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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 October;172(10):759-64
Low-energy extracorporeal shock-wave therapy in treatment of painful heel: double blind randomized controlled, prospective trial with follow-up after 24 months
Marks W. 1, 2, Jackiewicz A. 1, 2, Gołąbek-Dropiewska K. 1, 2, Witkowski Z. 1, 2, Kot J. 1, 2, Stasiak M. 1, 2, Gołaszewski J. 1, 2, Dudek R. 1, 2, Wieruszewski J. 1, 2, Lasek J. 1, 2
1 Department of Trauma Surgery, Medical University of Gdańsk, Gdańsk, Poland;
2 English Division, Department of Hyperbaric Medicine, Medical University of Gdańsk, Gdańsk, Poland
Aim: The low-energy extracorporeal shock wave therapy (ESWT) is widely used in a variety of soft tissue disorders however, no precise algorithm has yet been accepted into clinical management. There are no guidelines regarding energy influx density (high or low energy) and patterns of treatment sessions. The application of a new generation (pneumatic) device (low energy) in patients has not yet been characterized. The purpose of our study is to investigate a homogenous group of patients with plantar fasciitis exposed to ESWT therapy. There are a few similar studies with a significant statistical relevance that have been published to date.
Methods: Our trial consisted of a group of 61 patients (84 heels) who presented with chronic plantar fasciitis. The trial was double blind, randomized controlled. All patients have failed non-surgical treatment and have had suffered from plantar fasciitis for more than 6 months. 4500 shock wave impulses (in three sessions – 500, 2000 and 2000) of energy influx density of 0,16 mJ/mm2 and in total dose of 400 mJ/mm2 were applied. The main measure of outcome was based on the patients’ subjective assessment of pain using the Visual Analog Scale (VAS) and the Roles and Maudsley (RM) score. These were completed before each ESWT session and after 24 months post procedure.
Results and conclusion: The same effect was obtained using placebo therapy as it was using low energy ESWT in patients with painful heels. It is important to note that the treated group did result in a better outcome however without statistical significance. A significant decrease of VAS and RM scores over time in both groups may suggest that we observe a natural history of plantar fasciitis, but a statistically insignificant positive trend is observed in treated patients.