weeks in the 1st group and from 6.45 ± 2.04 at baseline to 0.40 ± 0.60 at 12 weeks in the 2nd group. Similar changes were found for mean AOFAS scores from baseline after rESWT but were not observed significance between groups. Conclusion There is no significant different effect between the two treatment groups' results.
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Affiliation(s)
- Selnur Narin
- Physiotherapy and Rehabilitation, Institute of Health, Dokuz Eylul University, Izmir, TUR
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, TUR
| | | | - Mehmet Erduran
- Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, TUR
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12
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Al-Abbad H, Allen S, Morris S, Reznik J, Biros E, Paulik B, Wright A. The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression. BMC Musculoskelet Disord 2020; 21:275. [PMID: 32345281 PMCID: PMC7189454 DOI: 10.1186/s12891-020-03270-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT. METHODS A comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects. RESULTS Sixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI -4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI -0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes. CONCLUSIONS SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. Registration number: PROSPERO CRD42018091140.
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Affiliation(s)
- Hani Al-Abbad
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA Australia
- Physical Therapy department, Rehabilitation hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sophie Allen
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA Australia
| | - Susan Morris
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA Australia
| | - Jackie Reznik
- College of Healthcare Science and Division of Tropical Health and Medicine, James Cook University, Townsville, QLD Australia
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | | | - Anthony Wright
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA Australia
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Wu CH, Lin YY, Chen WS, Wang TG. Sonoelastographic evaluation of plantar fascia after shock wave therapy for recalcitrant plantar fasciitis: A 12-month longitudinal follow-up study. Sci Rep 2020; 10:2571. [PMID: 32054959 PMCID: PMC7018829 DOI: 10.1038/s41598-020-59464-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/23/2020] [Indexed: 11/27/2022] Open
Abstract
Extracorporeal shockwave therapy (ESWT) is proposed to be effective in reducing pain and improving functional outcome in chronic plantar fasciitis. However, no long-term reports exist on the changes in plantar fascia (PF) elasticity after ESWT. We aimed to evaluate the changes in PF stiffness in patients with plantar fasciitis undergoing ESWT. The visual analogue scale (VAS, 0–100) was used for evaluating heel pain severity. B-mode sonography and strain sonoelastography were used for evaluating the PF thickness and stiffness. The sonoelastogram was analyzed using hue histogram analysis (value: 0–255, from stiffer to softer). All evaluations were recorded before ESWT, and 1 week, 1 month, 3 months, 6 months, and 12 months after ESWT. Repeated measures ANOVA was used to compare pain VAS, PF thickness, and PF hue value at different follow-up time-points. Twenty-two participants (8 men, 14 women) completed all measurements for 12 months. The VAS of heel pain, PF thickness, and PF hue values at pre-ESWT, and 1-week, 1-month, 3-month, 6-month, and 12-month evaluations after ESWT were 62.4 ± 4.2, 49.3 ± 5.8, 38.3 ± 5.7, 27.9 ± 5.3, 18.9 ± 4.7, and 13.2 ± 3.0 (p < 0.01 in all measurements post ESWT versus pre-ESWT); 5.57 ± 0.22 mm, 5.64 ± 0.18 mm, 5.45 ± 0.24 mm, 5.37 ± 0.20 mm, 5.08 ± 0.20 mm, and 4.62 ± 0.15 mm (p < 0.01 at 6-month; otherwise p > 0.05); and 24.5 ± 2.4, 35.2 ± 3.1, 31.0 ± 4.1, 30.5 ± 3.9, 21.4 ± 2.1, and 15.9 ± 1.6 (p < 0.01 at 1-week and 6-month; otherwise p > 0.05), respectively. In conclusion, the heel pain intensity and PF thickness reduced gradually over 12 months after ESWT. The PF stiffness decreased during the first week and increased thereafter; at the 12-month follow-up, stiffness was more than at pre-ESWT.
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Affiliation(s)
- Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun-Yi Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Rehabilitation Medicine, Da-Chien Hospital, Miao-Li, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Li H, Xiong Y, Zhou W, Liu Y, Liu J, Xue H, Hu L, Panayi AC, Mi B, Liu G. Shock-wave therapy improved outcome with plantar fasciitis: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2019; 139:1763-1770. [PMID: 31435724 DOI: 10.1007/s00402-019-03262-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Shock-wave therapy (SWT) has been widely applied and proven to be an effective treatment in ameliorating symptoms of plantar fasciitis (PF). Ultrasound therapy (UT) is another common treatment of PF, and several researches have documented its advantages when compared to corticosteroid injection. Despite this, few studies have focused on comparing the use of SWT and UT in the treatment of PF. The purpose of our meta-analysis is to evaluate whether SWT is better than UT in managing PF, both in terms of ameliorating pain and improving functionality. METHODS A systematic search of the literature was conducted to identify relevant articles that were published in Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov and OVID from the databases' inception to October 2018. All studies comparing the efficacy of SWT and UT in terms of pain levels and functionality improvement were included. Data on the two primary outcomes were collected and analyzed using the Review Manager 5.3. RESULTS Five studies were included in the current meta-analysis. A significant difference in VAS score (MD = - 13.14, Cl - 14.07 to - 12.75 P < 0.00001, I2 = 100%) was noted between the SWT group and the UT group. No significant difference was seen in the AOFAS (MD = 3.19, Cl - 1.72 to 8.10 P = 0.20, I2 = 100%); FFI or PFPS score was not found significant difference either (SMD = - 1.17, Cl - 4.45 to 2.10 P = 0.48, I2 = 96%). CONCLUSIONS The results from this meta-analysis highlight the effectiveness of both SWT and UT in the treatment of PF. Although inter-group differences were not significant, the VAS score was better improved in the SWT group, suggesting that SWT may be a superior alternative for the treatment of PF.
