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European Journal of Physical and Rehabilitation Medicine 2022 February;58(1):85-93

DOI: 10.23736/S1973-9087.21.06814-3


language: English

Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial

Lucrezia TOGNOLO 1 , Federico GIORDANI 2, Carlo BIZ 3, Andrea BERNINI 2, Pietro RUGGIERI 3, Carla STECCO 4, Anna C. FRIGO 5, Stefano MASIERO 1

1 Unit of Physical Medicine and Rehabilitation, Department of Neurosciences, University of Padua, Padua, Italy; 2 School of Physical Medicine and Rehabilitation, University of Padua, Padua, Italy; 3 Unit of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy; 4 Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy; 5 Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain. Among the several conservative treatment options, extracorporeal shock wave therapy (ESWT) is considered the standard treatment. However, recent studies suggest that PF may be sustained by a myofascial impairment proximal to the pain area with a biomechanical disequilibrium of the entire limb and pelvis.
AIM: By combining the concepts of fascial manipulation and ESWT, the purpose of this study was to evaluate the effectiveness of the ESWT on myofascial points in a sample of subjects with PF.
DESIGN: Open label randomized controlled clinical trial.
SETTING: Outpatient clinic.
POPULATION: Patients with PF were randomly assigned to an experimental treatment group (EG), treated with focused ESWT on myofascial points, and a control group (CG), treated with the focused ESWT traditional approach on the medial calcaneal tubercle.
METHODS: Every patient underwent a 3-session program and follow-up after 1 and 4 months. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and the Italian Foot Functional Index (17-iFFI).
RESULTS: Thirty patients were enrolled in the study. Four patients of the CG dropped out the study, therefore twenty-six patients were included in the final analysis. Improvement in 17-iFFI and FAOS scores was observed in both groups starting from the third treatment and confirmed at the 1-month and 4-month follow-ups, with earlier improvement in the score values observed in the EG.
CONCLUSIONS: Treatment of the myofascial points with ESWT in subjects suffering from plantar fasciitis could be an effective treatment option. It fosters the hypothesis that a global biomechanical re-equilibrium of the body would be necessary to completely solve the pathology.
CLINICAL REHABILITATION IMPACT: ESWT on myofascial points could provide an interesting alternative with better outcomes in terms of time needed for recovery compared to traditional ESWT for the conservative management of PF.

KEY WORDS: Fasciitis, plantar; Fascia; Extracorporeal shockwave therapy; Rehabilitation; Trigger points

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