1
|
Yildiz G, Perdecioglu GRG, Yuruk D, Can E, Akkaya OT. Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: a randomized clinical trial. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:493-499. [PMID: 38652568 DOI: 10.1093/pm/pnae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/07/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. DESIGN A prospective, randomized, single-blind study. SETTING Single-center pain clinic. SUBJECTS Forty-nine patients who met the inclusion criteria were randomized into two groups. METHODS Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. RESULTS NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. CONCLUSIONS US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. CLINICAL TRIAL NUMBER NCT06240507.
Collapse
Affiliation(s)
- Gokhan Yildiz
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
| | | | - Damla Yuruk
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
| | - Ezgi Can
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
| | | |
Collapse
|
2
|
Zheng Y, Wang T, Zang L, Du P, Kong X, Hong G, Zhang L, Li J. A Novel Combination Strategy of Ultrasound-Guided Percutaneous Radiofrequency Ablation and Corticosteroid Injection for Treating Recalcitrant Plantar Fasciitis: A Retrospective Comparison Study. Pain Ther 2024:10.1007/s40122-024-00629-y. [PMID: 38960997 DOI: 10.1007/s40122-024-00629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION The best treatment yielding clinical benefits was still equivocal and controversial for the treatment of recalcitrant plantar fasciitis (PF). This study aimed to propose a novel combination strategy of ultrasound-guided percutaneous radiofrequency ablation (RFA) and corticosteroid injection (CI) for recalcitrant PF, and to compare its therapeutic effects with CI alone and continued conservative management. METHODS We retrospectively reviewed consecutive patients with recalcitrant PF who underwent combined strategy (RFA + CI), CI alone, and continue conservative treatment at our institution between October 2021 and February 2023. The technical pearls were described elaborately. A comparison of demographic data and clinical outcomes, including visual analog scale (VAS), Ankle-Hindfoot Scale (AOFAS-AHS), and plantar fascia thickness, were conducted among the three groups. RESULTS Seventy-one eligible patients were enrolled in this study, with 17 in the combined strategy group, 25 in the CI group, and 29 in the continued conservative treatment group. Both the combined strategy group and the CI group showed significant improvements in VAS scores, AOFAS-AHS scores, and significant reductions in plantar fascia thickness during the 12-month follow-up period compared to those preoperatively (P < 0.05). The combined strategy group achieved comparable immediate pain relief to the CI group after the intervention ([25.7 ± 15.7] vs. [20.6 ± 17.6], P = 0.850). However, the combined strategy group demonstrated superior improvement in symptom and function compared to the CI group at the 3-month (VAS: [21.9 ± 13.5] vs. [39.6 ± 20.4]; AOFAS-AHS: [77.9 ± 12.4] vs. [60.5 ± 17.4], P < 0.05) and 12-month follow-up (VAS: [15.7 ± 12.0] vs. [56.8 ± 17.5]; AOFAS-AHS: [84.5 ± 10.7] vs. [53.8 ± 12.4], P < 0.05). Obvious adverse effects or complications were not identified in either group, while two cases (11.8%) in the combined strategy group and five cases (20.0%) in the CI group experienced unsatisfactory symptom remission. CONCLUSIONS We introduced and detailed a novel combination strategy involving ultrasound-guided percutaneous RFA and CI for treating recalcitrant PF. The strategy is both effective and safe in alleviating pain and enhancing function throughout the entire treatment course.
Collapse
Affiliation(s)
- Yinfeng Zheng
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Xiaochuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Gang Hong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Le Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Jian Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| |
Collapse
|
3
|
Orhan Ö, Ağır H, Sarıkaya B, Dolap MA, Akif Altay M. Pain relief and functional improvement provided by extracorporeal shock wave therapy in plantar fasciitis is better than corticosteroid injection and kinesio taping: A randomized trial. Turk J Phys Med Rehabil 2023; 69:469-478. [PMID: 38766588 PMCID: PMC11099853 DOI: 10.5606/tftrd.2023.12824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/16/2023] [Indexed: 05/22/2024] Open
Abstract
Objectives This study aimed to evaluate the results of extracorporeal shock wave therapy (ESWT), corticosteroid injection (CI), and kinesio taping (KT) in terms of pain and function in plantar fasciitis (PF). Patients and methods In this prospective study, 90 feet of 64 patients (11 males, 53 females; mean age: 38.3±10.4 years; range, 22 to 70 years) who presented with chronic PF between November 2021 and March 2022 were evaluated. The patients were randomized to three groups, with 30 feet in each group: the CI group, the ESWT group, and the KT group. Each group received only the respective treatment modalities assigned to their group. Pain assessment of the patients before the treatment and at six weeks, three months, and six months was evaluated with the Visual Analog Scale (VAS), and their functions were evaluated with the American Orthopedic Foot and Ankle Society (AOFAS) score. Results There was no statistical difference in the demographic data (age, body mass index, and VAS; all p>0.05). At six weeks, VAS was statistically significantly lower in the CI group compared to the other groups (p<0.001), but there was no difference in AOFAS between the groups (p=0.666). At three months, there was no statistical difference between the groups regarding VAS (p=0.311), while the AOFAS was higher in the ESWT group (p=0.006). At six months, VAS was lower (p<0.001) and AOFAS was higher (p=0.003) in the ESWT group. Conclusion All three commonly used treatment modalities, ESWT, CI, and KT, are effective in reducing pain and increasing function in chronic PF. However, while CIs can be more effective in relieving pain in the early period, the most significant improvement at the end of the sixth month was achieved by ESWT.
