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-
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