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Rehab after ECSWT for Plantar Fasciitis
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Rehab after ECSWT for Plantar Fasciitis - March 5, 2005 1:30:00 PM
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aconcors
Posts: 26
Joined: September 16, 2004
From: Northern San Diego County
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Does anyone have a reference for rehab on a patient who has undergone Shock Wave Therapy for Plantar Fasciitis? Personal experience?
Andy
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Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: Rehab after ECSWT for Plantar Fasciitis - March 6, 2005 4:14:00 AM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
Status: online
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Hello,
I have looked at some research articles referring to this and to my surprise, most of them either agreed or disagreed with the clinical effectiveness of ECSWT.
In addition, most of the articles did not mention any rehab done prior to followup.
However, one study I found showed what happens after a session:
Radiology. 2005 Jan;234(1):206-10. Epub 2004 Nov 24. Related Articles, Links
Chronic plantar fasciitis: acute changes in the heel after extracorporeal high-energy shock wave therapy--observations at MR imaging.
Zhu F, Johnson JE, Hirose CB, Bae KT.
Mallinckrodt Institute of Radiology and Department of Orthopedic Surgery, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63117, USA.
PURPOSE: To prospectively evaluate with magnetic resonance (MR) imaging the acute changes in the heel associated with extracorporeal shock wave therapy (ESWT). MATERIALS AND METHODS: Institutional clinical study review board approved the study, and informed consent was obtained. MR imaging was performed within 24 hours before and after ESWT on 18 feet of 12 patients (eight women and four men; age range, 33-63 years; average, 49.9 years) with chronic plantar fasciitis. ESWT was applied to the most painful point on the plantar surface of the heel, with a total of 1500 shocks at 18 kV. The MR imaging protocol consisted of sagittal and coronal T1- and T2-weighted images with and without fat saturation. The images were reviewed to assess the post-ESWT changes in soft-tissue and bone marrow edema, the thickness of the proximal plantar fascia, and the presence of a heel spur. Paired t test was used for the statistical analysis. RESULTS: Soft-tissue edema, which was present in 16 (89%) of 18 heels before ESWT, had increased in severity in 12 (75%) heels after ESWT. Calcaneus bone marrow edema at the insertion site was observed in eight heels before ESWT. After ESWT, the extant of bone marrow edema had increased in one heel and had newly developed in another heel. The heel spur seen in nine (50%) feet was not affected by ESWT. In 17 (94%) heels, the proximal plantar fascia was abnormally thick, with thickness not significantly changed with use of ESWT (P > .05). CONCLUSION: Increase in soft-tissue edema is the most common acute response associated with ESWT. (c) RSNA, 2004.
PMID: 15564391 [PubMed - indexed for MEDLINE]
If one such person had this done and came to your office, then one would treat it as a local inflammation.
Of course, this and other studies, wanted to see if this treatment worked or not, without any other intervention. Perhaps if there were studies that combined with PT, the results might be different in the studies that showed no favorable outcomes.
JMA
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Re: Rehab after ECSWT for Plantar Fasciitis - March 6, 2005 10:34:00 AM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
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We just did an inservice on this modality following a literature review. As JMA mentions there is little support for the effectiveness of this intervention...the most recent study in BMJ (2004) with a high participant number, RCT, etc. showed no better outcome between placebo and ESWT. Most studies used inclusion criteria of 6 months of failed conservative intervention (footwear modifications, stretches, modalities etc).
That said, the conclusion of the other articles available (interesting bias in some of the foot and ankle journals), were the following:
1. It is used primarily after conservative/traditional treatments have failed after 6 month trial. 10% of those with PFS fail conservative management.
2. The purpose of the treatment is to create neovascularization....following localized trauma. Meaning, irritate it, and circulation will be increased. Therefore, would you want to minimize the inflammatory response if that is the goal?
3. Surgery and ESWT have a similar effectiveness out come.
4. Most insurance companies do not pay for it due to the experimental nature of the procedure.
5. Results can take as long as 6 months to one year to be achieved. Makes you wonder if it is more natural course of the condition.
6. Used for chronic conditions, not acute problems.
7. From one (high intensity) to three (low intensity) treatments total are used.
None of the studies had patients continue active PT after treatment.
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PRC
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Re: Rehab after ECSWT for Plantar Fasciitis - March 6, 2005 5:57:00 PM
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aconcors
Posts: 26
Joined: September 16, 2004
From: Northern San Diego County
Status: offline
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Thank you for the responses. I noticed the bias in a lot of the articles as well.
Patients of mine who had it when therapy didn't work described it as having their feet beat on by a baseball bat.
i would imagine the patients would benefit from intrinsic strengthening and a gradual closed chain rehab progression depending on their goals.
Thanks again,
Andy
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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