Collapse
Affiliation(s)
- Özlem Orhan
- Department of Orthopedics and Traumatology, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Hatice Ağır
- Department of Physical Medicine and Rehabilitation, Şanlıurfa Regional Training and Research Hospital, Şanlıurfa, Türkiye
| | - Baran Sarıkaya
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Mehmet Ali Dolap
- Department of Orthopedics and Traumatology, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Mehmet Akif Altay
- Department of Orthopedics and Traumatology, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| |
Collapse
|
4
|
Tas NP, Kaya O. Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy? J Clin Med 2023; 12:6503. [PMID: 37892641 PMCID: PMC10607467 DOI: 10.3390/jcm12206503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to compare the effectiveness of ESWT (Extracorporeal Shock Wave Therapy) and RFA (Radiofrequency Thermal Ablation) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. MATERIALS AND METHODS Patients who apply to Orthopedics and Traumatology and Physical Medicine and Rehabilitation departments with a complaint of heel pain are included in this retrospective study. We included patients diagnosed with calcaneal spurs who received treatment with ESWT (n = 80) and RFA (n = 79) between 1 August 2021 and 1 September 2022. All patients were evaluated using the Visual Analog Scale (VAS), Foot Function Index (FFI), and the Roles and Maudsley score (RM) before and after treatment. An evaluation was performed on average 6 months after treatment. RESULTS This study included 79 RFA patients (34 females and 45 males) with a mean age of 55.8 ± 9.6 years and 80 ESWT patients (20 females and 60 males) with a mean age of 49.1 ± 9.5 years. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups (z: -4.98, z: -5.18, respectively, p < 0.001). The reductions in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, although the scores after treatment were lower in the RFA group. CONCLUSIONS This study demonstrates that ESWT and RFA significantly reduced pain, disability, and activity restriction in the treatment of plantar fasciitis in patients with calcaneal spurs. ESWT proved particularly effective in alleviating pain, whereas RFA had more pronounced effects on reducing disability and activity limitations. The choice of treatment should be based on the patient's specific complaints.
Collapse
Affiliation(s)
- Nevsun Pihtili Tas
- Department of Physical Medicine and Rehabilitation, Health Sciences University Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey
| | - Oğuz Kaya
- Department of Orthopedics and Traumatology, Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey;
| |
Collapse
|
5
|
Seth I, Bulloch G, Seth N, Lower K, Rodwell A, Rastogi A, Gibson D, Bedi H. The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis. Foot (Edinb) 2023; 54:101970. [PMID: 36774828 DOI: 10.1016/j.foot.2023.101970] [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: 04/20/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Plantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment. METHODS PubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration's tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST. RESULTS Eighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = - 11.53 [- 16.62; - 6.43], P < 0.0001). CONCLUSION Patients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis. LEVEL OF CLINICAL EVIDENCE II.
Collapse
Affiliation(s)
- Ishith Seth
- Department of Surgery, Peninsula Health, Victoria 3199, Australia; Faculty of Medicine and Science, Central Clinical School, Monash University, Victoria 3004, Australia.; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia.
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Victoria 3010, Australia
| | - Nimish Seth
- Department of Surgery, Peninsula Health, Victoria 3199, Australia; Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Kirk Lower
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Aaron Rodwell
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Anish Rastogi
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Damien Gibson
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Harvinder Bedi
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria 3128, Australia
| |
Collapse
|
6
|
Bildik C, Kaya O. Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial. Foot Ankle Int 2022; 43:1211-1218. [PMID: 35975719 DOI: 10.1177/10711007221114122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF. METHODS PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance. RESULTS Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index (P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups (PVAS = .589; PFADI = .742). CONCLUSION Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups. LEVEL OF EVIDENCE Level I, prospective randomized double-anonymized clinical comparative study.
