Intense Therapeutic Ultrasound for Plantar Fasciitis

NewsBot · Oct 13, 2016

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Randomized Controlled Trial of Intense Therapeutic Ultrasound for the Treatment of Chronic Plantar Fasciitis
L. Daniel Latt, MD, PhD, et al
Foot & Ankle Orthopaedics September 2016 – December 2016 vol. 1 no. 1

Introduction/Purpose: Initial treatment of plantar fasciitis (PF), consisting of anti-inflammatories, stretching and in-shoe orthosis (heel pad, heel wedge, or arch support), leads to symptomatic resolution in over 90% of patients but takes 3-6 months. This study was conducted to test the effectiveness of a minimally invasive modality, intense therapeutic ultrasound (ITU), in accelerating the healing of chronic plantar fasciitis (PF). ITU uses high-frequency high-intensity focused ultrasound to create small thermal injury zones inside soft tissue without damage to surrounding structures. ITU has been shown to initiate a tissue repair cascade and promote collagen generation in dermal and musculoskeletal tissue and is FDA approved for use in non-surgical brow lifts [1,2]. The goal of this study was to determine if ITU when combined with standard therapy could speed the healing of chronic PF.
Methods: 47 patients with chronic (greater than 3 months) heel pain due to PF were randomized to standard therapy (anti- inflammatory pills, stretching, and gel heel cups) plus ITU (“ITU”, n=33) or standard therapy plus sham ITU (“control”, n=14) groups. ITU treatments were administered at enrollment and two-weeks later using a custom 3.3 MHz therapeutic ultrasound system (Guided Therapy Systems, Mesa, AZ). Sham treatment utilized the same protocol but with the energy set to 0 Joules. Treatment effect was assessed at 2, 4, 6, and 12 weeks after the initiation of treatment using diagnostic ultrasound and patient reported outcomes (PROMIS physical function computer adaptive test, PROMIS global health, Foot Function Index pain subscale, and a non-validated heel pain specific questionnaire). Ultrasound images were analyzed to determine the size of lesions within the PF. Both the sonographer and the study coordinator administering the patient reported outcome instruments were blinded to group assignment.
Results: 38 patients completed the 12 week study (ITU: n=37, Control: n=11.). The ITU group reported a significantly greater reduction in heel pain scores [Mean 8.27, SD 4.69, P=0.027] compared to the control group [Mean 2.25, SD 5.92] (Figure 1). Ultrasound imaging showed an 81% decrease in perifascial lesion size in the treatment group, compared to a 26% increase in lesion size in the control group (Figure 2).
Conclusion: Preliminary results of this clinical study of noninvasive ITU for the treatment of chronic PF showed that ITU treatment as compared to sham control lead to a larger and more rapid reduction of heel pain and perifascial lesion size. ITU holds promise as a potential therapy to accelerate the healing of chronic plantar fasciitis
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Craig Payne · Oct 13, 2016

Well, on the surface, that looks to head things in a different direction to what has been preached in recent years.
However, and I not seen full paper, two alarm bells go of from abstract

if it is an RCT, then how do you end up with 33 in one group and 14 in the other? - the odds of that happening by randomization are astronomical. Hopefully they explain that in the full paper

they used a within groups analysis rather than a between groups analysis. fail.

NewsBot · Jan 5, 2017

Musculoskeletal treatments using intense therapy ultrasound: Clinical studies for chronic plantar fasciitis and lateral epicondylitis
Michael H. Slayton ; Richard C. Amodei ; Keegan B. Compton ; Daniel Latt ; John Kearney
Healthcare Innovation Point-Of-Care Technologies Conference (HI-POCT), 2016 IEEE