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Affiliation(s)
- Hui Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yi Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Liangcong Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Adriana C Panayi
- The Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Wu J, Zhang YZ, Gao Y, Luo TY. Assessment the reliability of ultrasonography in the imaging of the plantar fascia: a comparative study. BMC Med Imaging 2019; 19:62. [PMID: 31390990 PMCID: PMC6686529 DOI: 10.1186/s12880-019-0361-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Imaging methods for the plantar fascia have included radiography, ultrasound and magnetic resonance imaging (MRI), all of which have provided valuable information. This study assessed the reliability of ultrasonography examinations of the plantar fascia using a comparative study. METHODS Fifty healthy adult volunteers (25 males and 25 females, mean age 31.6 ± 3.5 years) were included in this study. Images of the plantar fascia from 100 ft were acquired with ultrasonography, CT and MRI. Ultrasound was used to measure the thickness of the plantar fascia. Imaging data from CT and MRI in a DICOM format were transformed into the Materialise Mimics Innovation Suite 16.0 software for digital analysis. SPSS software (SPSS, USA) was used for statistical analysis. The reliability was established by a t-test. Moreover, 42 patients with unilateral plantar fasciitis were examined by ultrasonography. RESULTS There were no significant differences between the three imaging modalities for patients of the same sex (P > 0.05). There were no statistically significant differences between the left and right sides for patients of the same sex (P > 0.05), but the difference between males and females was statistically significant (P < 0.01). There were no significant differences between US, CT and MRI in the normal group, but there were significant differences in the plantar fasciitis group evaluated with ultrasound. The plantar fascii of normal male subjects are significantly thicker than those of the normal female. CONCLUSION Ultrasonography can be a relatively simple and reliable method for the measurement of plantar fascia thickness.
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Affiliation(s)
- Jing Wu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, People's Republic of China
| | - Yuan-Zhi Zhang
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical University, No 1, Tongdao North Road, Huimin District, 010059, Hohhot, People's Republic of China.
| | - Yang Gao
- Department of MR, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, People's Republic of China
| | - Tian-You Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Giordani F, Bernini A, Müller-Ehrenberg H, Stecco C, Masiero S. A global approach for plantar fasciitis with extracorporeal shockwaves treatment. Eur J Transl Myol 2019; 29:8372. [PMID: 31579484 PMCID: PMC6767838 DOI: 10.4081/ejtm.2019.8372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/10/2019] [Indexed: 11/23/2022] Open
Abstract
Extracorporeal Shockwaves Treatment is considered an effective therapeutic option for plantar fasciitis, but the standard application in the medial insertion of the plantar fascia on the calcaneus has provided ambiguous evidences. In this case, a 63-year man with plantar fasciitis was treated in a 3-session program and Foot and Ankle Outcome Scale and Foot Functional Index questionnaires were chosen for the clinical outcome evaluation. The therapy was focused on the active trigger or myofascial points of the leg, thigh and pelvis in order to return the correct equilibrium of the myofascial system of the whole limb. The patient has already reported an improvement after the second session (FAOS: 76 vs 33, FFI: 85%) which was confirmed in the third one and in the 1-month follow up (FAOS: 79, FFI: 6%) Results suggest that plantar fasciitis may be due to proximal rigidity or tension of the fascia and a global approach using ESWT may have a similar or better outcome respect to the standard application.