Collapse
Affiliation(s)
- Celaleddin Bildik
- Orthopedics and Traumatology, Istanbul Atasehir Florence Nightingale, Atasehir, Istanbul, Turkey.,Faculty of Health Sciences, Istanbul Yeni Yüzyil University, Istanbul, Turkey
| | - Ozcan Kaya
- SBU Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Immunopathogenesis, early Detection, current therapies and prevention of plantar Fasciitis: A concise review. Int Immunopharmacol 2022; 110:109023. [PMID: 35834954 DOI: 10.1016/j.intimp.2022.109023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022]
Abstract
Plantar fasciitis or the inflammation of the fascial lining on the plantar aspect of the foot continues to be the leading cause of heel pain for many Americans. Common causes can range from anatomical deformities such as pes planus or flat foot, biomechanical etiology such as excessive pronation of the subtalar joint, or chronic diseases such as obesity and diabetes mellitus. The pathophysiology of plantar fasciitis can be either inflammatory due to vasodilation and immune system activation or non-inflammatory involving fibroblastic hypertrophy. Worsening pain of the inferior and medial heel after periods of prolonged rest and late in the day after hours of ambulation and weight-bearing activities is the most common symptom of plantar fasciitis. Common treatments for plantar fasciitis include plantar fascia stretching, physical therapy, orthotics, corticosteroid injections, and even surgery. Despite these treatment strategies, fasciitis remains a clinical problem and better treatment modalities are warranted. Late diagnosis is a common issue for prolonged and equivocal treatment and early diagnostic measures might be beneficial. In this concise review, we discussed the etiology, immunopathogenesis, current treatments of plantar fasciitis and potentially preventative measures prior to the onset of chronic treatment resistant condition.
Collapse
|
8
|
Zhu S, Niu Y, Wang J, Xu D, Li Y. Artificial Intelligence Technology Combined with Ultrasound-Guided Needle Knife Interventional Treatment of PF: Improvement of Pain, Fascia Thickness, and Ankle-Foot Function in Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3021320. [PMID: 35620204 PMCID: PMC9129964 DOI: 10.1155/2022/3021320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of artificial intelligence (AI) technology combined with ultrasound-guided needle knife intervention in the treatment of plantar fasciitis (PF) on pain, fascia thickness, and ankle and foot function. Methods A total of 130 patients with PF treated in our hospital from January 2019 to April 2021 were enrolled. The patients were randomly assigned into the control group and the study group. The control group received ultrasound-guided needle knife interventional therapy, and the study group received AI technology combined with ultrasound-guided needle knife interventional therapy. The curative effect, VAS score, plantar fascia thickness, plantar fascia elasticity score, plantar fascia blood flow index, and AOFAS score were investigated. Results The total effective rate of the study group was higher compared to that of the control (P < 0.05). There exhibited no significant difference in VAS score before treatment, but the VAS score of the study group was lower compared to that of the control group at 2, 4, and 8 weeks after treatment. There exhibited no significant difference in plantar fascia thickness before treatment (P > 0.05), but after treatment, the plantar fascia thickness in the study group was lower compared to that in the control (P < 0.05). The plantar fascia thickness in the study group was lower compared to that in the control at 2, 4, and 8 weeks after treatment (P < 0.05). In terms of the plantar fascia elasticity score, there exhibited no significant difference before treatment (P > 0.05), but the plantar fascia elasticity score of the study group was lower compared to that of the control at 2, 4, and 8 weeks after treatment (P < 0.05). There exhibited no significant difference in plantar fascia blood flow index before treatment (P > 0.05), but after treatment, the plantar fascia blood flow index in the study group was higher compared to that in the control (P < 0.05). The plantar fascia blood flow index in the study group was higher compared to that in the control at 2, 4, and 8 weeks after treatment (P < 0.05). There exhibited no significant difference in the AOFAS score before treatment, but after treatment, the AOFAS score of the study group was higher compared to that of the control at 2, 4, and 8 weeks after treatment. Conclusion Patients with PF receive AI technology combined with ultrasound-guided needle knife interventional therapy, which can effectively relieve pain and improve fascia thickness and ankle-foot function. Thus, AI technology combined with ultrasound-guided needle knife interventional therapy has the advantages of convenient operation, safety, and effectiveness, which is worthy of clinical application.
