超声引导下富血小板血浆注射治疗足底筋膜炎的疗效观察

目的观察超声引导下局部注射富血小板血浆(PRP)与类固醇激素治疗足底筋膜炎的临床疗效。方法选择2016年6月至2017年3月就诊于本院疼痛科的足底筋膜炎患者32例,男9例,女23例,年龄36～73岁,BMI 18～35kg/m2。随机分为超声引导下富血小板血浆注射治疗组(PRP组)和超声引导下类固醇激素注射治疗组(S组),每组16例。在超声引导下PRP组将制备出的4ml PRP注入跖筋膜表面。S组将复方倍他米松1ml+2%盐酸利多卡因注射液2ml的混合液注入跖筋膜表面。评估患者注射治疗前(T0)和治疗后1个月(T1)、3个月(T2)、6个月(T3)时晨起后起步状态、步行10步后状态和当天总体平均状态的VAS评分。采用超声测量T0和T2时患者俯卧位时跟骨-筋膜结合处足底筋膜厚度。观察注射部位有无出血、血肿、感染以及足底筋膜有无撕裂等并发症。结果与T0时比较,T1、T2和T3时两组患者晨起后起步状态、步行10步后状态和当天总体平均状态VAS评分均明显降低(P0.05)。与S组比较,T1和T2时PRP组晨起后起步状态、步行10步后状态和当天总体平均状态VAS评分明显升高(P0.05),T3时PRP组晨起后起步状态、步行10步后状态和当天总体平均状态VAS评分明显降低(P0.05)。与T0时比较,T2时两组足底筋膜厚度明显变薄(P0.05),T0和T2时两组足底筋膜厚度差异无统计学意义。两组患者治疗后均未发现出血、血肿、感染以及足底筋膜撕裂等并发症。结论超声引导下局部注射富血小板血浆与类固醇激素均能有效治疗足底筋膜炎,激素局部注射显效快,但富血小板血浆疗效相对更稳定持久。     

富血小板血浆与玻璃酸钠治疗膝骨关节炎的疗效对比

目的探讨富血小板血浆(PRP)与玻璃酸钠(SH)治疗膝骨关节炎(KOA)的临床效果。方法选取郑州大学第一附属医院骨科2020年3月至2022年6月符合纳排标准的KOA患者61例, 按治疗方式分PRP组30例和SH组31例。比较两组治疗前及治疗4周后的视觉模拟疼痛评分(VAS)、骨关节炎指数(WOMAC)评分、关节液白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α), 评估PRP与SH对不同KOA患者治疗的临床疗效, 样本数据采用配对t检验和独立样本t检验。结果 PRP组治疗4周后WOMAC评分低于治疗前[(76.8±12.1)分比(58.0±14.8)分, t=20.863, P<0.05], 治疗4周后VAS评分低于治疗前[(6.0±0.9)分比(4.2±1.1)分, t=48.694, P<0.05];SH组治疗4周后WOMAC评分低于治疗前[(77.4±9.2)分比(65.6±9.5)分, t=20.565, P<0.05], 治疗4周后VAS评分低于治疗前[(6.4±0.7)分比(5.1±0.6)分, t=11.180, P<0.05]。PRP组...     

