Ultra-som contínuo no tratamento da fasciíte plantar crônica

Effectiveness of therapeutic ultrasound on reducing pain intensity and functional disability in patients with plantar fasciitis: a systematic review of randomised controlled trials

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.

Study Registration

https://osf.io/xftzy/.

Intralesional Steroid Injection Versus Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Comparative, Prospective, Case Series Study

Background This study aimed to compare and evaluate the outcomes of intralesional steroid injections (ultrasound-guided) versus extracorporeal shockwave therapy in the treatment of plantar fasciitis. Methodology Between January 2021 and March 2022, 120 (84 male, 36 female) patients with a confirmed diagnosis of plantar fasciitis were identified. Subjective assessment was done using Mayo Clinical Score, and objective evaluation was done by measuring plantar fascia thickness using ultrasonography. For this study, two groups were made, wherein group A was administered a high dose of extracorporeal shockwave therapy, and group B was administered ultrasound-guided intralesional or local steroid injections. Results Plantar fascia thickness was considerably reduced after therapy in both groups; however, the difference in thickness reduction was not statistically significant between both groups. Mayo Clinic Scores showed statistically significant improvement in pain; however, the difference in pain reduction was not statistically significant between both groups. Conclusions A considerable clinical and radiological improvement was noted in both groups; however, we did not record statistically significant and superior results in either group. Intralesional steroid injections provided faster clinical improvement and better patient compliance.

Intense Therapeutic Ultrasound for Treatment of Chronic Plantar Fasciitis: A Pivotal Study Exploring Efficacy, Safety, and Patient Tolerance

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.

Additive Effect of Therapeutic Ultrasound in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial

BACKGROUND

Plantar fasciitis is the chief cause of pain in the plantar surface of the heel. Therapeutic ultrasound is one of the most common conservative treatment modalities used by physical therapists worldwide, despite scarce evidence of its efficacy in treating 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

In this prospective, randomized, double-blind, placebo-controlled clinical trial, 54 patients with plantar fasciitis, aged 24 to 80 years, who met the inclusion criteria were randomized into an active intervention and a control group. Individuals in the active intervention group were treated with self-performed stretching of the plantar fascia and calf muscles and with therapeutic ultrasound. Individuals in the control group were treated with the same stretching exercises and sham ultrasound. Both groups received 8 treatments, twice weekly. Outcome measures included a numeric pain-rating scale, the computerized adaptive test for the foot and ankle, and an algometric test.

RESULTS

Both groups showed statistically significant improvement in all outcome measures (P<.001, both groups). At the completion of the study, no statistically significant differences were found between the groups in any of the outcomes.

CONCLUSION

The addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis. Therefore, the authors recommend excluding therapeutic ultrasound from the treatment of plantar fasciitis and agree with results of previous studies that stretching may be an effective treatment for healing plantar fasciitis.

LEVEL OF EVIDENCE

Therapy, level 1b. J Orthop Sports Phys Ther 2018;48(11):847-855. Epub 11 Jul 2018. doi:10.2519/jospt.2018.8110.

Effect of Mitomycin C on recurrence of plantar fibromas

Although certainly not the first line treatment for plantar fibromas, surgical resection is a treatment option for some patients with have failed exhaustive non-surgical treatment. The use of topical Mitomycin C has been recently shown to reduce the recurrence rate of other fibrous lesions. The purpose of this study was to determine the impact of topical application of Mitomycin C on recurrence rate of plantar fibromas. A retrospective analysis was done from a prospectively gathered database with a total 50 consecutive patients over a 16-month study period. The control group (n = 29) consisted of patients who underwent only surgical resection, while the study group (n = 21) consisted of patients who underwent surgical resection with adjuvant therapy using Mitomycin C. The primary endpoint was local recurrence after the procedure. Secondary end points included complications and toxicity associated with this medication. No patients were lost to follow up. Of the 29 patients in the control group, there were 17 patients (17/29, 58.6%) had recurrence of the plantar fibroma at a mean follow-up of 9.1 months. In contrast, in the experimental study group, all patients were free from local recurrence. No complications or side effects were associated with Mitomycin C use. The results demonstrate that the topical application of Mitomycin C to the tumor bed after surgical resection of plantar fibromas reduced the recurrence rate. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2554-2561, 2018.

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm²; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm²); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles-Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes.

One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

OBJECTIVE

To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up.

METHOD

This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6 ±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly.

RESULTS

At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster.

CONCLUSION

Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment.

O ultrassom é efetivo no tratamento da tendinite calcárea do ombro?

Introdução: A tendinite calcária do ombro é uma calcificação caracterizada pela deposição de sais de cálcio nos tendões do manguito rotador, provocando dor no ombro e perda de amplitude de movimento (ADM). O ultrassom é sugerido como alternativa promissora para facilitar a reabsorção dos depósitos de cálcio. Os mecanismos que fundamentam esse efeito são, entretanto, ainda controversos na literatura, e a utilização clínica do ultrassom na tendinite calcária tem sido baseada mais em evidências empíricas do que científicas. Objetivos: Realizar uma revisão bibliográfica sobre os efeitos biológicos e terapêuticos do ultrassom, a fim de identificar o real papel desse recurso no tratamento da tendinite calcária do ombro. Materiais e métodos: Para sua elaboração, foi feita uma busca bibliográfica em bases de dados eletrônicas e uma pesquisa manual. Resultados: Dentre os estudos selecionados, dois demonstraram redução da dor e do tamanho da calcificação e dois não apresentaram resultados positivos. Discussão: Os benefícios promovidos pelo ultrassom são dependentes dos parâmetros utilizados. Variáveis como o tamanho da área a ser tratada, diferenças teciduais, duração da aplicação e o objetivo da conduta terapêutica também devem ser considerados. Conclusão: Com base nesta revisão, pode-se afirmar que o ultrassom terapêutico é um recurso efetivo no tratamento da tendinite calcária do ombro.

Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis

OBJECTIVE

To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis.

MATERIALS AND METHODS

Thirty-two patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 was composed of 16 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 was composed of 16 patients who underwent three applications of radial shockwaves (once a week) and received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 47.3 +/- 10.3 years (range 25-68); 81% were female, 87% were overweight, 56% had bilateral impairment, and 75% used analgesics regularly.

RESULTS

Both treatments were effective for pain reduction and for improving the functional abilities of patients with plantar fasciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment.

CONCLUSION

Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment.