Hsu Wei-Hsiu, Yu Pei-An, Lai Li-Ju, Chen Chi-Lung, Kuo Liang-Tseng, Fan Chun-Hao
Associate Professor, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Puzt City, Taiwan.
Surgeon, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Puzt City, Taiwan.
J Foot Ankle Surg. 2018 Jan-Feb;57(1):15-18. doi: 10.1053/j.jfas.2017.05.038. Epub 2017 Nov 3.
Plantar fasciopathy (PF) is the most common cause of heel pain. Extracorporeal shockwave therapy (ESWT) improves the gait pattern in patients with PF. However, the effects of ESWT on the biomechanics of the ankle in these patients remains unclear. Sixteen participants were included in the present study. Of the 16 participants, 8 patients with PF were assigned to receive extracorporeal shockwave therapy, and 8 healthy participants served as an external control group. ESWT was applied to the PF group for 1500 pulses at an energy flux of 0.26 mJ/mm every 3 weeks for 3 sessions. The biomechanics of the ankle joints were then assessed using an isokinetic dynamometer, and a health-related quality of life questionnaire was administered at baseline and at the final follow-up session 12 weeks after the initial treatment. Passive stiffness was calculated and compared between the foot affected with PF, the opposite foot, and both feet of those in the healthy control group. The Kruskal-Wallis 1-way analysis of variance with repeated measures was performed, and statistical significance was considered present at the 5% (p ≤ .05) level. Ankle dorsiflexion in the affected limb increased from 14° ± 3° to 17° ± 2° after ESWT (p < .05). No statistically significant differences were noted in the strength of dorsiflexion or plantarflexion at baseline and after ESWT. However, a statistically significant increase in the ratio of strength in ankle dorsiflexion versus plantarflexion was found after ESWT (p < .05). No differences in the passive stiffness of the ankle joint were demonstrated. Patients reported an improved physical function score after ESWT (p < .05). An increased dorsiflexion/plantarflexion torque ratio and maximal dorsiflexion associated with decreased pain might contribute to the improved physical function after ESWT for PF.
足底筋膜炎（PF）是足跟痛最常见的原因。体外冲击波疗法（ESWT）可改善PF患者的步态模式。然而，ESWT对这些患者踝关节生物力学的影响仍不清楚。本研究纳入了16名参与者。在这16名参与者中，8名PF患者被分配接受体外冲击波疗法，8名健康参与者作为外部对照组。ESWT应用于PF组，每3周进行1500次脉冲，能量通量为0.26 mJ/mm²，共进行3次治疗。然后使用等速测力计评估踝关节的生物力学，并在基线时以及初始治疗后12周的最终随访时进行与健康相关的生活质量问卷调查。计算并比较PF患足、对侧足以及健康对照组双足的被动僵硬度。进行重复测量的Kruskal-Wallis单因素方差分析，在5%（p≤0.05）水平认为具有统计学意义。ESWT后，患侧肢体的踝关节背屈从14°±3°增加到17°±2°（p<0.05）。在基线时和ESWT后，背屈或跖屈力量没有统计学上的显著差异。然而，ESWT后发现踝关节背屈与跖屈力量之比有统计学上的显著增加（p<0.05）。踝关节的被动僵硬度没有差异。患者报告ESWT后身体功能评分有所改善（p<0.05）。背屈/跖屈扭矩比增加以及最大背屈增加且疼痛减轻可能有助于ESWT治疗PF后身体功能的改善。