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Affiliation(s)
- Federico Giordani
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | - Andrea Bernini
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | | | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Stefano Masiero
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
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17
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Saber N, Diab H, Nassar W, Razaak HA. Ultrasound guided local steroid injection versus extracorporeal shockwave therapy in the treatment of plantar fasciitis. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Nayera Saber
- Physical Medicine & Rehabilitation Department, Faculty of Medicine , Ain Shams University , Cairo, Egypt
| | - Hosam Diab
- Orthopedic Department, Faculty of Medicine , Ain Shams University , Cairo, Egypt
| | - Wael Nassar
- Orthopedic Department, Faculty of Medicine , Ain Shams University , Cairo, Egypt
| | - Hanaa A. Razaak
- Radiodiagnosis Department, Faculty of Medicine , Ain Shams University , Cairo, Egypt
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18
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Xiong Y, Wu Q, Mi B, Zhou W, Liu Y, Liu J, Xue H, Hu L, Panayi AC, Liu G. Comparison of efficacy of shock-wave therapy versus corticosteroids in plantar fasciitis: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2019; 139:529-536. [PMID: 30426211 PMCID: PMC6420882 DOI: 10.1007/s00402-018-3071-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Corticosteroid (CS) injections have been proven to be effective in ameliorating symptoms of plantar fasciitis. Shock-wave (SW) therapy is another common treatment of plantar fasciitis, and several meta-analyses have documented its advantages when compared to placebo treatment. Despite this, few studies have focused on comparing the use of CS and SW in the treatment of plantar fasciitis. The purpose of this meta-analysis is to assess whether SW is superior to CS in managing plantar fasciitis, both in terms of ameliorating pain as well as improving functionality. METHODS A systematic search of the literature was conducted to identify relevant articles that were published in Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov and OVID from the databases' inception to July 2018. All studies comparing the efficacy of SW and CS in terms of pain levels and functionality improvement were included. Data on the two primary outcomes were collected and analyzed using the Review Manager 5.3. RESULTS Six studies were included in the current meta-analysis. A significant difference in VAS score (MD = - 0.96, Cl - 1.28 to - 0.63, P < 0.00001, I2 = 96%) was noted between the SW group and the CS group. No significant difference was seen in the Mayo CSS or FFI or HFI or 100 Scoring System score at the 3 months follow-up (Chi2 = 0.62, I2 = 0%, P > 0.05). CONCLUSIONS The clinical relevance of the present study is that both SW and CS were effective and successful in relieving pain and improving self-reported function in the treatment of plantar fasciitis at 3 months. Although inter-group differences were not significant, the VAS score was better improved in the SW group, highlighting that shock-wave therapy may be a better alternative for the management of chronic plantar fasciitis.
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Affiliation(s)
- Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Qipeng Wu
- Department of Orthopedics, Pu’ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Yi Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Jing Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Liangcong Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Adriana C. Panayi
- The division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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Li S, Wang K, Sun H, Luo X, Wang P, Fang S, Chen H, Sun X. Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13687. [PMID: 30558080 PMCID: PMC6320028 DOI: 10.1097/md.0000000000013687] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The argument on whether extracorporeal shock-wave therapy (ESWT) and corticosteroid injections (CSIs) exert an equivalent pain control or which is the better treatment for plantar fasciitis (PF) in adults remains to be resolved. It is important and necessary to conduct a meta-analysis to make a relatively more credible and overall assessment about which treatment method performs better pain control in treatment of PF in adults. METHODS From the inception to July 2018, the Embase, PubMed, Web of Science, and Cochrane Library electronic databases were searched for all relevant studies. Only randomized controlled trials (RCTs) focusing on comparing ESWT and CSI therapies in PF cases in adults were included. The primary outcome measure was visual analog scale (VAS) reduction, whereas the secondary outcomes included treatment success rate, recurrence rate, function scores, and adverse events. RESULTS Nine RCTs involving 658 cases were included in this meta-analysis. In the present study, meta-analysis showed that high-intensity ESWT had superior pain relief and success rates relative to the CSI group within 3 months, but the ESWT with low intensity was slightly inferior to CSI for efficacy within 3 months. In addition, patients with CSI may tend to increase the need for the analgesic and more adverse events may be associated with the ESWT. However, the ESWT and CSI present similar recurrent rate and functional outcomes. CONCLUSION Our analysis showed that the pain relief and success rates were related to energy intensity levels, with the high-intensity ESWT had the highest probability of being the best treatment within 3 months, followed by CSI, and low-intensity ESWT. More high-quality RCTs with long-term follow-up time are needed to further compare the differences of CSI and ESWT for adults with PF.
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Ermutlu C, Aksakal M, Gümüştaş A, Özkaya G, Kovalak E, Özkan Y. Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:442-446. [PMID: 30314878 PMCID: PMC6318475 DOI: 10.1016/j.aott.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 10/21/2017] [Accepted: 01/09/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities. METHODS Seventy patients (mean age: 49.10; range: 41-58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed. RESULTS Degree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = -0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = -0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = -0.943). CONCLUSIONS Plantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Comparison of effects of low-level laser therapy and extracorporeal shock wave therapy in plantar fasciitis treatment: A randomized, prospective, single-blind clinical study. Turk J Phys Med Rehabil 2018; 65:184-190. [PMID: 31453560 DOI: 10.5606/tftrd.2019.3528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 08/27/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives The aim of this study is to compare the efficacy of extracorporeal shock wave therapy (ESWT) and low-level laser therapy (LLLT) in terms of fascia thickness, heel pain, and foot functions in patients with plantar fasciitis (PF). Patients and methods Between April 2015 and October 2015, a total of 34 patients (5 males, 29 females; mean age 51.5±10.8 years; range, 18 to 65 years) with PF were randomized into two treatment groups to receive either ESWT or LLLT using closed envelope method. The patients were evaluated before and after treatment and one month after treatment using the visual analog scale (VAS)-pain, Foot Function Index (FFI), and plantar fascia thickness measured by ultrasonography. Results A significant improvement in the VAS-pain and FFI scores and plantar fascia thickness was observed in both groups after treatment and one month after treatment, compared to pre-treatment values (p<0.05). Changes over time in these outcome parameters were not different between study groups (p>0.05). Conclusion Our study results suggest that both ESWT and LLLT seem to be effective on pain, foot functions, and fascia thickness in the treatment of PF.Presented at the 26th National Congress of Physical Medicine and Rehabilitation, April 25-29, 2017 Antalya, Turkey.
