Comparison of Three Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis: Corticosteroid Injection, Extracorporeal Shock Wave Therapy and Radiofrequency Nerve Ablation

Year 2019, Volume: 21 Issue: 2, 118 - 122, 30.08.2019

Yalçın Turhan Mehmet Arıcan

https://doi.org/10.18678/dtfd.573049

Abstract

Aim: In this study, it was aimed to compare the clinical and functional outcomes of three popular conservative treatment options in the treatment of chronic plantar fasciitis (PF): corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT) and radiofrequency nerve ablation (RFNA).

Material and Methods: Patients with chronic PF refractory to other conservative treatment methods were included in this retrospective study. From January 2017 to February 2019, all the patients with the diagnosis of chronic PF who were treated with conservative treatment modalities were evaluated. Forty eight patients who met our eligibility criteria and treated either with CSI, ESWT or RFNA methods were included in the study. Clinical and functional assessments of the patients were done by American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and Visual Analogue Scale (VAS) just before the treatment, at 6th and at 12th weeks of the last session.

Results: There was a statistically significant difference in terms of VAS scores between the groups both for before treatment and for 6th week (both p<0.001), but there was not a statistically significant difference between the groups in terms of VAS scores at 12th week (p=0.436). Also, there was not a statistically significant difference between the three groups in terms of AOFAS scores before treatment, 6th and 12th week assessments (p=0.076, p=0.081, p=0.478 respectively).

Conclusion: Although the three treatment modalities showed significant improvements in the chronic PF treatment, no differences were found among effectiveness of them at the final follow-up period.

Keywords

Corticosteroids, extracorporeal shockwave therapy, plantar fasciitis, ablation techniques

Kronik Plantar Fasiit Tedavisinde Üç Farklı Tedavi Yönteminin Kıyaslanması: Kortikosteroid Enjeksiyonu, Ekstrakorporeal Şok Dalga Tedavisi ve Radyofrekans Sinir Ablasyonu

Abstract

Amaç: Bu çalışmada kronik plantar fasiit (PF) tedavisinde kullanılan üç farklı popüler konservatif tedavi yöntemi olan kortikosteroid enjeksiyonu (KSE), ekstrakorporeal şok dalga tedavisi (ESWT) ve radyofrekans sinir ablasyonu (RFSA) tedavi yöntemlerinin klinik ve fonksiyonel sonuçlarının karşılaştırması amaçlanmıştır.

Gereç ve Yöntemler: Bu retrospektif çalışmaya diğer konservatif tedavi yöntemlerine dirençli olan kronik PF'li hastalar dahil edildi. Ocak 2017 ile Şubat 2019 arasında konservatif tedavi yöntemleriyle tedavi edilmiş olan kronik PF tanılı tüm hastalar incelendi. Uygunluk kriterleri ile uyumlu olan ve KSE, ESWT veya RFSA yöntemlerinden biri ile tedavi edilen kırk sekiz hasta çalışmaya dahil edildi. Hastaların klinik ve fonksiyonel değerlendirmeleri tedaviden hemen önce ve son seansın 6. ve 12. haftalarında, Amerikan Ortopedik Ayak ve Ayak Bileği Birliği (AOFAS) skorlama sistemi ve görsel analog skala (VAS) ile yapıldı.

Bulgular: Gruplar arasında hem tedavi öncesi hem de 6. Hafta için VAS skorları bakımından istatistiksel olarak anlamlı düzeyde bir farklılık vardı (her iki p<0,001), ancak 12. hafta VAS skorları bakımından gruplar arasında istatistiksel olarak anlamlı bir farklılık yoktu (p=0,436). Ayrıca üç grup arasında, tedavi öncesi, 6. ve 12. hafta değerlendirmelerindeki AOFAS skorları açısından da istatistiksel olarak anlamlı bir fark yoktu (sırasıyla p=0,076, p=0,081, p=0,478).

Sonuç: Üç tedavi yöntemi de kronik PF tedavisinde önemli iyileşmeler göstermesine rağmen, son takip döneminde bu tedavilerin etkinlikleri açısından aralarında anlamlı bir fark bulunamamıştır.

