Revista de Medicina Desportiva (English) July 2018 - Page 14

Material and methods
An analytical study of prospectively collected data was carried out during the visit to a physical and rehabilitation ( PaR ) clinic , of patients with PF for more than six months , treated with shock waves ( inclusion criteria ). Patients that at the time of the data collection had not yet completed the treatment , those who for some reason interrupted it or whose cases did not have the variables mentioned below were excluded from the study .
The treatment with shockwaves were always performed by the same person , a PaR doctor , with the equipment Storz Duolith SD1 ® . The treatment included focal shock waves at a maximum dose tolerated by the patient . The number of treatments was decided individually according to the individual progression of each patient , with intervals of two to four weeks between them .
The variables studied were : age , gender , duration of symptoms , other treatments performed previously , body mass index ( BMI ), biomechanical alterations of the foot and ankle , changes in the X-ray of the foot , number of treatments with shock waves performed , total energy applied per session , pain ( analog visual scale – AVS ) and sports activity .
The patients were evaluated before each treatment session and four to six weeks after the last treatment .
For the statistical analysis of the data , the SPSS ® Statistics 20.0 ( IBM ®) program was used . The T-Student test was applied to find out differences between groups and the correlation coefficient of Pearson and Spearmen ’ s to find associations between variables . There was a statistical significance for P values < 0.05 , with a confidence interval of 95 %.
Results
We obtained an initial sample of 54 feet , of these 19 feet were excluded ( 14 for lack of some objective data , two were subjected to another therapeutic procedure and three had not yet finished the treatments ).
The final sample was 35 feet , corresponding to 29 patients ( n = 29 ). On the patients with bilateral PF , one foot was treated at a time and in some cases the complaints arose at different times on each foot .
The average age of the patients was 47 years , with a minimum of 30 and a maximum of 68 years ( 47 ± 10,7 ; n = 29 ). Of these , 83 % were female and 17 % male .
Of the 29 patients , 55 % had no personal medical background and 45 % had cardiovascular risk factors – 10.5 % ( 7.0 % high blood pressure e 3.5 % dyslipidemia ), peripheral vascular disease – 10.5 %, depression – 10.5 % and thyroid pathology – 13.5 %. Of the 29 patients , only 17 % practiced physical activity regularly ( n = 5 ). With regard to BMI , only 8.6 % of patients was within the normal reference values , 22.8 % had overweight and 68.6 % of patients had obesity ( 51.4 % of the type 1 , 8.6 % of type 2 and 8.6 % of type 3 ).
More than 50 % of treated feet ( n = 35 ) had symptoms for more than one year ( 42.9 % for more than 6 months , 34.3 % for more than one year and 22.9 % for more than 2 years ). Of the 35 feet treated ( n = 35 ), 17 % had biomechanical changes of the ankle and foot ( 14 % pronated foot and 3 % valgus flat foot ).
All patients had performed prior treatment for plantar fasciitis : NASDs ( 85.7 %), oral and intramuscular steroid therapy ( 57.1 %), injection in the plantar fascia ( 2.9 %), at least a series of physiotherapy ( 45.7 %) and an insole / heel cushion was prescribed on 65.7 % of cases for heel discharge ( Figure 1 ).
Of patients that undergo X-ray of the foot in our hospital ( n = 27 ), 88.9 % had changes ( 59.3 % spur on the calcaneus , 18.5 % spur and other arthritic changes of the joints , 7.4 % hallux valgus and spur and 3.7 % calcification at the Achilles insertion with no spur . We did not have access to the remaining X-rays carried out outside the hospital .
The average number of treatments was 3 (± 1.19 , with a minimum of
Insole
Previous treatments ( n = 35 )
FT NSADs .
Figure 2 – Previous treatments before extracorporeal shock wave ( ECSW )
AVS decrease (%)
Steroids ( Oral / IM )
Local injections
In 83 % of the cases there was a significant improvement
Figure 3 – Percentage of the descent of the analog visual scale ( AVS ).
Yes No
one treatment and a maximum of six ), and the with maximum doses was between 0.20 to 0.40 MJ / mm 2 , with a total energy average of 19.82 Joules .
There was improvement of the pain , with decreased AVS in 91.7 % of the treated feet ( n = 35 ), and in 74.3 % the final AVS was 0 , four to six weeks after treatment . The average pretreatment value of AVS for the whole group was 6.4 ± 2.5 cm and the average after four to six weeks of the treatment was 1.7 ± 3.3 cm , corresponding to an average descent of 4.9 ± 3.6 cm . This improvement was statistically significant ( p < 0.001 ). In 80 % ( n = 28 ) of the treated feet , AVS ’ s descent was more than 50 % of the initial value and 3 % between 30-50 % ( Figure 2 ).
There was no statistically significant correlation between the BMI index and the improvement of EVA ( r = -0.11 ; p = 0,54 ).
