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Pabón-Carrasco M, Coheña-Jiménez M, Pérez-Belloso AJ, Algaba-del-Castillo J, Cáceres-Matos R, Castro-Méndez A. Comparison of the Short-Term Effect between Iontophoresis and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:1223. [PMID: 38921337 PMCID: PMC11204007 DOI: 10.3390/healthcare12121223] [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: 05/15/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
Conservative treatments for plantar fasciitis have different levels of effectiveness, so it is necessary to personalize the therapeutic modality that improves the patients' symptoms. METHODS A double-blinded randomized clinical trial was designed to evaluate the short-term efficacy of a physical treatment in chronic plantar fasciitis, namely iontophoresis, compared with radial shockwave therapy. Heel pain, health status using the EuroQol-5D questionnaire, and fascia thickness measured with ultrasound were evaluated. In total, 127 patients were randomly selected for group A and treated with iontophoresis therapy (lidocaine 0.4% and dexamethasone 0.5%), or for group B, in which they were treated with radial shockwave therapy (EWST). Measurements were taken at baseline and at follow-up during the 5 weeks of the study. RESULTS Statistically significant differences were observed to the shockwave therapy group in respect to the final fascia thickness, and the VAS scale (p = 0.001). The differences between groups A and B showed that the shockwave group follow-up after 3 weeks experienced complete pain remission (1.0 ± 0.9; 95%CI 0.8-1.2) and after the 6-week follow-up, complete pain remission of plantar fasciitis was observed for both therapies. Patients had a better perception of the use of EWST at the end of the treatment, although in both groups it was satisfactory (p = 0.001). CONCLUSIONS The results of this study showed a shorter-term effectiveness of shockwave treatment compared with the use of iontophoresis. However, both techniques were effective in satisfactorily reducing pain in this short period.
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Affiliation(s)
| | - Manuel Coheña-Jiménez
- Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain; (M.P.-C.); (A.J.P.-B.); (J.A.-d.-C.); (R.C.-M.)
| | | | | | | | - Aurora Castro-Méndez
- Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain; (M.P.-C.); (A.J.P.-B.); (J.A.-d.-C.); (R.C.-M.)
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Hashmi Y, Zhou AK, Jawaid A, Zhou AY, Shah V, Thahir A, Krkovic M. The role of acetic acid in orthopaedic surgery. J Perioper Pract 2021; 32:162-166. [PMID: 34310234 PMCID: PMC9149521 DOI: 10.1177/17504589211015629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acetic acid has become more commonly used in orthopaedic surgery. The purposed roles
include biofilm eradication and surgical debridement, postoperative scar reduction and
managing soft tissue injuries. Current research is scarce and does not provide conclusive
evidence behind acetic acid’s efficacy in orthopaedic procedures such as biofilm
eradication or acetic acid iontophoresis in soft tissue injuries. Current literature on
acetic acid’s effects on biofilm eradication is composed of in-vitro studies, which do not
demonstrate the potential clinical efficacy of acetic acid. Acetic acid iontophoresis is a
novel technique which is now more commonly accepted for soft tissues injuries. Our
literature search identified calcifying tendonitis of the shoulder, rotator cuff
tendinopathy, heel pain syndrome, plantar fasciitis, achilles tendonitis, calcifying
tendonitis of the ankle, myositis ossificans and cervical spondylosis as documented
clinical uses. In this narrative review, we present the current uses of acetic acid and
acetic acid iontophoresis, while evaluating the evidence revolving around its efficacy,
benefits and risks.