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New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis. Arch Phys Med Rehabil 2017. [PMID: 28634056 DOI: 10.1016/j.apmr.2017.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. DESIGN Randomized, controlled, prospective study. SETTING Outpatient of local medical center settings. PARTICIPANTS Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). INTERVENTIONS ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm2, respectively (a rate of 8 impulses per second), were applied. MAIN OUTCOME MEASURES The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. RESULTS The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e[.011+42.807×heel spur+.109×edema+5.395×VASscore])-1.The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The Youden index was .4243, .3003, and .7189, respectively. The Hosmer-Lemeshow test showed a good fitting of the predictive model, with an overall accuracy of 89.6%. CONCLUSIONS This study establishes a new and accurate predictive model for the efficacy of ESWT in managing patients with chronic plantar fasciitis. The use of these parameters, in the form of a predictive model for ESWT efficacy, has the potential to improve decision-making in the application of ESWT.
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Sonoelastography in the Evaluation of Plantar Fasciitis Treatment: 3-Month Follow-Up After Collagen Injection. Ultrasound Q 2017; 32:327-332. [PMID: 27035685 DOI: 10.1097/ruq.0000000000000233] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether ultrasound elastography can demonstrate the outcome of the treatment in comparison with gray-scale imaging. METHODS Sixteen patients (mean age, 46.9 years) with plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment. Individuals graded their heel pain on a 100-mm visual analogue scale (VAS) and underwent gray-scale ultrasonography and sonoelastography. Collagen was injected in the heels. Fascial thickness and hypoechogenicity, perifascial edema, and plantar fascial elasticity were evaluated. Follow-up sonoelastography and VAS grading were done 3 months after the injection. Statistical analyses were performed by the paired t test and the Fisher exact test. A P < 0.05 was considered statistically significant. RESULTS Mean plantar fascial thickness showed insignificant decrease on follow-up (from 4.30 [1.37] to 4.23 [1.15] mm, P = 0.662). Fascial hypoechogenicity and perifascial edema did not change significantly after treatment. The mean strain ratio of the plantar fascia was significantly increased (from 0.71 [0.24] to 1.66 [0.72], P = 0.001). Softening of the plantar fascia decreased significantly after injection (from 12 to 3 ft, P = 0.004). Twelve (75%) of 16 patients showed significant VAS improvement at the follow-up. CONCLUSIONS Sonoelastography revealed a hardening of the plantar fascia after collagen injection treatment and could aid in monitoring the improvement of the symptoms of plantar fasciitis, in cases where gray-scale imaging is inconclusive.
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Bisi-Balogun A, Cassel M, Mayer F. Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity. Diagnostics (Basel) 2016; 6:diagnostics6020015. [PMID: 27089369 PMCID: PMC4931410 DOI: 10.3390/diagnostics6020015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 11/16/2022] Open
Abstract
This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC.
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Affiliation(s)
- Adebisi Bisi-Balogun
- Clinical Exercise Science, University of Potsdam, Am Neues Palais, Potsdam, Brandenburg 14467, Germany.
- Sports and Health Sciences, University Outpatient Clinic, Am Neues Palais, Potsdam, Brandenburg 14467, Germany.
| | - Michael Cassel
- Sports and Health Sciences, University Outpatient Clinic, Am Neues Palais, Potsdam, Brandenburg 14467, Germany
| | - Frank Mayer
- Sports and Health Sciences, University Outpatient Clinic, Am Neues Palais, Potsdam, Brandenburg 14467, Germany
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Moustafa AMA, Hassanein E, Foti C. Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound. Muscles Ligaments Tendons J 2016; 5:289-96. [PMID: 26958538 DOI: 10.11138/mltj/2015.5.4.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. METHODS this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. RESULTS increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. CONCLUSION US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis.
