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