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Affiliation(s)
- Yousuf Hashmi
- College of Medical and Dental Sciences, University of Birmingham, School
of Medicine, Birmingham, UK
- Yousuf Hashmi, College of Medical and Dental
Sciences, University of Birmingham, Birmingham, UK.
| | | | - Anam Jawaid
- College of Medical and Dental Sciences, University of Birmingham, School
of Medicine, Birmingham, UK
| | - Anli Yue Zhou
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Vianca Shah
- Natural Science Department, University of Cambridge, Cambridge, UK
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit,
Cambridge University Hospitals, Cambridge, UK
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit,
Cambridge University Hospitals, Cambridge, UK
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McClinton SM, Cleland JA, Flynn TW. Predictors of response to physical therapy intervention for plantar heel pain. Foot Ankle Int 2015; 36:408-16. [PMID: 25367253 DOI: 10.1177/1071100714558508] [Citation(s) in RCA: 18] [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 Age, weight, and duration of symptoms have been associated with a poor response to treatment for plantar heel pain (PHP), but no studies were identified that examined predictors of response to physical therapy intervention. The purpose of this investigation was to examine the influence of age, body mass index (BMI), and symptom duration on treatment response to physical therapy intervention. METHODS Sixty participants received 6 visits over 4 weeks of physical therapy intervention that included manual therapy and exercise or electrophysiological agents and exercise. Outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), and Global Rating of Change Scale (GRC). Logistic regression (P < .05) was used to analyze age, BMI, and symptom duration as potential predictors of a successful response based on the minimal clinically important difference of the outcome measures. Sensitivity analysis was used to assess the influence of success based on minimal clinically important changes in the FAAM, NPRS, and GRC or only the FAAM and NPRS. Receiver operating curves were used to determine the cut point for the significant predictor. RESULTS At the 6-month follow-up to physical therapy intervention, NPRS was improved by 3 points (95% CI, 2.4-3.6) and FAAM improved by 22.5 points (95% CI, 16.8-28.2). Individuals with symptoms less than 7.2 months were 4.2 (95% CI, 1.3-13.8; P = .016) and 8.5 (95% CI, 2.5-28.9; P = .001) times more likely to respond to treatment based on the NPRS/FAAM/GRC and NPRS/FAAM success criteria, respectively. Age and BMI were not significant predictors (P ≥ .455 and P ≥ .450, respectively). CONCLUSION Age and BMI were not associated with outcomes and obese individuals did achieve a successful outcome with the physical therapy intervention used in the clinical trial. Individuals with PHP symptoms longer than 7 months require additional consideration and further investigation of effective strategies to improve treatment response. LEVEL OF EVIDENCE Prognosis, level 2b comparative study.
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Affiliation(s)
- Shane M McClinton
- Physical Therapy Department, Des Moines University, Des Moines, IA, USA Orthopaedic and Sports Science Program, Rocky Mountain University of Health Professions, Provo, UT, USA
| | - Joshua A Cleland
- Physical Therapy Department, Franklin Pierce University, Manchester, NH, USA
| | - Timothy W Flynn
- Physical Therapy Department, Rocky Mountain University of Health Professions, Provo, UT, USA
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Dardas A, Bae GH, Yule A, Wright J, Straughn N, Day CS. Acetic acid iontophoresis for recalcitrant scarring in post-operative hand patients. J Hand Ther 2014; 27:44-8. [PMID: 24373451 DOI: 10.1016/j.jht.2013.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 10/23/2013] [Accepted: 10/30/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort comparison. INTRODUCTION Using acetic acid iontophoresis (AAI) as a treatment modality significantly improved the functionality of hand in patients with recalcitrant scarring. METHODS Open trigger finger release patients followed up exclusively at a hand clinic between 2009 and 2011 were analyzed. Group I recovered optimal total active range of motion (TAM) after 14 standard of care (SOC) therapy sessions but Group II (10 digits) could only reach optimal recovery after 7 additional AAI sessions. RESULTS After SOC therapy, Group I's TAM recovery plateaued at 245 and Group II's at 219 (p < 0.01). After undergoing AAI, the TAM of Group II increased from 219 to 239 (p < 0.01). DISCUSSION Clinical studies suggest that AAI can modify collagen structure in scars. AAI could be a novel non-surgical treatment for restoring functionality to areas affected by difficult, recalcitrant scars. CONCLUSION AAI significantly improved the TAM of hand surgical patients who could not recover optimally with SOC therapy alone. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Agnes Dardas
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Gordon H Bae
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA; Harvard College, Cambridge, MA, USA
| | - Arthur Yule
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA; Harvard College, Cambridge, MA, USA
| | - Judith Wright
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Noreen Straughn
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Charles S Day
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA.