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Affiliation(s)
- Asmaa Mahmoud Ali Moustafa
- Physical medicine, Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt; Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University, Rome, Italy
| | - Eshrak Hassanein
- Radio-diagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University, Rome, Italy
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Fleischer AE, Albright RH, Crews RT, Kelil T, Wrobel JS. Prognostic Value of Diagnostic Sonography in Patients With Plantar Fasciitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1729-1735. [PMID: 26307122 DOI: 10.7863/ultra.15.14.10062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The primary objective of this study was to determine whether the sonographic appearance of the plantar fascia is predictive of the treatment (ie, pain) response in patients receiving supportive therapy for proximal plantar fasciitis. This study was a secondary analysis of data obtained from a randomized controlled trial of ambulatory adults, which examined the efficacy of 3 different foot supports for plantar fasciitis. METHODS Participants underwent diagnostic sonographic examinations of their heel at baseline and again at 3 months by a single experienced foot and ankle surgeon. Quantitative (eg, thickness) and qualitative (eg, biconvexity) characteristics of the fascia were recorded according to a standard protocol. Logistic regression models were used to identify predictors of the pain response. RESULTS Seventy patients completed a baseline evaluation, and 63 patients completed a 3-month follow-up assessment. The pain response was not associated with the type of foot support (P> .05). The only significant indicator of an unfavorable response in the univariate and multivariate analyses was biconvexity of the plantar fascia on sonography at presentation (multivariate odds ratio, 4.76 [95% confidence interval, 1.16-19.5; P= .030). Furthermore, changes in self-reported pain over the 3-month study period were not accompanied by alterations in plantar fascia thickness over this time (r = .056; P = .671). CONCLUSIONS We conclude that patients who present with biconvexity of the plantar fascia may be less responsive to tier 1 treatment regimens that center around mechanical support of the plantar fascia. Furthermore, follow-up measurements of the fascia in this population should not weigh heavily in decisions such as return to play.
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Affiliation(s)
- Adam E Fleischer
- Weil Foot & Ankle Institute, Des Plaines, Illinois USA (A.E.F.); Center for Lower Extremity Ambulatory Research, Dr William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois USA (A.E.F., R.H.A., R.T.C.); Department of Diagnostic Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (T.K.); and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA (J.S.W.).
| | - Rachel H Albright
- Weil Foot & Ankle Institute, Des Plaines, Illinois USA (A.E.F.); Center for Lower Extremity Ambulatory Research, Dr William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois USA (A.E.F., R.H.A., R.T.C.); Department of Diagnostic Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (T.K.); and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA (J.S.W.)
| | - Ryan T Crews
- Weil Foot & Ankle Institute, Des Plaines, Illinois USA (A.E.F.); Center for Lower Extremity Ambulatory Research, Dr William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois USA (A.E.F., R.H.A., R.T.C.); Department of Diagnostic Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (T.K.); and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA (J.S.W.)
| | - Tatiana Kelil
- Weil Foot & Ankle Institute, Des Plaines, Illinois USA (A.E.F.); Center for Lower Extremity Ambulatory Research, Dr William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois USA (A.E.F., R.H.A., R.T.C.); Department of Diagnostic Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (T.K.); and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA (J.S.W.)
| | - James S Wrobel
- Weil Foot & Ankle Institute, Des Plaines, Illinois USA (A.E.F.); Center for Lower Extremity Ambulatory Research, Dr William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois USA (A.E.F., R.H.A., R.T.C.); Department of Diagnostic Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (T.K.); and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA (J.S.W.)
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Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis. Int J Radiat Oncol Biol Phys 2015; 92:659-66. [DOI: 10.1016/j.ijrobp.2015.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/20/2022]
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Park JW, Yoon K, Chun KS, Lee JY, Park HJ, Lee SY, Lee YT. Long-term outcome of low-energy extracorporeal shock wave therapy for plantar fasciitis: comparative analysis according to ultrasonographic findings. Ann Rehabil Med 2014; 38:534-40. [PMID: 25229032 PMCID: PMC4163593 DOI: 10.5535/arm.2014.38.4.534] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US.
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Affiliation(s)
- Jong-Wan Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungjae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Soo Chun
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon-Youn Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mohseni-Bandpei MA, Nakhaee M, Mousavi ME, Shakourirad A, Safari MR, Vahab Kashani R. Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1737-1754. [PMID: 24798393 DOI: 10.1016/j.ultrasmedbio.2014.03.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/13/2014] [Accepted: 03/01/2014] [Indexed: 06/03/2023]
Abstract
Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS.
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Affiliation(s)
- Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center and Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Evin, Tehran, Iran; University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Masoomeh Nakhaee
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Mohammad Ebrahim Mousavi
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Shakourirad
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Safari
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Vahab Kashani
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Berbrayer D, Fredericson M. Update on evidence-based treatments for plantar fasciopathy. PM R 2013; 6:159-69. [PMID: 24365781 DOI: 10.1016/j.pmrj.2013.08.609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/05/2013] [Indexed: 11/25/2022]
Abstract
Plantar fasciopathy, a common, painful condition of the foot, is often diagnosed by a musculoskeletal physiatrist in an outpatient practice setting. This focused review examines the most recent recommendations for the management of plantar fasciopathy in acute, subacute, and chronic phases. The evidence for treatment with various interventions is discussed, and suggestions for clinical care (along with the respective rationales for those therapies) are provided. The purpose of this review is to enable clinicians to make informed evidence-based decisions about the best available treatments for patients with any phase of plantar fasciopathy. Emerging technologies for the treatment of the condition are also addressed.