Background/Objective: Intense Therapy Ultrasound (ITU) effectively creates thermal injury zones inside soft tissue, initiating a tissue repair cascade in the skin, promoting collagen generation. It may be feasible to promote a robust healing response in musculoskeletal tissue accelerating healing from injury [1]. The objectives of the studies were to establish the feasibility of treatment by High Frequency ITU for Plantar Fasciitis and Lateral Epicondylitis.
Protocols/Methods: Chronic Plantar Fasciitis: Two treatments, 2 weeks apart, 38 patients, (27-treated, 11-sham group) consisted of 250–320 80 msec pulses creating matrices of small ablative thermal lesions of 4–5 joules at a pre-programmed pitch of 1.6 mm. Each treatment did not exceed 12 minutes. Treatment effects were assessed with diagnostic ultrasound imaging at 12 MHz. Ultrasound images were analyzed to determine changes in peri-fascial lesion size. Patients reported outcomes at 2, 4 6 and 12 weeks after initiating treatment [2].
Chronic Lateral Epicondylitis: Two treatments, 4 weeks apart, 24 patients, consisting of 80 14 msec pulses creating matrices of small ablative thermal lesions of 1 joule. Manually targeted area mapped by diagnostic ultrasound imaging. Each treatment was less than 10 minutes. Treatment effects were assessed with diagnostic ultrasound at 17MHz. Patient reported outcomes at 2, 4, 8 and 12 weeks after initial treatment. For both studies patients randomized, the principal investigator, sonographer and study coordinator administering the study were blinded to clinical assessments and diagnostic ultrasound results.
Results/Conclusions: Plantar Fasciitis: Results of the double blinded, randomized, sham controlled study for the treatment of Plantar Fasciitis with ITU appeared to have significant positive results within 12 weeks' post-treatment in 81% of patients treated. Both quantitative measurements from diagnostic ultrasound imaging and applied standardized assessment protocols showed statistically significant coincidental improvements in treated patients vs. control group.
Chronic Lateral Epicondylitis: Statistically significant improvements were seen in 75% of patients and diagnostic ultrasound images show significant reduction in free fluid at 8 weeks compared to baseline images in patients with no to mild peri-tendon calcifications. These patients correlated well with significantly improved PRTEE survey scores. Few patients with little or no improvement in PRTEE scores consistently presented with moderate to severe peri-tendon calcifications.
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NewsBot · Jul 10, 2018

COMPARATIVE STUDY OF SELF STRETCHING AND ULTRA SOUND FOR
PLANTAR FASCIITIS
Dr. S. Subbiah
Volume-7 | Issue-3 | March-2018 | ISSN No 2277 - 8179 | IF : 4.758 | IC Value : 93.98

Aim of this study was to compare the self stretching and ultra sound for plantar fasciitis. For this purpose twenty (N=20) planter fasciitis patients
were selected as subjects. Based on the treatment duration the group was divided into two groups of ten each, group-I was treated Self-stretching
Exercise for Plantar fascia and group-II was treated with ultra sound. Both groups were treated for a period of one week. Pain was measured before
and after the treatment through numerical pain rating scale (NPRS). The data obtained from the experimental groups before and after the treatment
period were statistically analyzed with Students 't' test. The results of the study found both Self-stretching Exercise and ultra sound treatment
effective in pain of Plantar fascia relief. But the patient treated with ultra sound showed better pain relief then patients who received ultra sound
treatment
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Craig Payne · Jul 10, 2018

NewsBot said: ↑

COMPARATIVE STUDY OF SELF STRETCHING AND ULTRA SOUND FOR
PLANTAR FASCIITIS
Dr. S. Subbiah
Volume-7 | Issue-3 | March-2018 | ISSN No 2277 - 8179 | IF : 4.758 | IC Value : 93.98
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OMG!
- not randomized
- only 1 week follow up
- within groups analysis rather than between groups
NEXT.

NewsBot · Jul 12, 2018

Additive Effect of Therapeutic Ultrasound in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial
Yigal Katzap et al
J Orthop Sports Phys Ther, Epub 11 Jul 2018. doi:10.2519/jospt.2018.8110

Study Design
A prospective, randomized, double-blinded, placebo-controlled clinical trial.

Background
Plantar fasciitis is the main cause of pain in the plantar surface of the heel. One of the most common conservative treatment modalities used by physical therapists worldwide is therapeutic ultrasound, despite the scarce evidence of its efficacy in the treatment of plantar fasciitis.