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Kilfoil RL, Shtofmakher G, Taylor G, Botvinick J. Acetic acid iontophoresis for the treatment of insertional Achilles tendonitis. BMJ Case Rep 2014; 2014:bcr-2014-206232. [PMID: 25056304 DOI: 10.1136/bcr-2014-206232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Gregory Taylor
- Department of Physical Therapy, New York College of Podiatric Medicine, New York, New York, USA
| | - Jessica Botvinick
- Department of Physical Therapy, New York College of Podiatric Medicine, New York, New York, USA
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Abstract
Foot and ankle injuries in athletes are common. Physical therapy plays a fundamental role in the management of sports injuries. The purpose of this article is to (1) raise awareness for using physical therapy for treatment of foot and ankle injuries in athletes, (2) discuss considerations specific to athletes during the rehabilitation process, and (3) increase the reader's knowledge about the in-depth role of physical therapy in the management of foot and ankle injuries in athletes.
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Affiliation(s)
- Suzanne T Hawson
- Physical Therapy Department, University Foot and Ankle Institute, 26357 McBean Parkway, Valencia, CA 91355, USA.
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Cozzarelli J, Sollitto RJ, Thapar J, Caponigro J. A 12-year long-term retrospective analysis of the use of radiofrequency nerve ablation for the treatment of neurogenic heel pain. Foot Ankle Spec 2010; 3:338-46. [PMID: 20817845 DOI: 10.1177/1938640010379048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors discuss their rationale for the use of radiofrequency nerve ablation (RFNA) in the treatment of chronic neurogenic heel pain. Patients treated for plantar fasciitis who fail to improve after conservative and/ or surgical treatment should be reevaluated for a coexistent nerve entrapment. The results of a retrospective study of 82 patients who have undergone RFNA are presented. The patients were followed at 5, 10, and 12 years after the procedure. An evaluation of medical records was performed as a means of inclusion in this study. A standardized telephone interview was then done, and subjectively scored responses of the patients were recorded and analyzed. Of the patients, 89% reported no recurrence of pain after 5, 10, and 12 years postoperatively. The procedure is relatively easy to perform and involves inserting a 22-gauge cannula with an electrode into the areas of pain. This is done under general anesthesia. It takes approximately 15 to 20 minutes per heel to perform, depending on how many sites of tenderness have been identified. The patient is discharged with a minimal bandage and returns to shoe gear immediately following the procedure. The success rate with RFNA appears to be quite high with fewer associated risks and less post-operative morbidity.
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Affiliation(s)
- John Cozzarelli
- Podiatry Associates of Belleville, P.C., Belleville, New Jersey 07109, USA.
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Szabó G, Marcsik Á, Farkas C. Patient information and results of training program in the treatment of plantar fasciitis. Orv Hetil 2010; 151:698-701. [DOI: 10.1556/oh.2010.28849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A sarokfájdalmak egyik leggyakoribb okozója a plantaris fasciitis. Kezelésére számos nem invazív eljárás ismert, amelyek gyakran nem hozzák meg a várt eredményt. Ilyen esetekben elhamarkodottan kerülhet sor helyi szteroidinfiltrációra vagy a műtéti beavatkozásra.
Célkitűzés:
Kidolgoztunk egy könnyen elsajátítható, otthon alkalmazható betegtájékoztató-tréning programot, melynek hatásosságát kívántuk vizsgálni a hagyományos kezelésünkkel összevetve.
Módszer:
A program Achilles-ín- és plantarisfascia-nyújtó, masszázs- és krioterápiás gyakorlatokat tartalmaz, cipőviselési tanácsokat nyújt, amelyet saját képanyagunkkal illusztráltunk. A betegeinket 3 különböző csoportra osztva kezeltük.
Eredmények:
Hathetes kezelést követően a csak iontoforézist kapott betegekhez képest lényegesen javultak a boka- és lábízületi funkciók, ezzel párhuzamosan a betegek panaszai jobban csökkentek a gyógytorna hatására.
