Ann Rehabil Med.  2014 Aug;38(4):534-540. 10.5535/arm.2014.38.4.534.

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

• Park JW
• Yoon K
• Chun KS
• Lee JY
• Park HJ
• Lee SY
• Lee YT

• KMID: 2165736
• DOI: http://doi.org/10.5535/arm.2014.38.4.534

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.

Keyword

Plantar fasciitis; Extracorporeal shock wave therapy (ESWT); Ultrasonography; Treatment outcome

MeSH Terms

Diagnosis
Fascia
Fasciitis, Plantar*
Follow-Up Studies
Foot
Heel
Humans
Interviews as Topic
Physical Examination
Shock*
Treatment Outcome
Ultrasonography

Figure

• 

  Fig. 1 Uncertain ultrasonographic finding that does not meet any of the Korean ultrasonographic diagnostic criteria for plantar fasciitis as detailed in the text.

• 

  Fig. 2 Apparent ultrasonographic abnormal finding shows a plantar fascia thickness >3.8 mm.

• 

  Fig. 3 Apparent ultrasonographic abnormal finding shows hypoechogenicity in the plantar fascia.

• 

  Fig. 4 Repeated measure ANOVA test demonstrates that pain score decreases with time up to long-term follow-up (mean 24 months after ESWT) (time effect, p<0.001) without significant group-time interaction (p=0.641 for interaction). The pain scores at short-term follow-up (one week after completion of all ESWT sessions) and long-term follow-up do not show significant difference between the study groups. ESWT, extracorporeal shock wave therapy; NRS, numeric rating scale; Apparent-US, apparent ultrasonographic abnormal group; Uncertain-US, uncertain ultrasonographic group.

Reference

1. League AC. Current concepts review: plantar fasciitis. Foot Ankle Int. 2008; 29:358–366. PMID: 18348838.

2. Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davis W, et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999; 20:214–221. PMID: 10229276.

3. 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; 113:486–495. PMID: 18523846.

4. Tsai WC, Wang CL, Tang FT, Hsu TC, Hsu KH, Wong MK. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil. 2000; 81:1416–1421. PMID: 11030509.

5. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2007; 8:36. PMID: 17442119.

6. Sperling JW, Antuna SA, Sanchez-Sotelo J, Schleck C, Cofield RH. Shoulder arthroplasty for arthritis after instability surgery. J Bone Joint Surg Am. 2002; 84:1775–1781. PMID: 12377907.

7. Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil. 2005; 84:649–654. PMID: 16141740.

8. May TJ, Judy TA, Conti M, Cowan JE. Current treatment of plantar fasciitis. Curr Sports Med Rep. 2002; 1:278–284. PMID: 12831690.

9. Malay DS, Pressman MM, Assili A, Kline JT, York S, Buren B, 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. J Foot Ankle Surg. 2006; 45:196–210. PMID: 16818146.

10. Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int. 2004; 25:290–297. PMID: 15134608.

11. Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes: a prospective, randomized, placebo-controlled trial. Am J Sports Med. 2003; 31:268–275. PMID: 12642264.

12. Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg Am. 2004; 86:2216–2228. PMID: 15466731.

13. Haake M, Buch M, Schoellner C, Goebel F, Vogel M, Mueller I, et al. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ. 2003; 327:75. PMID: 12855524.

14. Buchbinder R. Clinical practice: plantar fasciitis. N Engl J Med. 2004; 350:2159–2166. PMID: 15152061.

15. Hyer CF, Vancourt R, Block A. Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. J Foot Ankle Surg. 2005; 44:137–143. PMID: 15768363.

16. Kamel M, Kotob H. High frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. J Rheumatol. 2000; 27:2139–2141. PMID: 10990224.

17. Ozdemir H, Yilmaz E, Murat A, Karakurt L, Poyraz AK, Ogur E. Sonographic evaluation of plantar fasciitis and relation to body mass index. Eur J Radiol. 2005; 54:443–447. PMID: 15899349.

18. Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med. 2005; 24:1041–1048. PMID: 16040817.

19. Karabay N, Toros T, Hurel C. Ultrasonographic evaluation in plantar fasciitis. J Foot Ankle Surg. 2007; 46:442–446. PMID: 17980840.

20. Yoon K, Kim SB, Park JS. Ultrasonographic findings in plantar fasciitis. J Korean Acad Rehabil Med. 2002; 26:181–186.

21. Wang CJ, Wang FS, Yang KD, Weng LH, Ko JY. Long-term results of extracorporeal shockwave treatment for plantar fasciitis. Am J Sports Med. 2006; 34:592–596. PMID: 16556754.

22. Chen HS, Chen LM, Huang TW. Treatment of painful heel syndrome with shock waves. Clin Orthop Relat Res. 2001; (387):41–46. PMID: 11400893.

23. Hammer DS, Adam F, Kreutz A, Kohn D, Seil R. Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int. 2003; 24:823–828. PMID: 14655885.

24. Cosentino R, Falsetti P, Manca S, De Stefano R, Frati E, Frediani B, et al. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis. Ann Rheum Dis. 2001; 60:1064–1067. PMID: 11602481.

25. Chuckpaiwong B, Berkson EM, Theodore GH. Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors. J Foot Ankle Surg. 2009; 48:148–155. PMID: 19232966.

26. Cardinal E, Chhem RK, Beauregard CG, Aubin B, Pelletier M. Plantar fasciitis: sonographic evaluation. Radiology. 1996; 201:257–259. PMID: 8816554.

27. Gibbon WW, Long G. Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol. 1999; 28:21–26. PMID: 10068071.

28. Tsai WC, Chiu MF, Wang CL, Tang FT, Wong MK. Ultrasound evaluation of plantar fasciitis. Scand J Rheumatol. 2000; 29:255–259. PMID: 11028848.

29. Akfirat M, Sen C, Gunes T. Ultrasonographic appearance of the plantar fasciitis. Clin Imaging. 2003; 27:353–357. PMID: 12932690.

30. Hammer DS, Adam F, Kreutz A, Rupp S, Kohn D, Seil R. Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy. Arch Orthop Trauma Surg. 2005; 125:6–9. PMID: 14530990.

31. Liang HW, Wang TG, Chen WS, Hou SM. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy. Clin Orthop Relat Res. 2007; 460:219–225. PMID: 17353798.

32. Scheel AK, Schmidt WA, Hermann KG, Bruyn GA, D'Agostino MA, Grassi W, et al. Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR "Train the trainers" course. Ann Rheum Dis. 2005; 64:1043–1049. PMID: 15640263.

33. Cheng JW, Tsai WC, Yu TY, Huang KY. Reproducibility of sonographic measurement of thickness and echogenicity of the plantar fascia. J Clin Ultrasound. 2012; 40:14–19. PMID: 22109854.

34. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003; 85:872–877. PMID: 12728038.