Ann Rehabil Med.  2013 Jun;37(3):379-388. 10.5535/arm.2013.37.3.379.

Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

• Lee SJ
• Kang JH
• Kim JY
• Kim JH
• Yoon SR
• Jung KI

• KMID: 2219535
• DOI: http://doi.org/10.5535/arm.2013.37.3.379

Abstract

OBJECTIVE
To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis.
METHODS
Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT.
RESULTS
Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05).
CONCLUSION
Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT.

Keyword

Plantar fasciitis; Extracorporeal shock wave therapy; Dose-related Effect

MeSH Terms

Fascia
Fasciitis, Plantar
Follow-Up Studies
Humans
Outcome Assessment (Health Care)
Shock

Figure

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  Fig. 1 Flow diagram showing the treatment process and assessment. ESWT, extracorporeal shock wave therapy; EFD, energy flux density.

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  Fig. 2 Ultrasonographic finding of plantar fasciitis. (A) Thickening of the plantar fascia, Sagittal sonogram of 40-year-old man who had a clinical diagnosis of plantar fasciitis. (B) Normal sonographic finding of plantar fascia.

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  Fig. 3 Temporal changes of pain (mean±standard deviation) at 0 and 1 week and at 1-3 month follow-up after extracorporeal shock wave therapy (ESWT) in the same total energy influx groups (groups M3 and L6). Group M3, 3 sessions of medium-energy (0.16 mJ/mm2) in ESWT group; group L6, 6 session of low-energy (0.08 mJ/mm2) ESWT group; VAS (U), visual analogue scale at usual time; VAS (F), visual analogue scale at first step in the morning; VAS (C), visual analogue scale of compression at calcaneus; VAS (S), visual analogue scale at sleeping. No significant difference was observed between both groups in VAS (U), p=0.717; VAS (F), p=0.778; VAS (C), p=0.829; and VAS (S), p=0.998. a)p<0.001 significantly different vs. 0 week within group M3. b)p<0.001 significantly different vs. 0 week within group L6.

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  Fig. 4 Temporal changes of Roles and Maudsley score (mean±standard deviation) at 0 and 1 week and at 1-3 months follow-up after extracorporeal shock wave therapy in the same total energy influx groups (groups M3 and L6). a)p<0.001 significantly different vs. 0 week within group M3. b)p<0.001 significantly different vs. 0 week within group L6. No significant difference between both groups (p=0.689) in Roles and Maudsley score.

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  Fig. 5 Temporal changes of plantar fascia thickness (mean±SD) at 0 and 1 week and at 1-3 month follow-up after extracorporeal shock wave therapy in the same total energy influx groups (group M3 and L6). a)p<0.001 significant difference vs. 0 week within group M3. b)p<0.001 significant difference vs. 0 week within group L6. No significant difference occurred between both groups (p=0.859) in plantar fascia thickness.

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