Következtetés:
Az általunk kidolgozott betegtájékoztató-tréning program hasznos segítség a mindennapi ortopédiai és a háziorvosi gyakorlat számára is. Műtéti kezelés csak korrektül véghezvitt és eredménytelen konzervatív kezelés után jöhet szóba.
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Affiliation(s)
- Gábor Szabó
- 1 Jósa András Oktatókórház Nonprofit Kft. Traumatológiai és Kézsebészeti Osztály Nyíregyháza Szent István u. 68. 4400
| | - Ákos Marcsik
- 2 Jósa András Oktatókórház Nonprofit Kft. Központi Fizioterápiás Osztály Nyíregyháza
| | - Csaba Farkas
- 3 Jósa András Oktatókórház Nonprofit Kft. Ortopédiai Osztály Nyíregyháza
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De Vera Barredo R, Menna D, Farris JW. An Evaluation of Research Evidence for Selected Physical Therapy Interventions for Plantar Fasciitis. J Phys Ther Sci 2007. [DOI: 10.1589/jpts.19.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Dale Menna
- The Graduate Program in Physical Therapy, Arkansas State University
| | - James W. Farris
- The Graduate Program in Physical Therapy, Arkansas State University
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10
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Osborne HR, Allison GT. Treatment of plantar fasciitis by LowDye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid. Br J Sports Med 2006; 40:545-9; discussion 549. [PMID: 16488901 PMCID: PMC2465091 DOI: 10.1136/bjsm.2005.021758] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine if, in the short term, acetic acid and dexamethasone iontophoresis combined with LowDye (low-Dye) taping are effective in treating the symptoms of plantar fasciitis. METHODS A double blinded, randomised, placebo controlled trial of 31 patients with medial calcaneal origin plantar fasciitis recruited from three sports medicine clinics. All subjects received six treatments of iontophoresis to the site of maximum tenderness on the plantar aspect of the foot over a period of two weeks, continuous LowDye taping during this time, and instructions on stretching exercises for the gastrocnemius/soleus. They received 0.4% dexamethasone, placebo (0.9% NaCl), or 5% acetic acid. Stiffness and pain were recorded at the initial session, the end of six treatments, and the follow up at four weeks. RESULTS Data for 42 feet from 31 subjects were used in the study. After the treatment phase, all groups showed significant improvements in morning pain, average pain, and morning stiffness. However for morning pain, the acetic acid/taping group showed a significantly greater improvement than the dexamethasone/taping intervention. At the follow up, the treatment effect of acetic acid/taping and dexamethasone/taping remained significant for symptoms of pain. In contrast, only acetic acid maintained treatment effect for stiffness symptoms compared with placebo (p = 0.031) and dexamethasone. CONCLUSIONS Six treatments of acetic acid iontophoresis combined with taping gave greater relief from stiffness symptoms than, and equivalent relief from pain symptoms to, treatment with dexamethasone/taping. For the best clinical results at four weeks, taping combined with acetic acid is the preferred treatment option compared with taping combined with dexamethasone or saline iontophoresis.
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Affiliation(s)
- H R Osborne
- Centre for Musculoskeletal Studies, School of Surgery and Pathology, University of Western Australia, Perth, Australia
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GREENBAUM STEVENS. Iontophoresis as a Tool for Anesthesia in Dermatologic Surgery. Dermatol Surg 2001. [DOI: 10.1097/00042728-200112000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
One of the biggest challenges of performing dermatologic surgery procedures is to minimize pain. Not only will the experience of each patient be enhanced by increased comfort, but the medical and aesthetic results achieved by the physician will be facilitated as well. Iontophoresis is the use of electrical impulses to drive molecules into the skin. Anesthetic agents are one type of medicine that can be delivered in such a way. There is a tremendous potential for the applications of iontophoresis to be expanded. As our understanding of the technique increases we will be able to modify the skin's surface as well as the individual agents we wish to transport.
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Affiliation(s)
- S S Greenbaum
- Skin & Laser Surgery Center of Pennsylvania, Philadelphia, Pennsylvania 19102, USA
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