Comparing the groups with and without spur , there were no statistically significant differences on the level of the improvement on the AVS scale ( P = 0,19 ). There was also no statistically significant correlation between the duration of the symptoms and the improvement of AVS ( r = – 0.08 ; p = 0.63 ). comparing groups with and without biomechanical changes of the ankle and foot , there was statistically significant differences on the
12 july 2018 www . revdesportiva . pt
Material and methods An analytical study of prospec- tively collected data was carried out during the visit to a physical and rehabilitation (PaR) clinic, of patients with PF for more than six months, treated with shock waves (inclusion criteria). Patients that at the time of the data collection had not yet com- pleted the treatment, those who for some reason interrupted it or whose cases did not have the variables mentioned below were excluded from the study. The treatment with shockwaves were always performed by the same person, a PaR doctor, with the equip- ment Storz Duolith SD1 ® . The treat- ment included focal shock waves at a maximum dose tolerated by the patient. The number of treatments was decided individually according to the individual progression of each patient, with intervals of two to four weeks between them. The variables studied were: age, gender, duration of symp- toms, other treatments performed previously, body mass index (BMI), biomechanical alterations of the foot and ankle, changes in the X-ray of the foot, number of treatments with shock waves performed, total energy applied per session, pain (analog visual scale – AVS) and sports activity. The patients were evaluated before each treatment session and four to six weeks after the last treat- ment. For the statistical analysis of the data, the SPSS ® Statistics 20.0 (IBM ®) program was used. The T-Student test was applied to find out dif- ferences between groups and the correlation coefficient of Pearson and Spearmen’s to find associations between variables. There was a statistical significance for P values < 0.05, with a confidence interval of 95%. Results We obtained an initial sample of 54 feet, of these 19 feet were excluded (14 for lack of some objective data, two were subjected to another therapeutic procedure and three had not yet finished the treatments). 12 july 2018 www.revdesportiva.pt The final sample was 35 Previous treatments (n=35) feet, corresponding to 29 patients (n = 29). On the patients with bilateral PF, one foot was treated at a Yes No time and in some cases the complaints arose at differ- ent times on each foot. Steroids Local Insole FT NSADs. The average age of the (Oral/IM) injections patients was 47 years, with Figure 2 – Previous treatments before extracorporeal a minimum of 30 and a shock wave (ECSW) maximum of 68 years (47 ± 10,7; n = 29). Of these, 83% AVS decrease (%) were female and 17% male. Of the 29 patients, 55% had no personal medical background and 45% had In 83% of the cardiovascular risk fac- cases there was a significant tors – 10.5% (7.0% high improvement blood pressure e 3.5% dyslipidemia), peripheral Figure 3 – Percentage of the descent of the analog vascular disease– 10.5%, visual scale (AVS). depression – 10.5% and thyroid pathology – 13.5%. Of the 29 patients, only 17% practiced physical one treatment and a maximum of activity regularly (n = 5). With regard six), and the with maximum doses to BMI, only 8.6% of patients was was between 0.20 to 0.40 MJ/mm 2 , within the normal reference values, with a total energy average of 19.82 22.8% had overweight and 68.6% of Joules. patients had obesity (51.4% of the There was improvement of the type 1, 8.6% of type 2 and 8.6% of pain, with decreased AVS in 91.7% type 3). of the treated feet (n = 35), and in More than 50% of treated feet (n 74.3% the final AVS was 0, four to six = 35) had symptoms for more than weeks after treatment. The average one year (42.9% for more than 6 pretreatment value of AVS for the months, 34.3% for more than one whole group was 6.4 ± 2.5 cm and year and 22.9% for more than 2 the average after four to six weeks of years). Of the 35 feet treated (n = 35), the treatment was 1.7 ± 3.3 cm, cor- 17% ́)ɕѼٕɅ͍Ё)ѡЀДɽѕ(и Ā̸؁Q́ɽٕЁ݅)Ё̔م́ЁФ)хѥѥͥЀĤ%)ѥ́əɵɥ(ँѡɕѕаYOe)ɕѵЁȁхȁ͍ѥ)͍Ё݅́ɔѡѡ)9M̀ԸܔɅɅ͍ԴѥمՔ̔ݕ)ȁѕɽѡɅ䀠ܸĔѥ(ɔȤ)ѡхȁ͍ȸ䔤Ё)Qɔ݅́хѥѥͥ)͕ɥ́ͥѡɅ䀠Ըܔ)Ёɕѥݕѡ 5$)ͽ݅͡)ѡɽٕЁY)ɕ͍ɥԸܔ͕́ȁȀФ)͍ɝɔĤ) ɥѡɽ́ݥѠ)=ѥ́ѡЁչɝ`Ʌ)ݥѡЁȰѡɔݕɔф)ѡЁȁхܤ)ѥѥͥЁɕ(䔁̀̔ȁ)ѡٕѡɽٕ)ѡ̰Ԕȁѡ)ѡYL͍@䤸Qɔ)ѡɥѥ́ѡ̰ܸД)݅́ͼхѥѥͥ)م́ȁ̸ܔ)ɕѥݕѡɅѥ)ѥЁѡ͕́ѥѡѽ́ѡɽٔ)ݥѠȸ]Ёٔ́ЁYLȀL̤)Ѽѡɕ`Ʌ́ɥ)ɥɽ́ݥѠݥѠ)ͥѡх)Ё́ѡ)QٕɅյȁɕѵ́аѡɔ݅́хѥѤ)݅̀̀ Āĸ䰁ݥѠմ)ͥЁɕ́ѡ