Plantar fasciitis: shock waves for pain in the foot
All content is checked by medical journalists.MunichIf the arch of the foot hurts with every step, it is often caused by tendinitis. And it can be persistent. Munich doctors then rely on shock waves.
Most people have never heard of the term plantar fasciitis. But those who are affected are reminded of it by a mean foot pain with every step. Plantar fasciitis (also known as plantar fasciitis) is an inflammation of the large tendon plate on the sole of the foot. It stretches the arch of the foot between the heel bone and toe joints. And is therefore exposed to great stress, especially with athletes or heavy people. If it becomes too much for her, it can become infected - and that is an extremely painful affair.
There are plenty of treatments available, from resting and cooling to stretching and medication. But with around ten percent of those affected, all of these therapy attempts remain ineffective.
Last hope before the operation: shock wave therapy. In many cases, however, they are not used correctly, suspect scientists from the Munich Clinic on the right of the Isar. And see this as a reason why the usefulness of shock wave therapy is still controversial. "The results of our study provide evidence that focused shock wave therapy with large amounts of energy effectively relieves pain in the foot," write sports medicine specialist Dr. Hans Gollwitzer and his team.
2,000 high energy pulses
250 people with chronic plantar fasciitis who had failed to respond to at least four conventional treatments took part in the study. Conventional methods include, for example, relief through rest or the use of crutches, the adaptation of movement sequences, special stretching exercises, physiotherapy and drug treatments such as anti-inflammatory drugs (e.g. diclofenac) and corticoid injections.
Half of the test persons received three shock wave treatments with 2000 pulses (four pulses per second, 0.25 mJ / mm²) at intervals of one week. The impulses were specially bundled and focused on the most pain-sensitive area. The other half received sham therapy. Local anesthesia prior to treatment was waived for all participants.
Less pain in the long term
In 54 percent of the “shock wave group”, the pain had decreased by at least 60 percent after twelve weeks - the value that the researchers had determined as the therapeutic success. Only 37 percent of the subjects in the placebo group achieved this.
As expected, the functional improvement of the foot tendon and the satisfaction of the participants were greater in the treatment group than in the placebo group.
Participants who had responded to the therapy - including the sham therapy - were asked again after one year. They were still symptom-free.
Useful when other therapies fail
The experts conclude that shock wave therapy for plantar fasciitis should always be focused on the most pain-sensitive area with a relatively high amount of energy. At the same time, local anesthesia should be avoided. Then the method could save those affected who do not respond to conventional forms of treatment, in many cases, having to go to the surgeon.
"Hardly any side effects, low costs"
American scientists also provide support. The orthopedist Dr. Michael Aronow from the University of Connecticut in a comment on the Munich study pointed out that the therapy had only minor side effects and was inexpensive. Only corticoid injections are equally effective and even cheaper, says Aronow.
Athletes and overweight people are particularly at risk
Plantar fasciitis is usually triggered by excessive stress, especially when doing sports such as running and jumping. People who are overweight are also at increased risk. Inflammation manifests itself as severe pain in the area of the heel and arch of the foot, which mainly occurs when there is pressure and strain. (vv)
Sources:
Gollwitzer, H. et al. Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis. A Randomized, Controlled Multicenter Study. J Bone Joint Surg Am, 2015 May 06; 97: 701-708. http://dx.doi.org/10.2106/JBJS.M.01331.
Aronow, M.S. Is Extracorporeal Shock Wave Therapy an Underutilized Treatment for Chronic Plantar Fasciitis ?. Commentary on an article by Hans Gollwitzer, MD, et al .: “Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis. A Randomized, Controlled Multicenter Study ”. J Bone Joint Surg Am, 2015 May 06; 97: e44. http://dx.doi.org/10.2106/JBJS.O.00192.
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