Pandey Sanjay, Kumar Niraj, Kumar Anjani, Biswas Anurug, Sinha Upasna, Pandey Jyoti, Ghosh Srutarshi, Das Subha, Johnson Renu A, Kumar Ranjeet, E V Anjusha, Kumari Kalyani
Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, Patna, IND.
Radiology, All India Institute of Medical Sciences, Patna, Patna, IND.
Cureus. 2023 Jan 31;15(1):e34430. doi: 10.7759/cureus.34430. eCollection 2023 Jan.
Introduction Plantar fasciitis is a degenerative condition of the plantar fascia that leads to heel and sole pain. Physical modalities, physiotherapy, medication, and orthoses have been tried before as treatments. Extracorporeal shockwave therapy (ESWT) and the injection of autologous platelet-rich plasma (PRP) are generally effective in the treatment of plantar fasciitis, which might be resistant to other conservative measures. The present study compares the efficacy of ESWT and PRP injection in respect of symptomatic relief, functional improvement, and change in plantar fascia thickness (PFT). Methods Seventy-two patients were enrolled and randomized into two groups. Patients in the first group received ESWT, whereas patients in the second group received PRP injections. Patients were evaluated using the Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) score, along with PFT measurement (using ultrasonography) before the treatment and at days 15, 30, and 90 after the treatment. The X test was used to compare qualitative variables, and the paired T-test was used to evaluate quantitative data. Quantitative variables had a normal distribution with a standard deviation, and the significance level was set at P-value=0.05. Results On day 0, the mean VAS of the ESWT and PRP groups were 6.44±1.11 and 6.78±1.17, respectively (p=0.237). On day 15, the mean VAS of the ESWT and PRP groups were 4.67±1.45 and 6.67±1.35, respectively (p<0.001). At day 30, the mean VAS of the ESWT and PRP groups were 4.97±1.46 and 4.69±1.39, respectively (p=0.391). On day 90, the mean VAS of the ESWT and PRP groups were 5.47±1.63 and 3.36±0.96 (p<0.001). On day 0, the mean PFTs of the ESWT and PRP groups were 4.73±0.40 and 5.19±0.51, respectively (p<0.001). At day 15, the mean PFT of the ESWT and PRP groups were 4.64±0.46 and 5.11±0.62, respectively (p<0.001) which changed to 4.52±0.53 and 4.40±0.58 at day 30 (p<0.001), and to 4.40±0.50 and 3.82±0.45 at day 90 (p<0.001). The mean AOFAS of the ESWT and PRP groups were 68.39±5.88 and 64.86±8.95 on day 0 (p=0.115), 72.58±6.26 and 67.22±10.47 on day 15 (p=0.115), 73.22±6.92 and 74.72±7.52 on day 30 (p=0.276), and 72.75±7.90 and 81.08±6.01 on day 90, respectively (p<0.001). Conclusion Both PRP injection and ESWT are very effective methods to improve pain and cause reduced plantar fascia thickness in patients with chronic plantar fasciitis non-responsive to other conservative measures. PRP injection is more effective at a longer duration as compared to ESWT.
引言 足底筋膜炎是足底筋膜的一种退行性病变，可导致足跟和足底疼痛。之前曾尝试过物理治疗、理疗、药物治疗和矫形器等治疗方法。体外冲击波疗法（ESWT）和自体富血小板血浆（PRP）注射通常对足底筋膜炎的治疗有效，而足底筋膜炎可能对其他保守治疗措施无效。本研究比较了ESWT和PRP注射在缓解症状、改善功能以及足底筋膜厚度（PFT）变化方面的疗效。
方法 纳入72例患者并随机分为两组。第一组患者接受ESWT治疗，而第二组患者接受PRP注射。在治疗前以及治疗后第15天、30天和90天，使用视觉模拟量表（VAS）和美国矫形足踝协会（AOFAS）评分对患者进行评估，并测量PFT（使用超声检查）。采用X检验比较定性变量，采用配对T检验评估定量数据。定量变量呈正态分布且具有标准差，显著性水平设定为P值 = 0.05。
结果 在第0天，ESWT组和PRP组的平均VAS分别为6.44±1.11和6.78±1.17（p = 0.237）。在第15天，ESWT组和PRP组的平均VAS分别为4.67±1.45和6.67±1.35（p<0.001）。在第30天，ESWT组和PRP组的平均VAS分别为4.97±1.46和4.69±1.39（p = 0.391）。在第90天，ESWT组和PRP组的平均VAS分别为5.47±1.63和3.36±0.96（p<0.001）。在第0天，ESWT组和PRP组的平均PFT分别为4.73±0.40和5.19±0.51（p<0.001）。在第15天，ESWT组和PRP组的平均PFT分别为4.64±0.46和5.11±0.62（p<0.001），在第30天变为4.52±0.53和4.40±0.58（p<0.001），在第90天变为4.40±0.50和3.82±0.45（p<0.001）。在第0天，ESWT组和PRP组的平均AOFAS分别为68.39±5.88和64.86±8.95（p = 0.115），在第15天分别为72.58±6.26和67.22±10.47（p = 0.115），在第30天分别为73.22±6.92和74.72±7.52（p = 0.276），在第90天分别为72.75±7.90和81.08±6.01（p<0.001）。
结论 PRP注射和ESWT都是改善慢性足底筋膜炎患者疼痛并减少足底筋膜厚度的非常有效的方法，而这些患者对其他保守治疗措施无效。与ESWT相比，PRP注射在较长时间内更有效。