中医电针联合体外冲击波治疗创伤性桡骨茎突狭窄性腱鞘炎的临床疗效

目的观察电针联合体外冲击波疗法(extracorporeal shock wave therapy,ESWT)治疗创伤性桡骨茎突狭窄性腱鞘炎的临床疗效。方法选取2013年1月至2015年3月在新疆体育职业技术学院附属运动创伤医院门诊收治确诊的36例创伤性桡骨茎突狭窄性腱鞘炎患者,随机分为ESWT组、电针组和联合组,每组12例。ESWT组只进行ESWT治疗;电针组只进行电针治疗;联合组采用ESWT联合电针交替治疗,即首日采用ESWT治疗,次日采用电针治疗,治疗期间如此循环交替。三组患者在治疗前和治疗后的第1、2、4和8周分别进行VAS疼痛评分,并且在治疗后第8周采用VAS评分加权值评定临床疗效。结果 (1)三组患者VAS评分在治疗后各时间点均比治疗前明显下降,并且联合组又低于ESWT组和电针组(P0.05);ESWT组在治疗后第8周VAS评分改善优于电针组(P0.05);ESWT组及联合组VAS评分逐渐下降,但电针组第8周VAS评分却有升高;(2)联合组治愈率明显优于ESWT组和电针组,ESWT组治愈率优于电针组(P0.05)。结论 ESWT和电针对治疗创伤性桡骨茎突狭窄性腱鞘炎均具有临床疗效,但二者联合治疗明显优于单一治疗,具有近期和远期疗效方面的双重优势,不但可以让ESWT发挥即时的镇痛效果,还能弥补电针治疗远期疗效差的不足。     

中度腕管综合征的体外冲击波治疗效果研究

目的评估体外冲击波(extracorporeal shock wave therapy,ESWT)这一新型的无创性方法对中度腕管综合征(carpal tunnel syndrone,CTS)的治疗效果。方法选取2014年6月-2016年6月收治的CTS患者80例,随机分为A、B两组(n=40)。A组给予ESWT治疗,每周一次,疗程共4周;B组给予口服塞来昔布(200 mg)和维生素B1片(300 mg),2次/d,疗程共4周。两组夜间均采用腕部支具固定。在治疗前和治疗后1、3、6个月采用视觉模拟评分(VAS)、波士顿问卷量表评分(BCTQ)以及中华医学会手外科学会上肢功能评定标准评价患者的临床疗效。结果两组在治疗后1、3、6个月的VAS评分均较治疗前显著改善(P<0.05),但A组的改善程度较同期B组更为显著(P<0.05);A组的Boston SYMPT评分和FUNCT评分均较治疗前显著改善,而B组的Boston SYMPT评分和FUNCT评分仅在治疗后3个月有明显差别,并且均低于同期A组;A组在治疗6个月后的各项评分几乎保持不变,基本趋于稳定,而B组的各项评分却明显增加;随访终末期评价,虽然两组有效率相比差异无统计学意义(P>0.05),但A组的优良率明显高于B组(P<0.05),复发率也明显低于B组(P<0.05)。结论在临床上可以推荐ESWT作为中度CTS患者的一种保守治疗手段。     

两种冲击波方法治疗慢性跖筋膜炎疗效的比较

[目的]比较两种冲击波方法治疗慢性跖筋膜炎的不同疗效。[方法]选取112例慢性跖筋膜炎患者为研究对象,随机分为足底组和复合组,足底组对足底区进行冲击波治疗,复合组在足底区治疗的基础上对同侧小腿三头肌进行冲击波治疗。分别于治疗前,治疗终结时,治疗后1、4、12周对两组进行视觉模拟评分(VAS)及足底部压痛阈值(PPT)比较分析。[结果]两组在治疗终结时,治疗后1、4、12周VAS评分较治疗前明显降低,差异有统计学意义,尤以复合组显著(P0.05)。复合组在治疗后各时间点VAS评分与足底组比较更低,两组间差异有统计学意义(P0.05)。两组在治疗终结时、治疗后1周PPT与治疗前无明显变化(P0.05),在治疗后4、12周PPT明显改善,与治疗前差异有统计学意义,尤以复合组显著(P0.05)。复合组在治疗后4、12周与足底组比较改善更为明显,两组间差异有统计学意义(P0.05)。[结论]足底筋膜与小腿三头肌同时冲击波治疗效果优于单纯足底筋膜治疗。     