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Affiliation(s)
- David Berbrayer
- Department of Rehabilitation Medicine, University of Toronto Sunnybrook HSC, 2075 Bayview Ave, Toronto, Ontario, ON M4N 3M5, Canada(∗).
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Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis. J Orthop Sports Phys Ther 2013; 43:727-34. [PMID: 23886626 DOI: 10.2519/jospt.2013.4774] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Single-cohort laboratory-based study. OBJECTIVES To identify whether plantar fascia vascularity and thickness are associated with foot pain and dysfunction in individuals with chronic plantar fasciitis. Background Altered plantar fascia vascularity and thickening of the fascia have been identified in individuals with chronic plantar fasciitis. METHODS Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. RESULTS There were significantly higher VI (mean ± SD, 2.4% ± 1.4%) and fascia thickness (5.0 ± 1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4% ± 0.5%; fascia thickness, 3.3 ± 0.7 mm) and with the dominant side of the controls (VI, 1.6% ± 0.4%; fascia thickness, 2.9 ± 0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. CONCLUSIONS Individuals with unilateral chronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia vascularity and thickness were associated with foot dysfunction in patients with chronic plantar fasciitis. Public trials registry: Current Controlled Trials, ISRCTN49594569.
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Lee SJ, Kang JH, Kim JY, Kim JH, Yoon SR, Jung KI. Dose-related effect of extracorporeal shock wave therapy for plantar fasciitis. Ann Rehabil Med 2013; 37:379-88. [PMID: 23869336 PMCID: PMC3713295 DOI: 10.5535/arm.2013.37.3.379] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/04/2012] [Indexed: 11/07/2022] Open
Abstract
Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT.
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Affiliation(s)
- Su-Jin Lee
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
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Grecco MV, Brech GC, Greve JMD. One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy. Clinics (Sao Paulo) 2013; 68:1089-95. [PMID: 24037003 PMCID: PMC3752632 DOI: 10.6061/clinics/2013(08)05] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/01/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6 ±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment.
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Affiliation(s)
- Marcus Vinicius Grecco
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia (IOT/FMUSP), São Paulo/SPSP, Brazil
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Abstract
Objective To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analogue scale (VAS) and pressure threshold by digital algometer. Method Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm2, 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm2. The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer. Results There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91±1.76 to 2.27±1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4±9.94 N to 61.2±12.16 N in the treated group (p<0.05), but there was no significant change in the control group. Conclusion ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.
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Affiliation(s)
- Hye Min Ji
- Department of Rehabilitation Medicine, School of Medicine, Ewha Womans University, Seoul 158-710, Korea
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Gordon R, Wong C, Crawford EJ. Ultrasonographic evaluation of low energy extracorporeal pulse activated therapy (EPAT) for chronic plantar fasciitis. Foot Ankle Int 2012; 33:202-7. [PMID: 22734281 DOI: 10.3113/fai.2012.0202] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ultrasonographic measurement of the plantar fascia can be used to objectively diagnose plantar fasciitis. The purpose of this study was to determine the long-term effectiveness of Extracorporeal Pulse Activated Therapy (EPAT) for the treatment of plantar fasciitis using ultrasonographic measurement as an objective outcome measure, with a minimum followup of 12 months. METHODS Patients with chronic recalcitrant plantar fasciitis were prospectively recruited and underwent EPAT. Ultrasound measurement of the plantar fascia and patient-rated pain scores were collected before treatment and at followup (minimum of 12 months post-treatment). Twenty-five subjects (35 feet) met the inclusion criteria. The average followup time was 29.4 +/- 13.1 (M +/- SD; range, 12 to 54) months. RESULTS The average thickness of the plantar fascia of the symptomatic heels was 7.3 +/- 2.0 mm before treatment and 6.0 +/- 1.3 mm after treatment (p < 0.001). The average change in thickness of the treated heels was -1.3 mm (-0.8 to -1.8 mm; 95% CI, p < 0.0001). No correlation was found between length of followup and change in ultrasound measured plantar fascia thickness (r = -0.04, p = 0.818). CONCLUSION For patients with a greater than 12-month history of heel pain, EPAT can effectively decrease plantar fascia thickness as demonstrated objectively by ultrasound evaluation and reduce patient-reported pain. No relationship between length of followup and change in plantar fascia thickness was found after 12 months.
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Affiliation(s)
- Robert Gordon
- William Osler Health System, Division of Orthopaedics, 89 Humber College Boulevard, Suite 106, Toronto, Ontario M9V 488, Canada.
