Ilieva Elena M
Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University Plovdiv, Bulgaria.
Folia Med (Plovdiv). 2013 Jan-Mar;55(1):42-8. doi: 10.2478/folmed-2013-0004.
The vast majority of published papers on the efficacy of extracorporeal shockwave therapy (ESWT) have come up with rather controversial results in patients with plantar fasciitis. The AIM of the present study was to investigate the effect of radial shock wave therapy in patients with chronic proximal plantar fasciitis.
Twenty-one patients were included in the study (mean age 51.29 +/- 2.02 yrs, mean duration of symptoms 10.14 +/- 1.11 mos). Radial shock wave therapy was administered in five sessions. Total number of shocks per session was 2500 at a pressure of 2.5 bars. Visual analog scale (VAS) and a modification of the clinical rating system of the American Orthopedic Foot and Ankle Society (AOFAS) were used for outcome measurement. The patients were assessed before treatment and followed up 3, 6, and 12 months after end of treatment.
Statistically significant improvement in pain and functional capacity was found after completion of treatment in comparison with baseline; the improvement was preserved throughout a one-year follow-up. VAS mean score for pain showed changes in pain while walking the first few steps in the morning from 6.28 +/- 0.4 before therapy to 2.85 +/- 0.48 after treatment and to 1.52 +/- 0.31 at 3 months, to 1.09 +/- 0.25 at 6 months, and to 0.52 +/- 0.14 at 12 months of follow up (p <0.001). Similar dynamics was observed in pain intensity during daily activities, at rest, in the evening and upon compression. The AFOAS score showed a statistically significant reduction in pain--from 11.90 +/- 2.35 at baseline to 31.90 +/- 1.48 after the end of interventions (p < 0.001), and to 39.52 +/- 0.47 at one year of follow-up (p < 0.001). The mean values of the evaluation reflecting activity limitations and support requirements increased from 3.85 +/- 0.42 to 7.85 +/- 0.46 after treatment and to 9.71 +/- 0.19 at one year of follow up (p < 0.001). Similar dynamics was seen in the maximum walking distance and walking surfaces. Gait abnormalities changed from 3.43 +/- 0.50 at baseline to 6.28 +/- 0.59 after treatment (p < 0.001).
Based on the results of this study we could conclude that radial shock wave therapy is a safe non-invasive method of treatment. Our preliminary findings indicate that it could be an effective treatment of choice for patients with chronic plantar fasciitis that is recalcitrant to other conservative treatment modalities.
绝大多数已发表的关于体外冲击波疗法（ESWT）疗效的论文，在跖筋膜炎患者中得出了颇具争议的结果。本研究的目的是调查径向冲击波疗法对慢性近端跖筋膜炎患者的疗效。
本研究纳入了21例患者（平均年龄51.29±2.02岁，平均症状持续时间10.14±1.11个月）。进行了5次径向冲击波治疗。每次治疗的冲击波总数为2500次，压力为2.5巴。采用视觉模拟评分法（VAS）和美国矫形足踝协会（AOFAS）临床评级系统的改良版进行疗效评估。在治疗前对患者进行评估，并在治疗结束后3个月、6个月和12个月进行随访。
与基线相比，治疗结束后疼痛和功能能力有统计学意义的改善；在为期一年的随访中，这种改善得以维持。VAS疼痛平均评分显示，早晨刚开始走几步时的疼痛有变化，治疗前为6.28±0.4，治疗后为2.85±0.48，3个月时为1.52±0.31，6个月时为1.09±0.25，12个月随访时为0.52±0.14（p<0.001）。在日常活动、休息、晚上和按压时的疼痛强度方面也观察到了类似的变化趋势。AOFAS评分显示疼痛有统计学意义的降低——从基线时的11.90±2.35降至干预结束后的31.90±1.48（p<0.001），随访一年时降至39.52±0.47（p<0.001）。反映活动受限和支撑需求的评估平均值从治疗前的3.85±0.42增加到治疗后的7.85±0.46，随访一年时增加到9.71±0.19（p<0.001）。在最大行走距离和行走路面方面也观察到了类似的变化趋势。步态异常从基线时的3.43±0.50变为治疗后的6.28±0.59（p<0.001）。
基于本研究结果，我们可以得出结论，径向冲击波疗法是一种安全的非侵入性治疗方法。我们的初步研究结果表明，对于对其他保守治疗方式无效的慢性跖筋膜炎患者，它可能是一种有效的治疗选择。
