Ultrasonographic Evaluation of Low Energy Extracorporeal PulseActivatedTherapy (EPAT) for Chronic Plantar Fasciitis
By Robert Gordon, MD; Charles Wong, BHSc; Eric J. Crawford, BHSc Toronto, Canada
FOOT & ANKLE INTERNATIONAL ©2012 by the American Orthopaedic Foot & Ankle Society DOI: 10.3113/FAI.2012.0202
Background: Ultrasonographic measurement of the plantar fascia can be used to objectively diagnose plantar fasciitis. The purpose of this study was to determine the long-term effectiveness of Extracorporeal Pulse-Activated Therapy (EPAT) – Shockwave therapy – for the treatment of plantar fasciitis using ultrasonographic measurement as an objective outcome measure, with a minimum follow-up of 12 months.
Methods: Patients with chronic recalcitrant plantar fasciitis were prospectively recruited and underwent EPAT. Ultrasound measurement of the plantar fascia and patient-rated pain scores were collected before treatment and at follow-up (minimum of 12 months post-treatment). Twenty-five subjects (35 feet) met the inclusion criteria. The average follow-up time was 29.4 ± 13.1 (M ± SD; range, 12 to 54) months.
Results: The average thickness of the plantar fascia of the symptomatic heels was 7.3 ± 2.0 mm before treatment and 6.0 ± 1.3 mm after treatment (p < 0.001). The average change in thickness of the treated heels was − 1.3 mm (− 0.8 to − 1.8 mm; 95% CI, p < 0.0001). No correlation was found between length of follow-up and change in ultrasound measured plantar fascia thickness (r = − 0.04, p = 0.818).
Conclusion: For patients with a greater than 12-month history of heel pain, Shockwave therapy can effectively decrease plantar fascia thickness as demonstrated objectively by ultrasound evaluation and reduce patient-reported pain. No relationship between length of follow-up and change in plantar fascia thickness was found after 12 months.