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Mahowald S, Legge BS, Grady JF. The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc 2012; 101:385-9. [PMID: 21957269 DOI: 10.7547/1010385] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis. METHODS Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed. RESULTS Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ± 1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P < 0.005). CONCLUSIONS This study provides evidence that changing thickness of the plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols.
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Kayhan A, Gökay NS, Alpaslan R, Demirok M, Yılmaz İ, Gökçe A. Sonographically guided corticosteroid injection for treatment of plantar fasciosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:509-515. [PMID: 21460151 DOI: 10.7863/jum.2011.30.4.509] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of this study was to prospectively investigate the effect of sonographically guided corticosteroid injection on the clinical and radiologic responses in patients with proximal plantar fasciosis. METHODS Thirty-one consecutive patients with unilateral plantar fasciosis were enrolled. A 4-cm 21-gauge needle was positioned in a caudocranial oblique manner, and the needle was withdrawn to the near edge of the fascia so that the solution dispersed around the edge. Two milliliters (20 mg/mL) of lignocaine/prilocaine, 1%, and 0.5 mL (20 mg) of methylprednisolone acetate solutions were injected separately. The plantar fascia and fat pad thickness, fascial echogenicity, and perifascial edema were assessed with a 10-5 MHz linear array transducer. The American Orthopedic Foot and Ankle Society midfoot scale was used to assess function, alignment, and pain. The initial radiologic and clinical measurements were compared with data obtained not less than 6 weeks after the injections. RESULTS A statistically significant decrease in the mean plantar fascia thickness was detected after treatment (P < .0001). There was no statistically significant difference in the plantar fascia echogenicity before and after treatment (P = .11). A statistically significant decrease was found for perifascial edema (P < .0001), and a statistically significant increase in American Orthopedic Foot and Ankle Society scores was detected (P = .0007). There was no decrease in fat pad thickness (P > .1). Plantar fascia rupture was detected in 1 patient. CONCLUSIONS Sonographically guided corticosteroid injection enables real-time imaging of the plantar fascia during needle insertion. A caudocranial oblique injection beneath the fascia may have an incremental value in the treatment response in patients with plantar fasciosis.
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Affiliation(s)
- Arda Kayhan
- Department of Radiology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey.
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Rathleff MS, Moelgaard C, Lykkegaard Olesen J. Intra- and interobserver reliability of quantitative ultrasound measurement of the plantar fascia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:128-134. [PMID: 21387326 DOI: 10.1002/jcu.20787] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 10/25/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE To determine intra- and interobserver reliability and measurement precision of sonographic assessment of plantar fascia thickness when using one, the mean of two, or the mean of three measurements. METHODS Two experienced observers scanned 20 healthy subjects twice with 60 minutes between test and retest. A GE LOGIQe ultrasound scanner was used in the study. The built-in software in the scanner was used to measure the thickness of the plantar fascia (PF). Reliability was calculated using intraclass correlation coefficient (ICC) and limits of agreement (LOA). RESULTS Intraobserver reliability (ICC) using one measurement was 0.50 for one observer and 0.52 for the other, and using the mean of three measurements intraobserver reliability increased up to 0.77 and 0.67, respectively. Interobserver reliability (ICC) when using one measurement was 0.62 and increased to 0.82 when using the average of three measurements. LOA showed that when using the average of three measurements, LOA decreased to 0.6 mm, corresponding to 17.5% of the mean thickness of the PF. CONCLUSIONS The results showed that reliability increases when using the mean of three measurements compared with one. Limits of agreement based on intratester reliability shows that changes in thickness that are larger than 0.6 mm can be considered actual changes in thickness and not a result of measurement error.
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Affiliation(s)
- Michael Skovdal Rathleff
- Orthopaedic Division, North Denmark Region, Aalborg Hospital-Aarhus University Hospital, Aalborg, Denmark.
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Chou LW, Hong CZ, Wu ES, Hsueh WH, Kao MJ. Serial Ultrasonographic Findings of Plantar Fasciitis After Treatment With Botulinum Toxin A: A Case Study. Arch Phys Med Rehabil 2011; 92:316-9. [DOI: 10.1016/j.apmr.2010.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 08/04/2010] [Accepted: 10/14/2010] [Indexed: 11/29/2022]
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Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial. Lasers Med Sci 2009; 25:275-81. [DOI: 10.1007/s10103-009-0737-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 09/21/2009] [Indexed: 10/20/2022]
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Abstract
Plantar fasciitis is a painful condition affecting many athletes. Anatomic and biomechanical factors combined with overuse can contribute to its genesis. Correction of gait disturbances, changes in footwear, use of tension night splints, and stretching of tight calf and plantar tissues have all be proven to relieve symptoms. Anti-inflammatory modalities, including medications, iontophoresis, and corticosteroid injection generally provide temporary improvement. Recent studies on the efficacy of extracorporeal shock wave therapy are conflicting. Injections with platelet-rich plasma or sclerotic agents are currently under investigation for use in this and other similar conditions. A small percentage of patients with refractory symptoms may benefit from surgical release of the plantar fascia. Diagnosis and correction of biomechanical factors leading to this condition should be a mainstay of treatment and may prevent recurrences.
