Shock wave versus endoscopic plantar fascial release for resistant plantar fasciitis

NewsBot · Jul 12, 2012

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Resistant plantar fasciopathy: shock wave versus endoscopic plantar fascial release.
Radwan YA, Mansour AM, Badawy WS.
Int Orthop. 2012 Jul 11.

PURPOSE:
To compare the results of Extracorporeal shock wave (ESWT) with a modified endoscopic plantar fasciotomy technique for the treatment of recalcitrant heel pain.

METHOD:
Sixty-five patients suffering from chronic heel pain that failed to respond to standard nonoperative methods were randomized to undergo either high-energy extracorporeal shock wave therapy (group 1), or modified endoscopic plantar fasciotomy (group 2). The primary outcome measure was the reduction of pain in the two groups from base line to month three post intervention at the first few steps in the morning. In addition, patients' functions were assessed using American Orthopedic Foot and Ankle-Hindfoot Scale (AOFAS) at week three, month three, and month 12 post-intervention, and finally, Roles and Maudsley scores were assessed. The primary analysis was intention-to-treat and involved all patients who were randomly assigned.

RESULTS:
Both groups achieved improvement from the base line at 3 weeks, 3 months and 12 months post-intervention. The success rate (Roles and Maudsley score excellent and good) in the ESWT group at month 12 was 70.6 %, while in the fasciotomy group, the success rate was 77.4 % (p = 0.19).

CONCLUSION:
In patients who had experienced failure of conventional treatment of plantar fasciopathy, both endoscopic plantar fasciotomy and shock wave therapy can be potentially helpful lines of management.
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Admin2 · Jul 12, 2012

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NewsBot · Jun 6, 2013

Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete.
Saxena A, Fournier M, Gerdesmeyer L, Gollwitzer H.
Muscles Ligaments Tendons J. 2013 Jan 21;2(4):312-6.

Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient's return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment.
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NewsBot · Mar 25, 2015

Extracorporeal Shockwave Therapy Compared to Fasciotomy for Plantar Fasciitis - A Cost Comparison Analysis
Erin E. Klein, DPM, MS, Grayslake, IL
Lowell S. Weil, DPM, Lake Forest, IL
Lowell S. Weil, DPM, Des Plaines, IL
Michael Bowen, DPM, Des Plaines, IL
Adam Fleischer, DPM, MPH, North Chicago, IL
Mitchell B. Sheinkop, MD, Chicago, IL
Presented at AAOS Annual Meeting; March 2015

INTRODUCTION: With the current ever changing healthcare environment, there has been an increased
emphasis of the cost effectiveness of care provided to patients. Plantar fasciitis is the most encountered
form of heel pain for which a patient presents to the foot and ankle specialists office. There are multiple
conservative and surgical methods to care for this problem. The purpose of this study is to assess the
cost effectiveness of extracorporeal shockwave therapy (ESWT) when compared to surgical release of
the plantar fascia.
METHODS: A database review was undertaken of patients who were treated between 2002 and 2013,
had a diagnosis code of plantar fasciitis (PF), with billing and collections information available for
analysis. Patients were excluded if they had a diagnosis other than plantar fasciitis or if records were not
complete with the information noted above. A cost analysis was then undertaken to compare treatment
with ESWT to surgical release of the plantar fascia. This analysis included the number of patient visits,
direct cost of care to the insurance company, and direct cost of care to the patient during the duration
of the patient's care. Direct costs were calculated from patient billing records. Indirect costs were not
calculated. This study obtained exempted status from the local IRB.
RESULTS: A total of 6,715 patients were included in the analysis. Of these patients, 305 (4.5%) were
treated with ESWT and 100 (1.6%) were treated with surgical release. Patients who underwent surgical
release had an average of five more office visits during the course of their care. The direct cost of care to
insurance companies was $1,471 more for surgical release. The direct total cost of care was $761 more
with surgical release than with ESWT. Results can be seen in Figure 1.
DISCUSSION AND CONCLUSION: Plantar fasciitis is a common problem, accounts for 11-15% of office
visits, and can affect as many as 1 million people yearly1
. Previous literature has demonstrated that
ESWT is as effective as percutaneous fasciotomy but has a significantly shorter recovery period2
. The
current study demonstrates that ESWT is more cost effective than surgical release. When these two
factors are combined, it seems that ESWT may be the more favorable treatment for plantar fasciitis.
ESWT treatment, although not currently covered by most insurance companies, is a cost effective
alternative approach to tendon and fascia problems when compared to more traditional surgical means
of managing these problems.
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NewsBot · Jun 6, 2018

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial.
Vahdatpour B et al
Adv Biomed Res. 2018 Apr 24;7:62. doi: 10.4103/abr.abr_40_17. eCollection 2018.

BACKGROUND:
Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis.

MATERIALS AND METHODS:
Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention.

RESULTS:
One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292).

CONCLUSIONS:
This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.
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