Objective
To evaluate the additive effect of therapeutic ultrasound in the treatment of plantar fasciitis in terms of pain, function, and quality of life.

Methods
54 patients afflicted with plantar fasciitis, aged 24-80, who met the inclusion criteria, were randomized into an active intervention group and treated by self-performed stretching of the plantar fascia and calf muscles in addition to therapeutic ultrasound. The control group was treated with the same stretching exercises with an addition of sham ultrasound. Both groups received eight treatments, twice weekly. Outcome measures included a Numeric Pain Rate Scale (NPRS), the Foot & Ankle Computerized Adaptive Test (CAT) and an algometric test.

Results
Both groups showed statistically significant improvement in all outcome measures (P<0.001, both groups). At the completion of the study, no statistically significant differences were found between the groups in any of the outcomes.

Conclusions
The addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis, therefore, we recommend excluding therapeutic ultrasounds from the treatment of plantar fasciitis. We agree with the results of previous studies that stretching may be an effective treatment for healing plantar fasciitis.
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NewsBot · Mar 24, 2019

Intense Therapeutic Ultrasound for Treatment of Chronic Plantar Fasciitis: A Pivotal Study Exploring Efficacy, Safety, and Patient Tolerance
Evelyn Heigh et al
JFAS: Article in Press: March 23, 2019

Intense therapeutic ultrasound for chronic plantar fasciitis musculoskeletal tissue pain reduction was evaluated in a pivotal clinical trial examining effectiveness, safety, and patient tolerance. In this single-blinded study, 33 patients received 2 treatments that were 4 weeks apart on plantar fascia tissue along with conservative standard of care. Patients were followed for up to 6 months after the first treatment, receiving a physical examination and diagnostic ultrasound at each follow-up visit and completing patient-/subject-reported outcome measure and Foot Function Index surveys. The goal was to reduce overall pain by ≥25% on average and >25% individually. Hypoechoic area changes on diagnostic ultrasound and adverse events were measured. The percentage meeting pain reduction criteria at weeks 4, 8, 12, and 26 were 72%, 81%, 86%, and 79%, respectively. Mean pain scores at each visit were significantly different from baseline (p < .001) at –39%, –49%, –51%, and –44%. Hypoechoic lesions were found in all patients and decreased in size significantly (p < .05) at weeks 8 and 12 (–56% and –67%). Foot Function Index scores declined favorably from baseline (p < .001) at all time points (–32%, –46%, –49%, and –32%). The percentages of patients meeting satisfaction criteria were 72%, 85%, 90%, and 83%. The mean pain score during treatment 1 was 3.4, and during treatment 2, 2.9. Attrition of only 1 patient owing to pain occurred, after treatment 1. No adverse events occurred. Intense therapeutic ultrasound for chronic plantar fasciitis is shown to be effective, safe, and well tolerated in this pivotal clinical trial.
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NewsBot · Nov 26, 2019

This clinical trial was just registered:
The Effectiveness of Ultrasound Treatment in the Management of Plantar Fasciitis

The purpose of this study is to examine the effectiveness of ultrasound treatment in addition to a program consisting of manual therapy and exercise (stretching and strengthening exercises) to improve pain and function in individuals with plantar fasciitis. Our primary hypothesis is individuals with plantar fasciitis will show a greater improvement in pain and function with ultrasound, manual therapy and an exercise program compared to manual therapy and exercise program alone.
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NewsBot · May 28, 2021

The use of low intensity pulsed ultrasound in the foot and ankle
Mustafa S Rashid et al
EFORT Open Rev. 2021 Apr 1;6(4):217-224

Low intensity pulsed ultrasound (LIPUS) therapy has demonstrated clinical effectiveness in achieving union in a variety of fracture situations.Few studies have investigated the effectiveness of LIPUS therapy in foot and ankle surgery.The overall rate of union in all published studies relating to the use of LIPUS in a variety of foot and ankle fracture and fusion situations is 95%.Some studies suggest lower healing rates (~ 67%) when LIPUS therapy is used to treat hindfoot fusion nonunion.A well-powered, high-quality, randomized controlled trial is needed to demonstrate the clinical and cost effectiveness of LIPUS therapy in foot and ankle surgery.
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NewsBot · Aug 14, 2021