体外冲击波联合富血小板血浆注射治疗膝关节骨关节炎的前瞻性临床对比研究

目的采用前瞻性临床对比研究,探讨体外冲击波联合富血小板血浆(platelet-rich plasma,PRP注射治疗膝关节骨关节炎(knee osteoarthritis,KOA)的疗效。方法以2015年6月—2018年6月收治且符合选择标准的180例KOA患者作为研究对象,随机分为3组,每组60例。A组膝关节腔穿刺注射自体PRP,B组体外冲击波治疗,C组膝关节腔穿刺注射自体PRP联合体外冲击波治疗;每周治疗1次,共5次。3组患者年龄、性别、病程、侧别及Kellgren-Lawrence分级比较,差异均无统计学意义(P0.05)。治疗前及首次治疗后第1、3、5周,采用疼痛视觉模拟评分(VAS)、Lequesne指数评分、美国西部Ontario与McMaster大学骨关节炎指数评分(WOMAC)及膝关节活动度评定膝关节疼痛和功能情况。结果 3组治疗后第1、3、5周VAS评分、Lequesne指数评分、WOMAC评分及膝关节活动度与治疗前比较,差异均有统计学意义(P0.05);随治疗时间延长,VAS评分、Lequesne指数评分和WOMAC评分逐渐降低(P0.05),但膝关节活动度各时间点间差异均无统计学意义(P0.05)。治疗前3组间VAS评分、Lequesne指数评分、WOMAC评分及膝关节活动度比较,差异均无统计学意义(P0.05);治疗后第1、3、5周,C组上述3项评分明显优于A、B组(P0.05),但3组间膝关节活动度差异均无统计学意义(P0.05)。结论体外冲击波联合PRP注射治疗KOA具有协同作用,能进一步缓解关节疼痛。     

超声引导下高容量注射与冲击波治疗慢性非止点跟腱腱病的比较

目的观察和比较超声引导下高容量注射治疗(HVUGI)与冲击波治疗(ESWT)慢性非止点跟腱腱病的临床疗效。方法选择2017年3月至2018年2月慢性非止点跟腱腱病保守治疗无效的患者52例,男21例,女31例,年龄35～70岁,BMI 18～35 kg/m~2。随机分为HVUGI组(H组)和ESWT组(E组),每组26例。H组在超声引导下将1%利多卡因10 ml及生理盐水40 ml注入到跟腱与跟腱前脂肪垫之间。E组采用瑞士STORZ医用放射式冲击波治疗仪MP100治疗跟腱疼痛部位,每周治疗1次,共3次。分别在治疗前、治疗后6周、3个月和6个月采用VAS评估疼痛程度,采用0～10分评估踝关节僵硬程度,采用维多利亚学院足踝运动功能评估评分(VISA-A)综合评估跟腱病变程度。观察注射部位有无出血、血肿、感染以及跟腱断裂等并发症。结果与治疗前比较,治疗后6周至6个月两组患者VAS疼痛评分均明显降低(P0.05),治疗后6周H组、治疗后6个月两组患者僵硬程度评分均明显降低(P0.05)。与治疗前比较,治疗后6周至6个月两组患者VISA-A评分均明显升高(P0.05)。两组VAS疼痛评分、僵硬程度评分和VISA-A评分差异均无统计学意义。两组患者治疗后均无出血、血肿、感染以及跟腱断裂等并发症。结论冲击波及超声引导下高容量注射治疗慢性非止点跟腱腱病具有良好效果,而高容量注射治疗在治疗后6周时僵硬程度的改善优于冲击波治疗。     

关节镜清理联合富血小板血浆治疗创伤性踝关节炎

[目的]探讨关节镜清理联合富血小板血浆（platelet-rich plasma, PRP）治疗创伤性踝关节炎（post-traumatic osteoarthritis, PTOA）的临床疗效及安全性。[方法]回顾性分析2019年2月—2021年2月收治的41例PTOA患者的临床资料。依据医患沟通结果,23例采用关节镜术联合PRP治疗,18例采用关节镜术联合透明质酸（hyaluronate acid, HA）治疗。比较两组围手术期、随访及辅助检查结果。[结果]两组手术时间、术中出血量、切口总长度、切口愈合等级、下肢深静脉血栓形成、住院时间的差异均无统计学意义（P>0.05）。两组患者均获12个月以上随访,两组完全负重活动时间差异无统计学意义（P>0.05）。随时间推移,两组VAS评分、AOFAS评分显著改善（P<0.05）,踝背伸-跖屈ROM无显著变化（P>0.05）。术后12个月PRP组的VAS评分[(1.3±0.6) vs (2.7±1.1), P<0.05]和AOFAS评分[(80.9±6.5) vs (71.0±5.6), P<0.05]均...     

