Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial

Authors
Alireza Moghtaderi
Saeid Khosrawi
Farnaz Dehghan
Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone.
Materials and Methods: The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session.
Results: Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group.
Conclusion: The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

Keywords

1. Riddle DL, Pulisic M, Sparrow K. Impact of demographic and impairment related variables on disability associated with plantar fasciitis. Foot Ankle Int 2004;25:311-7.  Back to cited text no. 1
    
2. Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician 2011;84:909-16.  Back to cited text no. 2
    
3. Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: A systematic review. J Sci Med Sport 2006;9:11-22, 23-4.  Back to cited text no. 3
    
4. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: A matched case-control study. J Bone Joint Surg Am 2003;85-A:872-7.  Back to cited text no. 4
    
5. Werner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk factors for plantar fasciitis among assembly plant workers. PM R 2010;2:110-6.  Back to cited text no. 5
    
6. Labovitz JM, Yu J, Kim C. The role of hamstring tightness in plantar fasciitis. Foot Ankle Spec 2011;4:141-4.  Back to cited text no. 6
    
7. DiGiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, et al. Plantar fasciaspecific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year of follow-up. J Bone Joint Surg Am 2006;88:1775-81.  Back to cited text no. 7
    
8. Glazer JL. An approach to the diagnosis and treatment of plantar fasciitis. Phys Sports Med 2009;37:74-9.  Back to cited text no. 8
    
9. Placzek R, Deuretzbacher G, Meiss AL. Treatment of chronic plantar fasciitis with botulinum toxin A: Preliminary clinical results. Clin J Pain 2006;22:190-2.  Back to cited text no. 9
    
10. Rompe JD, Cacchio A, Well L Jr, Furia JP, Haist J, Reiners V, et al. Plantar fascia specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. J Bone Joint Surg Am 2010;92:2514-22.  Back to cited text no. 10
    
11. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: A review. Curr Rev Musuculoskelet Med 2008;1:165-74.  Back to cited text no. 11
    
12. Seyler TM, Smith BP, Marker DR, Ma J, Shen J, Smith TL, et al. Botulinum neurotoxin as a therapeutic modality in orthopaedic surgery: More than twenty years of experience. J Bone Joint Surg Am 2008;90:133-45.  Back to cited text no. 12
    
13. Soomekh DJ. Using platelet-rich plasma in the foot and ankle. Foot Ankle Spec 2010;3:88-90.  Back to cited text no. 13
    
14. Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ. Plantar fasciitis treated with local steroid injection: Comparison between sonographic and palpation guidance. J Clin Ultrasound 2006;34:12-6.  Back to cited text no. 14
    
15. Tillu A, Gupta S. Effect of acupuncture treatment on heel pain due to plantar fasciitis. Acupunct Med 1998;16:66-8.  Back to cited text no. 15
    
16. Perez-Millan R, Foster L. Low frequency electroacupuncture in the management of refractory plantar fasciitis. Acupunct Med 2001;13:1-6.  Back to cited text no. 16
    
17. Eftekhar-Sadat B, Babaei-Ghazani A, Zeinolabedinzadeh V. Evaluation of dry needling in patients with chronic heel pain due to plantar fasciitis. Foot (Edinb) 2012 Nov 28. pii: S0958-2592(12)00107-1.  Back to cited text no. 17
    
18. Müller-Ehrenberg H, Licht G. Diagnosis and therapy of myofascial pain syndrome with focused shock waves (ESWT). Medizinisch Orthopädische Technik 2005;5:1-6.  Back to cited text no. 18
    
19. Ji HM, Kim HJ, Han SJ. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius. Ann Rehabil Med 2012;36:675-80.  Back to cited text no. 19
    
20. Roles NC, Maudsley RH. Radial tunnel syndrome: Resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br 1972;54:499-508.  Back to cited text no. 20
    
21. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1998;19:91-7.  Back to cited text no. 21
    
22. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1994;15:376-81.  Back to cited text no. 22
    
23. Henney JE. From the food and drug administration: Shock wave for heel pain. JAMA 2000;284:2711.  Back to cited text no. 23
    
24. Hyer CF, VanCourt R, Block A. Evaluation of ultrasound-guided extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis. J Foot Ankle Surg 2005;44:137-43.  Back to cited text no. 24
    
25. Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci 2012;17:799-804.  Back to cited text no. 25
[PUBMED]  Medknow Journal  
26. Vahdatpour B, Sajadieh S, Bateni V, Karami M, Sajjadieh H. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments. J Res Med Sci 2012;17:834-8.  Back to cited text no. 26
[PUBMED]  Medknow Journal  
Advanced Biomedical Research
Volume 2014, March
March 2014
Pages 1-4