Comparison of laser versus ultrasound therapy in management of chronic plantar fasciitis
Gururaj Joshi , Anu Ranjan
BHARATI VIDYAPEETH MEDICAL JOURNAL (BVMJ) | VOL-1 - No. 2 | April - June 2021

The most common cause of heel pain is “plantar fasciitis” which is accountable for 80% of the cases. There are
limitations in its treatment availability. The non-surgical treatments although have shown promising response and
satisfactory outcomes. Such two treatments viz. laser and ultrasound therapy were studied and compared in plantar
fasciitis patients. In the present study 100 plantar fasciitis patients recruited and divided into two groups with 50
patients each, one group was treated with laser therapy and the other with ultrasound therapy. The outcomes were
reported in the form of Visual Analog Scale (VAS) and Foot Function Index (FFI) scores. There was a promising
improvement noted in VAS score and FFI score when compared within the groups. The comparison of these scores
between the groups revealed laser therapy to be more effective in reducing the symptoms than the ultrasound
therapy, as the VAS and FFI scores were significantly improved in laser therapy group compared to ultrasound
therapy. So here we conclude the laser therapy is more effective in relieving from the symptoms of plantar fasciitis as
compared to ultrasound therapy.
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NewsBot · Sep 7, 2023

Comparison between Therapeutic Ultrasound and Laser Therapy in
Treatment of Plantar Fasciitis Diagnosed by Ultrasonography
Maha Arafa Ali, Abeer Fikry A. Eldawoody, Abdelmoaty Ali Afifi
The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6508- 6513

Background: The majority of people who experience pain in the plantar surface of their heel have plantar fasciitis
(PF). Patients who suffer from chronic plantar fasciitis have access to a variety of additional treatment options, such as
extracorporeal shockwave therapy, ultrasound (US) therapy, low-level laser therapy, and surgical plantar fasciotomy.
Objective: This study aimed to evaluate the efficacy of therapeutic US in comparison with laser therapy in plantar
fasciitis treatment.
Methods: This prospective randomized clinical study included 56 patients diagnosed as plantar fasciitis. The patients
were divided into two groups according to the treatment they received. Group (1) had 28 patients who were treated by
laser therapy (scanning method), with 808 nm wavelength. The area is irradiated in 3 points over 3 cm2
three times
weekly for 2 weeks and group (2) had 28 patients who were treated by ultrasound therapy at a frequency of 3 MHZ in
a pulsed mode (1;4) for eight minutes (min) at an intensity of 0.5W/cm2
three times weekly for 4 weeks. Hamstrings
and calf muscles were stretched.
Results: The Mayo score, the foot and ankle ability and the foot function index pain subscale (FFI-P) thad
significantly improved in both groups four and eight weeks after treatment in comparison with the baseline and at 8
weeks compared to 4 weeks. The improvement was significantly higher in the laser therapy at 8 weeks after treatment.
The plantar fascia thickness (PFT) decreased significantly in both groups 4 and 8 weeks after treatment compared to
the baseline and at 8 weeks compared to 4 weeks.
Conclusion: When it comes to the treatment of PF, it has been demonstrated that laser therapy, specifically the
scanning method, when combined with stretching exercises, is more effective than traditional ultrasound.
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NewsBot · Mar 26, 2024

Effectiveness of therapeutic ultrasound on reducing pain intensity and functional disability in patients with plantar fasciitis: a systematic review of randomised controlled trials
Anas Mohammed Alhakami et al
Peer J

Background
Ultrasound therapy is one of the preferred conservative treatments for patients with plantar fasciitis. This study aims to evaluate the effectiveness of therapeutic ultrasound in decreasing pain intensity and improving functional disability in patients with plantar fasciitis.