不同剂量体外冲击波治疗膝骨性关节炎近期疗效比较

[目的]比较不同能流密度的体外冲击波治疗(ESWT)早中期膝关节骨性关节炎(KOA)的近期临床疗效,探索最佳ESWT治疗剂量。[方法]将150个患有骨性关节炎的膝关节分为A、B、C、D、E五组,均使用ESWT治疗4周,各组的能流密度分别为0.06、0.10、0.14、0.18、0.22 mJ/mm~2。分别在治疗前、治疗后1个月及治疗后12个月,进行肢体活动疼痛视觉模拟评分(VAS评分)、Lysholm评分和WOMAC骨关节炎指数评分评价临床疗效。[结果]按时间点比较,各组VAS和WOMAC评分治疗前最高,治疗后1个月降至最低,而在治疗后12个月再次升高(P0.05),然而,各组Lysholm评分治疗前最低,治疗后1个月最高,治疗后12个月再次降低(P0.05)。按组间比较观察,治疗前各组患膝的VAS、Lysholm和WOMAC评分差异无统计学意义(P0.05)。治疗1个月后和治疗12个月后,VAS与WOMAC评分由低到高依次为:D组C组B组E组A组,组间差异有统计学意义(P0.05);相反,Lysholm评分由高到低依次为:D组C组B组E组A组,组间差异有统计学意义(P0.05)。[结论]中低能量的ESWT能有效地缓解早中期KOA患者的疼痛症状并改善关节功能,采用能流密度为0.18 mJ/mm~2,近期临床疗效最佳。     

意大利筋膜手法治疗慢性非特异性腰痛患者的疗效研究

目的 探讨意大利筋膜手法对慢性非特异性腰痛患者的疗效.方法 2019年11月～2020年11月,选取40例慢性非特异性腰痛患者,随机分为筋膜组(n=20)和推拿组(n=20).两组均进行家庭训练2周,1次/d;筋膜组在此基础上辅以筋膜手法,治疗2周,每周2次;推拿组辅以推拿治疗,治疗2周、每周2次.在治疗前、治疗后和随访1个月后,分别采用VAS评分、ODI指数、腰背核心肌群屈伸和旋转的峰力矩(peak torque,PT)进行疗效评价.结果 治疗后两组腰背核心肌群屈伸和旋转的PT和VAS评分、ODI指数均较治疗前显著改善(P<0.05);但与推拿组相比,筋膜组的PT改善更显著(P<0.05).随访1个月,推拿组各项评分显著差于治疗后(P<0.05);而筋膜组VAS评分和ODI指数较治疗后改善更显著(P<0.05).结论 筋膜手法可有效减轻慢性非特异性腰痛患者的疼痛,更有效地改善功能障碍,其长期疗效和预防作用较好.     

Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy

Introduction The aim of this study was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the ultrasonographic appearance of chronically painful, proximal plantar fasciitis.Materials and methods Twenty-two patients with a unilateral proximal plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment lasting 6 months. The contralateral plantar fascia was used as the control. ESWT (3×3000 shock waves/session of 0.2 mJ/mm²) was performed at weekly intervals. The thickness of the plantar fascia was measured ultrasonographically about 2 cm distal of the medial calcaneal tuberosity. Pain estimation on a visual analogue scale (VAS) and the comfortable walking time were recorded. No local anaesthesia was applied. Follow-up was done at 6, 12 and 24 weeks.Results Before ESWT, the plantar fasciitis side was ultrasonographically significantly thicker than the control side (p<0.05), whereas 6 months after ESWT, the thickness of the fascia was no longer significantly different. The decrease in thickness of the plantar fasciitis side was significant (p<0.05). Pain during activities of daily living decreased by 79% according to the VAS, and the comfortable walking time increased, both significantly (p<0.01). In patients with little pain (VAS<30), the thickness of the plantar fasciitis side was significantly less (p<0.01) compared with patients who still suffered more pain (VAS>30).Conclusion After ESWT, the thickness of the plantar fascia in patients with plantar fasciitis decreased, pain and walking time improved (all significantly).     

