Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

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.

[1]  R. Cofield,et al.  Shoulder Arthroplasty for Arthritis After Instability Surgery , 2002, The Journal of bone and joint surgery. American volume.

[2]  P. Pasquina,et al.  Treatment of Pain Attributed to Plantar Fasciitis with Botulinum Toxin A: A Short-Term, Randomized, Placebo-Controlled, Double-Blind Study , 2005, American journal of physical medicine & rehabilitation.

[3]  F. Baldi,et al.  Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis , 2001, Annals of the rheumatic diseases.

[4]  J. Feller,et al.  Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial , 2004, British Journal of Sports Medicine.

[5]  D. S. Malay,et al.  Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. , 2006, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[6]  B. Nafe,et al.  Shock Wave Application for Chronic Plantar Fasciitis in Running Athletes: A Prospective, Randomized, Placebo-Controlled Trial , 2003, The American journal of sports medicine.

[7]  D. Kohn,et al.  Extracorporeal Shock Wave Therapy (ESWT) in Patients with Chronic Proximal Plantar Fasciitis: A 2-Year Follow-up , 2003, Foot & ankle international.

[8]  W. Tsai,et al.  Reproducibility of sonographic measurement of thickness and echogenicity of the plantar fascia , 2012, Journal of clinical ultrasound : JCU.

[9]  N. Karabulut,et al.  Clinical Utility of Sonography in Diagnosing Plantar Fasciitis , 2005, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[10]  M. Wong,et al.  Ultrasound evaluation of plantar fasciitis. , 2000, Scandinavian journal of rheumatology.

[11]  Kuender D Yang,et al.  Long-term Results of Extracorporeal Shockwave Treatment for Plantar Fasciitis , 2006, The American journal of sports medicine.

[12]  C. Şen,et al.  Ultrasonographic appearance of the plantar fasciitis. , 2003, Clinical imaging.

[13]  Alan C League,et al.  Current Concepts Review: Plantar Fasciitis , 2008, Foot & ankle international.

[14]  Huey-Wen Liang,et al.  Thinner Plantar Fascia Predicts Decreased Pain after Extracorporeal Shock Wave Therapy , 2007, Clinical orthopaedics and related research.

[15]  M. Wong,et al.  Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. , 2000, Archives of physical medicine and rehabilitation.

[16]  Christopher F. Hyer,et al.  Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. , 2005, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[17]  G. Long,et al.  Ultrasound of the plantar aponeurosis (fascia) , 1999, Skeletal Radiology.

[18]  R. Buchbinder,et al.  Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial , 2007, BMC musculoskeletal disorders.

[19]  Thomas A. Judy,et al.  Current treatment of plantar fasciitis. , 2002, Current sports medicine reports.

[20]  R. Buchbinder,et al.  Plantar fasciitis , 2004, Santosh University Journal of Health Sciences.

[21]  A. Iagnocco,et al.  Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR “Train the trainers” course , 2005, Annals of the rheumatic diseases.

[22]  E. Berkson,et al.  Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors. , 2009, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[23]  M. Kamel,et al.  High frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. , 2000, The Journal of rheumatology.

[24]  Robert B. Anderson,et al.  Comparison of Custom and Prefabricated Orthoses in the Initial Treatment of Proximal Plantar Fasciitis , 1999, Foot & ankle international.

[25]  A. Goverde,et al.  Train the trainers! , 2006 .

[26]  D. Kohn,et al.  Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy , 2005, Archives of Orthopaedic and Trauma Surgery.

[27]  N. Dastgir Extracorporeal shock wave therapy for treatment of plantar fasciitis. , 2004, JPMA. The Journal of the Pakistan Medical Association.

[28]  J. Ogden,et al.  Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. , 2004, The Journal of bone and joint surgery. American volume.

[29]  T. Toros,et al.  Ultrasonographic evaluation in plantar fasciitis. , 2007, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[30]  R K Chhem,et al.  Plantar fasciitis: sonographic evaluation. , 1996, Radiology.

[31]  Peter Pidcoe,et al.  Risk Factors for Plantar Fasciitis: A Matched Case-Control Study , 2003, The Journal of bone and joint surgery. American volume.

[32]  H. Ozdemir,et al.  Sonographic evaluation of plantar fasciitis and relation to body mass index. , 2005, European journal of radiology.

[33]  M. Midiri,et al.  Role of high-resolution ultrasound in guiding treatment of idiopathic plantar fasciitis with minimally invasive techniques , 2008, La radiologia medica.

[34]  Han-Shiang Chen,et al.  Treatment of Painful Heel Syndrome With Shock Waves , 2001, Clinical orthopaedics and related research.