Methods
Five randomised control trials (RCT) were selected based on an electronic search in PubMed, Trip Database and PEDro. To be included in the systematic review, the study should be an RCT which investigated the effectiveness of therapeutic ultrasound conducted in patients with plantar fasciitis with pain intensity and functional disability as outcome measures. Only studies published in peer-reviewed journals written in the English language were included. The quality of the selected studies was measured by the PEDro scale.

Results
All the included studies showed that ultrasound therapy is beneficial in reducing pain score and improving functional disability, except one study did not recommend using ultrasound therapy for plantar fasciitis. Moreover, regarding another outcome measure, two studies found that ultrasound therapy reduces thickness and tenderness in plantar fasciitis and improves static and dynamic balance.

Conclusion
After reviewing the five studies, this systematic review support using ultrasound therapy to decrease pain and improve functional disability in patients with plantar fasciitis.Effectiveness of therapeutic ultrasound on reducing pain intensity and functional disability in patients with plantar fasciitis: a systematic review of randomised controlled trials
Systematic reviewAnesthesiology and Pain ManagementClinical TrialsDrugs and DevicesOrthopedicsRehabilitation
Anas Mohammed Alhakami1, Reem Abdullah Babkair1, Ahmad Sahely2,3, Shibili Nuhmani1
March 22, 2024Read the peer review reports
Author and article information
Abstract

Background
Ultrasound therapy is one of the preferred conservative treatments for patients with plantar fasciitis. This study aims to evaluate the effectiveness of therapeutic ultrasound in decreasing pain intensity and improving functional disability in patients with plantar fasciitis.

Methods
Five randomised control trials (RCT) were selected based on an electronic search in PubMed, Trip Database and PEDro. To be included in the systematic review, the study should be an RCT which investigated the effectiveness of therapeutic ultrasound conducted in patients with plantar fasciitis with pain intensity and functional disability as outcome measures. Only studies published in peer-reviewed journals written in the English language were included. The quality of the selected studies was measured by the PEDro scale.

Results
All the included studies showed that ultrasound therapy is beneficial in reducing pain score and improving functional disability, except one study did not recommend using ultrasound therapy for plantar fasciitis. Moreover, regarding another outcome measure, two studies found that ultrasound therapy reduces thickness and tenderness in plantar fasciitis and improves static and dynamic balance.

Conclusion
After reviewing the five studies, this systematic review support using ultrasound therapy to decrease pain and improve functional disability in patients with plantar fasciitis.Effectiveness of therapeutic ultrasound on reducing pain intensity and functional disability in patients with plantar fasciitis: a systematic review of randomised controlled trials
Systematic reviewAnesthesiology and Pain ManagementClinical TrialsDrugs and DevicesOrthopedicsRehabilitation
Anas Mohammed Alhakami1, Reem Abdullah Babkair1, Ahmad Sahely2,3, Shibili Nuhmani1
March 22, 2024Read the peer review reports
Author and article information
Abstract

Background
Ultrasound therapy is one of the preferred conservative treatments for patients with plantar fasciitis. This study aims to evaluate the effectiveness of therapeutic ultrasound in decreasing pain intensity and improving functional disability in patients with plantar fasciitis.

Methods
Five randomised control trials (RCT) were selected based on an electronic search in PubMed, Trip Database and PEDro. To be included in the systematic review, the study should be an RCT which investigated the effectiveness of therapeutic ultrasound conducted in patients with plantar fasciitis with pain intensity and functional disability as outcome measures. Only studies published in peer-reviewed journals written in the English language were included. The quality of the selected studies was measured by the PEDro scale.

Results
All the included studies showed that ultrasound therapy is beneficial in reducing pain score and improving functional disability, except one study did not recommend using ultrasound therapy for plantar fasciitis. Moreover, regarding another outcome measure, two studies found that ultrasound therapy reduces thickness and tenderness in plantar fasciitis and improves static and dynamic balance.

Conclusion
After reviewing the five studies, this systematic review support using ultrasound therapy to decrease pain and improve functional disability in patients with plantar fasciitis.
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