Prediction of clinical response to corticosteroid or platelet-rich plasma injection in plantar fasciitis with MRI: A prospective,randomized, double-blinded study

PurposeThe purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment.Material and methodsThe study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease > 50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points.ResultsIn the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P < 0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones).ConclusionInitial facia thickness (> 7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness.     

Dextrose prolotherapy versus radial extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized,controlled clinical trial

In the recent years, prolotherapy is increasingly being used in the field of musculoskeletal medicine. However, few studies have investigated its effectiveness in plantar fasciitis (PF). The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic PF. This randomized controlled trial was conducted on 59 patients with chronic PF. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided intrafascial 2 cc dextrose 20% injection (30 patients). The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments: pain intensity by visual analog scale (VAS), daily life and exercise activities by Foot and Ankle Ability Measure (FAAM), and the plantar fascia thickness by ultrasonographic imaging. The VAS and FAAM scales showed significant improvements of pain and function in both study groups 6 weeks and 12 weeks after the treatments. A significant reduction was noted for plantar fascia thickness at these intervals (all p < .05). The inter-group comparison revealed that except for the FAAM-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures. Dextrose prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group.Level of evidenceLevel I, randomized controlled trial.     

The Impact of Extracorporeal Shock Wave Therapy and Dry Needling Combination on Pain and Functionality in the Patients Diagnosed with Plantar Fasciitis

This study aimed to evaluate the efficiency of extracorporeal shock wave therapy (ESWT) and dry needling (DN) combination on pain and functionality in plantar fasciitis. Forty patients who were clinically diagnosed with plantar fasciitis were included in the study. The patients were randomly divided into 2 groups. The ESWT-DN group was applied 3 sessions of ESWT to plantar fascia and DN to the trigger points in the gastrosoleus muscles. The ESWT group was applied only ESWT treatment to plantar fascia. We used visual analog scale (VAS) for pain and a pressure algometer for pressure pain threshold. The functionality of the patients was evaluated with Foot Function Index (FFI). Also, maximum painless standing time and maximum painless walking distance were recorded. All assessments were repeated twice; first, pretreatment and second 1 month after the treatment. In both groups, there were statistically significant improvements in VAS, pressure pain threshold, maximum painless standing time, maximum painless walking distance, and FFI's pain, disability, and activity limitation subscales scores (p ≤ .001). In intergroup comparison; it was showed that VAS scores, maximum painless standing time (p = .002), maximum painless walking distance (p ≤ .001), and FFI pain subscale scores (p = .034) were statistically superior in the ESWT-DN group. There was no statistically difference between the groups in pressure pain threshold (p = .132), FFI disability (p = .081), and FFI activity limitation subscale (p = .226) scores. ESWT and DN combination therapy in plantar fasciitis was seen to be superior in the pain scores. Further studies with larger patients’ groups and longer term results of this combination are needed for a better comparison.     

Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment

Objective

The aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities.

The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis

BackgroundPlantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment.MethodsPubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration’s tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST.ResultsEighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = − 11.53 [− 16.62; − 6.43], P < 0.0001).ConclusionPatients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis.Level of clinical evidenceII.     

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy,Ultrasound Therapy,and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm²; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm²); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles–Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes.     

The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis

Introduction

In this study, the results of local injection of platelet-rich plasma (PRP) and corticosteroids in the treatment of plantar fasciitis were compared.

Patients and methods

Sixty patients who were diagnosed as plantar fasciitis and treated conservatively for at least 3?months and had no response to conservative treatment modalities were involved in this study. The first 30 consecutive patients were treated by local injection of 2?mL of 40?mg Methylprednisolone with 2?mL of 2% prilocaine (metilprednizalone) and the second 30 patients were treated by injecting 3?mL PRP after 2?mL of 2% prilocaine injection. Patients were evaluated according to the modified criteria of the Roles and Maudsley scores and visual analog scale before injection and 3?weeks and 6?months following injection.

