Revista de Medicina Desportiva (English) July 2018 | Page 15

improvement in the AVS scale (p =
0,001), where the feet with changes
improved less.
Discussion and conclusion
There are several alternatives for
the treatment of plantar fasciitis:
conservative treatment (which
includes modification of the activity,
cryotherapy, massage, NSADs and
corticosteroids), stretching, position-
ing orthosis night, plant injections,
radiotherapy, ECMO and surgical
treatment. 9,13 Although in many
patients the pain is self-limited
and it disappears after one year,
the limitation of the daily activities
caused by the pain from the heel
leads most of the patients to seek
treatment before the resolution of
the pain. 13 About 70-80% of patients
will have a decrease of the pain
with conservative treatment alone. 14
However, many patients will need to
add other types of treatments. 15 For
those patients that do not resolve
pain with conservative treatment,
stretching, orthosis for night posi-
tioning and plant injections, the
treatment with ECMO may be a good
option. 13
A recent systematic review from
the database of Evidence of Physical
Therapy (EPT) concluded that both
the radial and the focal shock waves
are effective: 88.5% (23 out of 26)
of all controlled randomized trials
in the EPT, and 81.5% (66 of 81) of
all controlled randomized trials in
the EPT. These positive results were
statistically significant in compar-
ing with placebo or other treatment
modalities. 16 It can be said that
besides being effective, they are
a safe treatment without serious
adverse events reported in the stud-
ies included in this analysis. 16
Comparing with the surgical treat-
ment, it is known that treatment
with ECMO has multiple advantages
in relation to the surgical treatment
of chronic plant fasciitis. 17 Unlike
surgery, the treatment with ECMO is
non-invasive and, since it does not
require the use of anesthesia, can be
performed as an office procedure. In
contrast, surgery has risks, like the
edema in the soft tissues of the heel,
posterior tibial nerve injury or of its
branches and flattening the longitu-
dinal arc, that will cause in pain in
the midfopot. 17 Besides that, patients
are not required to avoid weight or
to have a prolonged recovery time,
delaying this way the return to
work. 17
In this work, only patients with
chronic plant fasciitis were included,
with symptoms for at least six
months and that were refractory
to other types of treatments. The
results revealed significant benefi-
cial effects of the treatment with
focal extracorporeal shock waves in
patients with chronic plant fascii-
tis, where 83% of patients had an
important improvement of their
complains and decrease of AVS’s
initial value bigger than 30%.
Although there was no statistically
significant difference on the level of
the improvement in the AVS scale
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