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 www.clinicamedicadamarginal.com Saúde é connosco! A Clínica Médica da Marginal foi fundada em 1990 e dedica-se à prestação de cuidados de saúde especializados de proximidade, em regime de ambulatório, nos concelhos de Vila do Conde (sede) e Póvoa de Varzim (filial). É uma unidade poliva- lente com múltiplas especialidades e valências clínicas e terapêuticas. A expe- riência desenvolvida no decorrer de mais de 25 anos permitiu elevar o seu nome como uma referência local no setor da saúde e fortalecer a capacidade competiti- va na excelência dos serviços prestados. Tem uma forte presença na Medicina e Traumatologia Desportiva, incluindo uma sucursal do Centro Internacional de Traumatologia Desportiva do Ave. Avenida Infante Dom Henrique, 1326 - Caxinas 4480-670 Vila do Conde T · 252 623 347 · 252 299 690 T · 962 057 263 · 926 957 578 F · 252 299 697