Results

The mean VAS heel pain scores measured 6?months after treatment were 3.4 in steroid group and 3.93 in PRP group, and the scores in both groups were significantly lower when compared with pretreatment levels (6.2 in steroid group and 7.33 in PRP group). There was no significant difference between steroid and PRP groups in visual analog scale scores and modified criteria of the Roles and Maudsley scores measured at 3?weeks and 6?months (P?>?0.05).

Conclusion

Our results revealed that both methods were effective and successful in treating plantar fasciitis. When the potential complication of corticosteroid treatment was taken into consideration, PRP injection seems to be safer and at least having same effectivity in the treatment of plantar fasciitis.     

Comparison of Ultrasound-Guided Prolotherapy Versus Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized Clinical Trial

This study aimed to compare the effectiveness of extracorporeal shockwave therapy (ESWT) versus dextrose prolotherapy on pain and foot functions in patients with chronic plantar fasciitis with a prospective randomized-controlled trial. A total of 29 patients in whom conservative care failed were enrolled for the study after the clinical and ultrasonographic assessment. The patients were randomly assigned to receive ESWT (ESWT group, n = 15) or dextrose prolotherapy (dextrose prolotherapy group, n = 14). ESWT group received 1800 to 2000 focused shock waves (session of 0.20-0.30 mJ/mm² with a frequency of 4-6 Hz) followed by soft tissue 3000 to 3500 radial pulses (session of 1.8-3.0 bar with a frequency of 15-21 Hz). Dextrose prolotherapy group underwent an injection of 5 ml 15% dextrose solution with 2% lidocaine. ESWT and dextrose prolotherapy were repeated 3 times by 2 weeks apart. A 100-mm Visual Analog Scale (VAS) for overall and morning pain, Foot Function Index (FFI) and the Roles and Maudsley Scale score (RMS) were assessed at baseline, 6 weeks, and 12 weeks after the last intervention. Overall VAS, Morning VAS, RMS and FFI scores improved significantly in both treatment groups at 6 weeks and 12 weeks compared to baseline (p < .001). Comparison of changes in overall VAS, Morning VAS, RMS and FFI scores did not show a significant difference between the groups at each time point (p > .05) In our study dextrose prolotherapy and ESWT had similar effectiveness in patients with chronic plantar fasciitis who have not respond to conservative care. The results showed ESWT and dextrose prolotherapy were not superior to each other     

Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection

OBJECTIVE: To evaluate the long-term efficacy of steroid injection for plantar fasciitis using clinical parameters and high-resolution ultrasonography. MATERIAL AND METHODS: Thirty patients (27 female and three male) with plantar fasciitis and 30 healthy controls matched by age, gender and body mass index (BMI), were enrolled in this study. Seventeen of the patients had bilateral and 13 had unilateral (six right, seven left) plantar fasciitis. Palpation-guided steroid injection was applied to the 47 heels of 30 plantar fasciitis patients. Ultrasound examination and pain intensity with visual analog scale (VAS) were assessed three times in each plantar fasciitis patients; before injection and at 1 and 6 months after steroid injection. Ultrasonography was performed to the controls at initial assessment. RESULTS: The plantar fascia was remarkably thicker in the plantar fasciitis group than in controls (P < 0.001). The thickness of the plantar fascia and mean VAS values in the plantar fasciitis group decreased significantly 1 month after steroid injection (P < 0.001, P < 0.001, respectively) and a further decrease was noted 6 months postinjection (P < 0.001, P < 0.001, respectively). Strong correlation was found between the changes of plantar fascia thickness and VAS values 1 month after (P < 0.001, r: 0.61) and 6 months after (P < 0.001, r: 0.49) steroid injection. The incidence of hypoechoic fascia was 73% in the plantar fasciitis group before steroid injection. It decreased significantly at 1 and 6 months postinjection (33% and 7%, respectively, P < 0.001). Gross fascia disruption or other side effects were not observed after steroid injection. CONCLUSION: Steroid injection could be used in plantar fasciitis treatment for its positive long-term effects.