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Affiliation(s)
- James L Glazer
- Division of Sports Medicine, Department of Family Medicine, Maine Medical Center, 272 Congress Street, Portland, ME 04103, USA.
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Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis. Arch Orthop Trauma Surg 2009; 129:695-701. [PMID: 18839190 DOI: 10.1007/s00402-008-0760-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Indexed: 02/09/2023]
Abstract
BACKGROUND The aim of the study was to compare the efficacies of steroid injections guided by scintigraphy, ultrasonography, and palpation in plantar fasciitis. METHODS A total of 35 heels of 27 patients were randomly assigned to three steroid injection groups: palpation-guided (pg), ultrasound-guided (ug), and scintigraphy-guided (sg). Patients were evaluated for pain intensity before the injections and at the last follow-up of 25.3 months with a 100-mm visual analog scale (VAS). RESULTS There were significant improvements in plantar fascia thickness, fat pad thickness, and VAS. Among the three groups of ug-pg, ug-sg, and pg-sg there were no statistically significant differences after treatment (P = 0.017, MWU = 36.5; P = 0.023, MWU = 29.5; and P = 0.006, MWU = 13, respectively). CONCLUSIONS The ug, pg, and sg injections were effective in the conservative treatment of plantar fasciitis. We are of the opinion that steroid injections should be performed, preferably with palpation or ultrasonographic guidance.
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Greve JMD, Grecco MV, Santos-Silva PR. Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis. Clinics (Sao Paulo) 2009; 64:97-103. [PMID: 19219314 PMCID: PMC2666476 DOI: 10.1590/s1807-59322009000200006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 10/21/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis. MATERIALS AND METHODS Thirty-two patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 was composed of 16 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 was composed of 16 patients who underwent three applications of radial shockwaves (once a week) and received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 47.3 +/- 10.3 years (range 25-68); 81% were female, 87% were overweight, 56% had bilateral impairment, and 75% 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.
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Affiliation(s)
- Júlia Maria D'Andréa Greve
- Laboratório de Estudos do Movimento - LIM 41 - Departamento de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
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Sorrentino F, Iovane A, Vetro A, Vaccari A, Mantia R, Midiri M. Role of high-resolution ultrasound in guiding treatment of idiopathic plantar fasciitis with minimally invasive techniques. Radiol Med 2008; 113:486-95. [DOI: 10.1007/s11547-008-0277-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Accepted: 08/24/2007] [Indexed: 11/25/2022]
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Wearing SC, Smeathers JE, Sullivan PM, Yates B, Urry SR, Dubois P. Plantar fasciitis: are pain and fascial thickness associated with arch shape and loading? Phys Ther 2007; 87:1002-8. [PMID: 17553919 DOI: 10.2522/ptj.20060136] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Although plantar fascial thickening is a sonographic criterion for the diagnosis of plantar fasciitis, the effect of local loading and structural factors on fascial morphology are unknown. The purposes of this study were to compare sonographic measures of fascial thickness and radiographic measures of arch shape and regional loading of the foot during gait in individuals with and without unilateral plantar fasciitis and to investigate potential relationships between these loading and structural factors and the morphology of the plantar fascia in individuals with and without heel pain. SUBJECTS The participants were 10 subjects with unilateral plantar fasciitis and 10 matched asymptomatic controls. METHODS Heel pain on weight bearing was measured by a visual analog scale. Fascial thickness and static arch angle were determined from bilateral sagittal sonograms and weight-bearing lateral foot roentgenograms. Regional plantar loading was estimated from a pressure plate. RESULTS On average, the plantar fascia of the symptomatic limb was thicker than the plantar fascia of the asymptomatic limb (6.1+/-1.4 mm versus 4.2+/-0.5 mm), which, in turn, was thicker than the fascia of the matched control limbs (3.4+/-0.5 mm and 3.5+/-0.6 mm). Pain was correlated with fascial thickness, arch angle, and midfoot loading in the symptomatic foot. Fascial thickness, in turn, was positively correlated with arch angle in symptomatic and asymptomatic feet and with peak regional loading of the midfoot in the symptomatic limb. DISCUSSION AND CONCLUSION The findings indicate that fascial thickness and pain in plantar fasciitis are associated with the regional loading and static shape of the arch.
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Affiliation(s)
- Scott C Wearing
- Centre of Excellence for Applied Sport Science Research, Queensland Academy of Sport, Queensland, Australia.
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Liang HW, Wang TG, Chen WS, Hou SM. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy. Clin Orthop Relat Res 2007; 460:219-25. [PMID: 17353798 DOI: 10.1097/blo.0b013e31804ffd19] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.
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Affiliation(s)
- Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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