Razzano Cristina, Carbone Stefano, Mangone Massimiliano, Iannotta M Raffaella, Battaglia Alessandro, Santilli Valter
Resident, Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, Rome, Italy; Resident, Department of Physical Medicine and Rehabilitation, Centro Medico Erre, Sant'Agata dei Goti, Italy.
PhD Student, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy; FIMAC Onlus, Rome, Italy.
J Foot Ankle Surg. 2017 Jul-Aug;56(4):768-772. doi: 10.1053/j.jfas.2017.02.015.
The initial treatment of plantar fasciitis should be conservative, with most cases responding to standard physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), heel pads, and stretching. In cases of chronic refractory symptoms, more invasive treatment could be necessary. Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that works by locating areas of lower skin impedance. The objective of the present prospective randomized controlled study was to evaluate whether the use of NIN for chronic plantar fasciitis could result in greater improvement in a foot functional score, lower levels of reported pain, reduced patient consumption of NSAIDs, and greater patient satisfaction compared with electric shockwave therapy in patients without a response to standard conservative treatment. The patients were randomized using random blocks to the NIN program (group 1) or electric shockwave therapy (group 2). The outcome measurements were the pain subscale of the validated Foot Function Index (PS-FFI), patient-reported subjective assessment of the level of pain using a standard visual analog scale, and daily intake of NSAID tablets (etoricoxib 60 mg). The study group was evaluated at baseline (time 0), week 4 (time 1), and week 12 (final follow-up point). Group 1 (55 patients) experienced significantly better results compared with group 2 (49 patients) in term of the PS-FFI score, visual analog scale score, and daily intake of etoricoxib 60 mg. NIN was an effective treatment of chronic resistant plantar fasciitis, with full patient satisfaction in >90% of cases. The present prospective randomized controlled study showed superior results for noninvasive neurostimulation compared with electric shockwave therapy, in terms of the functional score, pain improvement, and use of NSAIDs.
足底筋膜炎的初始治疗应采取保守方法，大多数病例对标准物理治疗、非甾体抗炎药（NSAIDs）、足跟垫和拉伸治疗有效。对于慢性难治性症状的病例，可能需要更具侵入性的治疗。非侵入性交互式神经刺激（NIN）是一种电疗法，其通过定位皮肤阻抗较低的区域发挥作用。本前瞻性随机对照研究的目的是评估，对于对标准保守治疗无反应的患者，使用NIN治疗慢性足底筋膜炎是否能比冲击波疗法在足部功能评分上带来更大改善、降低报告的疼痛水平、减少患者对NSAIDs的使用并提高患者满意度。患者使用随机区组法随机分为NIN治疗组（第1组）或冲击波疗法组（第2组）。结局指标包括经过验证的足部功能指数疼痛子量表（PS-FFI）、患者使用标准视觉模拟量表报告的主观疼痛程度评估，以及NSAID片剂（依托考昔60mg）的每日摄入量。研究组在基线（时间0）、第4周（时间1）和第12周（最终随访点）进行评估。在PS-FFI评分、视觉模拟量表评分和依托考昔60mg的每日摄入量方面，第1组（55例患者）与第2组（49例患者）相比，结果明显更好。NIN是治疗慢性难治性足底筋膜炎的有效方法，超过90%的病例患者完全满意。本前瞻性随机对照研究表明，在功能评分、疼痛改善和NSAIDs使用方面，非侵入性神经刺激比冲击波疗法效果更佳。
