Vahdatpour Babak, Mokhtarian Arghavan, Raeissadat Seyed Ahmad, Dehghan Farnaz, Nasr Nafiseh, Mazaheri Mahsa
Department of Physical Medicine and Rehabilitation, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Physical Medicine and Rehabilitation Research Center, School of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Adv Biomed Res. 2018 Apr 24;7:62. doi: 10.4103/abr.abr_40_17. eCollection 2018.
Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis.
Patients in both groups ( = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention.
One month after intervention, VAS morning showed significant improvement in intervention group ( = 0.006) and RMS showed better improvement in intervention group ( = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups ( = 0.292).
This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.
慢性顽固性足底筋膜炎是一种致残性疾病。我们推测，如果冲击波能增加皮肤通透性并促进局部皮质类固醇透过皮肤；联合治疗效果将比单独使用冲击波更强。本研究目的是利用冲击波与局部皮质类固醇的协同作用治疗足底筋膜炎。
两组患者（每组 = 40 例）均接受相同方案的四疗程冲击波治疗，每周一次。在每次治疗前 30 分钟，干预组使用丙酸氯倍他索封闭敷料，对照组使用凡士林油。在基线、干预后 1 个月和 3 个月时，用视觉模拟评分法（VAS）和改良的罗尔斯和莫兹利评分（RMS）评估疼痛严重程度。在基线和干预后 3 个月时，用超声测量足底筋膜（PF）厚度。
干预后 1 个月，干预组 VAS 晨间评分有显著改善（ = 0.006），RMS 在干预组改善更好（ = 0.026）。3 个月后，两组在 RMS 或 VAS 评分上无显著差异。两组 PF 厚度均显著降低，但两组间差异无统计学意义（ = 0.292）。
与单独使用冲击波相比（单独使用冲击波），这种联合治疗能更早减轻疼痛并改善功能；局部皮质类固醇可在短期内增强冲击波治疗顽固性足底筋膜炎的效果。 （注：括号内“单独使用冲击波”为补充完整句子意思添加，原文此处表述稍简略）