Collapse
Affiliation(s)
- Silai Zhu
- Department of Ultrasound Imaging, Wuhan Ninth Hospital, China
| | - Yuli Niu
- Department of Ultrasound Imaging, Wuhan Ninth Hospital, China
| | - Jing Wang
- Department of Ultrasound Imaging, Wuhan Ninth Hospital, China
| | - Dan Xu
- Department of Ultrasound Imaging, Wuhan Ninth Hospital, China
| | - Yong Li
- Department of Ultrasound Imaging, Wuhan Ninth Hospital, China
| |
Collapse
|
9
|
Wheeler PC, Dudson C, Gregory KM, Singh H, Boyd KT. Autologous Blood Injection With Dry-Needling vs Dry-Needling Alone Treatment for Chronic Plantar Fasciitis: A Randomized Controlled Trial. Foot Ankle Int 2022; 43:646-657. [PMID: 35068224 DOI: 10.1177/10711007211061365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Autologous blood injection (ABI) for patients with chronic plantar fasciitis has been promoted as an approach to improve outcomes over standard dry-needling approaches. The purpose of this trial was to investigate if there are improved outcomes following an ultrasonography-guided ABI compared to dry needling alone for patients with chronic plantar fasciitis. METHODS A double-blinded (participant-blinded and observer-blinded) RCT within a single clinic enrolled 90 patients with symptoms of plantar fasciitis that had failed to improve with a minimum of 3 months of rehabilitation. The mean age was 49.5±8.9 years, 67% were female, and the mean symptom duration was 40.0±28.2 months (range: 8 months-10 years). Participants were randomized to receive ABI or an identical dry-needle fenestration-procedure without coadministration of autologous blood. All participants received identical structured rehabilitation and were followed up at 2, 6, 12, and 26 weeks. Outcome measures included local foot pain, validated foot patient-reported outcome measures (Foot Function Index-revised, Manchester-Oxford Foot Questionnaire, Foot and Ankle Ability Measure), measures of general function and "ability" (EuroQol [EQ]-5D-5L, Oswestry Disability Index), specific measures of activity (International Physical Activity Questionnaire), sleep (Pittsburgh Sleep Quality Index), and mood (Hospital Anxiety and Depression Scale). RESULTS There were no significant between-group differences seen at any time-point studied. There were a number of statistically significant within-group improvements for local foot pain and function in both groups comparing baseline/follow-up data. Overall, levels of pain improved by 25% by 6 weeks and by 50% at 6 months. There were improvements in some generalized function markers. Activity rates did not change, demonstrating that improvements in pain did not necessarily influence physical activity. CONCLUSION Coadministration of 3 mL of autologous blood had no additional effect compared to a dry-needling procedure alone for patients with chronic plantar fasciitis. LEVEL OF EVIDENCE Level I, double-blinded randomized controlled trial.
Collapse
Affiliation(s)
- Patrick C Wheeler
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Chloe Dudson
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Kim M Gregory
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Harjinder Singh
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Kevin T Boyd
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| |
Collapse
|
10
|
Effects of intralesional pulsed radiofrequency treatment on pain in patients with calcaneal spur: results of 460 patients. BMC Musculoskelet Disord 2021; 22:1033. [PMID: 34893055 PMCID: PMC8665537 DOI: 10.1186/s12891-021-04926-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the efficacy of intralesional pulsed radiofrequency (RF) in the treatment of calcaneal spur and the results of patients who underwent single and double sessions of RF treatment. Methods The population of this retrospective study consisted of 460 patients who were diagnosed with calcaneal spur with clinical examination and direct radiography. The Wong-Baker Faces Pain Rating Scale and The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were used to determine the pain status and functional capacities of the patients. Posttreatment evaluation was carried out on average in the 6th week. Results The study involved 460 patients, 76.9% of whom were female, with the average age of 50.8 ± 10.9 years in total. Of the patients 43% was given RF therapy in a single session, and 57% of them in double sessions. After the RF procedure, the number of patients whose pain decreased according to both AOFAS and Wong-Baker pain scoring systems increased statistically significantly (p < 0.001). There was a statistically significant increase in the AOFAS-pain scores and the total AOFAS scores and a significant decrease in the Wong Baker-pain scale after treatment. However, there was no significant change in treatment success with respect to the number of RF sessions. Although not statistically significant, the differences in the AOFAS-pain scores and in the total AOFAS scores were found to be higher in patients who underwent single session RF, while the difference in the Wong Baker-pain ranking was higher in patients who received double sessions RF. Conclusion Intralesional pulsed RF procedure can be preferred as a relatively less invasive method that does not have any serious complications in patients with persistent calcaneal spurs who do not respond to the use of oral anti-inflammatory drugs and shoe insoles, nor corticosteroid injection to the lesion area.
Collapse
|