Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial

Abstract

Background: Plantar fasciitis (PF) is a common cause of heel pain. Among the several conservative treatment options, extracorporeal shock wave therapy (ESWT) is considered the standard treatment. However, recent studies suggest that PF may be sustained by a myofascial impairment proximal to the pain area with a biomechanical disequilibrium of the entire limb and pelvis.

Aim: By combining the concepts of fascial manipulation and ESWT, the purpose of this study was to evaluate the effectiveness of the ESWT on myofascial points in a sample of subjects with PF.

Design: Open label randomized controlled clinical trial.

Setting: Outpatient clinic.

Population: Patients with PF were randomly assigned to an experimental treatment group (EG), treated with focused ESWT on myofascial points, and a control group (CG), treated with the focused ESWT traditional approach on the medial calcaneal tubercle.

Methods: Every patient underwent a 3-session program and follow-up after 1 and 4 months. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and the Italian Foot Functional Index (17-iFFI).

Results: Thirty patients were enrolled in the study. Four patients of the CG dropped out the study, therefore twenty-six patients were included in the final analysis. Improvement in 17-iFFI and FAOS scores was observed in both groups starting from the third treatment and confirmed at the 1-month and 4-month follow-ups, with earlier improvement in the score values observed in the EG.

Conclusions: Treatment of the myofascial points with ESWT in subjects suffering from plantar fasciitis could be an effective treatment option. It fosters the hypothesis that a global biomechanical re-equilibrium of the body would be necessary to completely solve the pathology.

Clinical rehabilitation impact: ESWT on myofascial points could provide an interesting alternative with better outcomes in terms of time needed for recovery compared to traditional ESWT for the conservative management of PF.

Figure 1

—CONSORT flow diagram of the study.

Figure 2

—Graphic representation of the treated points in the experimental treatment group (EG) during the first (light gray; red in the online version), second (white; green in the online version) and third (dark gray; blue in the online version) session.

Figure 3

—The lower and upper fences of the box represent the 1^st and 3^rd quartile, the bisecting line the median, the diamond the mean. The upper whisker is the largest datum smaller than 1.5×interquartile range above the 3^rd and the lower whisker is the datum larger than 1.5× interquartile range below the 1^st quartile. A) Box plot of 17-iFFI Score distribution at session T1, T2, T3, T4 and T5. B) Box plot of FAOS score distribution at session T1, T2, T3, T4 and T5. FAOS: Foot and Ankle Outcome Score; 17-iFFI: 17-Italian Foot Functional Index.

Figure 4

—A) Least squares mean estimates of the absolute variation of the 17-iFFI Score in T2, T3, T4 and T5 with respect to the baseline (T1). B) Least squares mean estimates of the absolute variation of the FAOS Score in T2, T3, T4 and T5 with respect to the baseline (T1). 17-iFFI: 17-Italian Foot Functional Index; FAOS: Foot and Ankle Outcome Score.