Biomechanical changes following shockwave for plantar fasciitis

Admin2 · Aug 1, 2013

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Effect of shockwave therapy on plantar fasciopathy
A biomechanical prospective
W-H. Hsu, L-J. Lai, H-Y. Chang, R. W-W. Hsu,
Bone Joint J August 2013 vol. 95-B no. 8 1088-1093

It has been suggested that extracorporeal shockwave therapy is a safe and effective treatment for pain relief from recalcitrant plantar fasciopathy (PF). However, the changes in gait and associated biomechanical parameters have not been well characterised. We recruited 12 female patients with recalcitrant PF who had a mean age of 59 years (50 to 70) and mean body mass index of 25 kg/m2 (22 to 30). The patients reported a mean duration of symptoms of 9.3 months (6 to 15). Shockwave therapy consisting of 1500 impulses (energy flux density 0.26 mJ/mm2) was applied for three sessions, each three weeks apart. A pain visual analogue scale (VAS) rating, plantar pressure assessment and motion analysis were carried out before and nine weeks after first shock wave therapy. It was demonstrated that patients increased their walking velocity and cadence as well indicating a decrease in pain after shockwave therapy. In the symptomatic foot, the peak contact pressure over the forefoot increased and the contact area over the digits decreased. The total foot impulse also decreased as did stance duration. The duration the centre of pressure remained in the hindfoot increased in the symptomatic foot after shockwave therapy. The differences in centre of pressure trajectory at baseline decreased at final follow-up. In conclusion, shockwave therapy not only decreased the pain VAS rating but also improved the gait parameters of the symptomatic foot in PF patients.
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Admin2 · Aug 1, 2013

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efuller · Aug 2, 2013

It was demonstrated that patients increased their walking velocity and cadence as well indicating a decrease in pain after shockwave therapy. In the symptomatic foot, the peak contact pressure over the forefoot increased and the contact area over the digits decreased...... In conclusion, shockwave therapy not only decreased the pain VAS rating but also improved the gait parameters of the symptomatic foot in PF patients.
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Well, it might be interesting information on what gait changes one might expect with plantar heel pain. They do have a correlation between gait and VAS. However, that conclusion is quite a reach.

Eric

NewsBot · Sep 16, 2014

Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings
Jong-Wan Park, et al
Ann Rehabil Med > v.38(4); Aug 2014

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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NewsBot · Jan 10, 2015

Finite element modelling of radial shock wave therapy for chronic plantar fasciitis
Alkhamaali, Zaied
University of Surrey Thesis (Ph.D.) 2014

Plantar fasciitis is a chronic pain condition caused by the inflammation of the connective tissue along the sole of the foot (the plantar fascia). The condition affects up to 10% of the total population during the course of their lives. While non-invasive treatment methods are effective in most cases, surgical procedure is considered if the pain persists for several months. Shock wave therapy has been used as a last resort to avoid surgical intervention after other conservative treatment methods have proved to be ineffective. Radial shock wave therapy uses a ballistic method to generate high-amplitude pressure in the tissue; a metal object of 6-15 mm in diameter (an applicator) is applied superficially to the location that has to be treated. The applicator is impacted by a small cylindrical metal object (projectile) which is driven by compressed air. The understanding of the mechanical effects of shock wave therapy is not complete, and the insight into the mechanisms through which these effects may promote the healing process is at the level of speculation. The objectives of this research are to gain a better understanding of: the physical mechanisms through which the ballistic shock wave source operates; the mechanical stimuli that this method produces in the context of plantar fasciitis treatment; and the potential biological effects of these stimuli on the tissues of the foot. A finite element model of the pressure wave source was constructed based on the geometry of an actual device. The model consisted of the applicator, the projectile, parts of the casing, and the o-rings on which the applicator is suspended in the casing. A finite element model of the foot was also constructed. The model was based on the geometry reconstructed from MRI images of a volunteer and it comprised of bon~s, cartilage, soft tissue, plantar fascia, and Achilles tendon. The material properties for the model components were taken from the literature. Simulations were conducted both to characterise the behaviour of the shock wave source and to simulate the effect of shock wave therapy on the foot. When . the shock wave device is "fired in the air", the bulk movement of the applicator is in the fmm of highly damped oscillations with a maximum displacement of 0.2 mm and a period of about 0.5 ms. The collision between the projectile and the applicator lasts for about 10 f1S which is the time needed for the stress wave to traverse the ii applicator in both directions. After the collision, there is a standing stress wave in the applicator with amplitude of the order of 10 MPa. When the device is applied to the soft tissue of the foot, pressure waves are generated that propagate in all directions. The waves consist of positive and negative pressure phases with the wave length of approximately 10 mm. The magnitude of the pressure generated in the soft tissue is of the order of several MPa, which is consistent with data reported for'· experiments conducted in water. The pressure amplitude at the surface of the soft tissue can be related in a simple way to the speed of the projectile and acoustic impedance of the soft tissue. The pressure magnitude and energy density decrease rapidly with the distance from the source, so that the effect of the treatment is localised to the region where the device is applied. The negative pressure at the plantar fascia origin reaches values of up to 3 MPa which should be sufficient to generate cavitation in the tissue. This result supports the hypothesis that cavitation-induced micro-trauma may be one of the mechanisms that enhance the healing process. Simulations of multiple pulses delivered at 20 Hz show that energy transferred to the foot with a pulse is not dissipated before the subsequent pulse. This result suggests that multiple pulses may lead to accumulation of energy in the foot.
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