Keywords

Kortikosteroidler, ekstrakorporeal şok dalga tedavisi, plantar fasiit, ablasyon teknikleri

References

• Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303-10.
• Schwartz EN, Su J. Plantar fasciitis: a concise review. Perm J. 2014;18(1):e105-7.
• Böddeker R, Schäfer H, Haake M. Extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis-a biometrical review. Clin Rheumatol. 2001;20(5):324-30.
• Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl):S1-19.
• Ang TW. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis. Singapore Med J. 2015;56(8):423-32.
• Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford). 1999;38(10):974-7.
• Roos E, Engström M, Söderberg B. Foot orthoses for the treatment of plantar fasciitis. Foot Ankle Int. 2006;27(8):606-11.
• Kalaci A, Cakici H, Hapa O, Yanat AN, Dogramaci Y, Sevinç TT. Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial. J Am Podiatr Med Assoc. 2009;99(2):108-13.
• Peerbooms JC, van Laar W, Faber F, Schuller HM, van der Hoeven H, Gosens T. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial. BMC Musculoskelet Disord. 2010;11:69.
• Placzek R, Deuretzbacher G, Buttgereit F, Meiss AL. Treatment of chronic plantar fasciitis with botulinum toxin A: an open case series with a 1 year follow up. Ann Rheum Dis. 2005;64(11):1659-61.
• Thomson CE, Crawford F, Murray GD. The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2005;6:19.
• Sollitto RJ, Plotkin EL, Klein PG, Mullin P. Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. J Foot Ankle Surg. 1997;36(3):215-9.
• Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med. 2005;15(3):119-24.
• Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288(11):1364-72.
• Lapidus PW, Guidotti FP. Local injections of hydrocortisone in 495 orthopedic patients. Ind Med Surg. 1957;26(5):234-44.
• Speed CA. Fortnightly review: Corticosteroid injections in tendon lesions. BMJ. 2001;323(7309):382-6.
• Tsai WC, Wang CL, Tang FT, Hsu TC, Hsu KH, Wong MK. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil. 2000;81(10):1416-21.
• Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;(3):CD000416.
• Ogden JA, Alvarez RG, Marlow M. Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis. Foot Ankle Int. 2002;23(4):301-8.
• Kudo P, Dainty K, Clarfield M, Coughlin L, Lavoie P, Lebrun C. Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study. J Orthop Res. 2006;24(2):115-23.
• Buch M, Knorr U, Fleming L, Theodore G, Amendola A, Bachmann C, et al. Extracorporeal shockwave therapy in symptomatic heel spurs. An overview [Article in German]. Orthopade. 2002;31(7):637-44.
• Rompe JD, Küllmer K, Vogel J, Eckardt A, Wahlmann U, Eysel P, et al. Extracorporeal shock-wave therapy. Experimental basis, clinical application [Article in German]. Orthopade. 1997;26(3):215-28.
• Speed CA, Nichols D, Wies J, Humphreys H, Richards C, Burnet S, et al. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. 2003;21(5):937-40.
• Vulpiani MC, Trischitta D, Trovato P, Vetrano M, Ferretti A. Extracorporeal shockwave therapy (ESWT) in Achilles tendinopathy. A long-term follow-up observational study. J Sports Med Phys Fitness. 2009;49(2):171-6.
• Landsman A. Radiofrequency nerve ablation for the treatment of heel pain. Tech Foot Ankle Surg. 2011;10(2):76-81.
• Liden B, Simmons M, Landsman AS. A retrospective analysis of 22 patients treated with percutaneous radiofrequency nerve ablation for prolonged moderate to severe heel pain associated with plantar fasciitis. J Foot Ankle Surg. 2009;48(6):642-7.
• Arslan A, Koca TT, Utkan A, Sevimli R, Akel İ. Treatment of chronic plantar heel pain with radiofrequency neural ablation of the first branch of the lateral plantar nerve and medial calcaneal nerve branches. J Foot Ankle Surg. 2016;55(4):767-71.
• Erken HY, Ayanoglu S, Akmaz I, Erler K, Kiral A. Prospective study of percutaneous radiofrequency nerve ablation for chronic plantar fasciitis. Foot Ankle Int. 2014;35(2):95-103.
• Xiong Y, Wu Q, Mi B, Zhou W, Liu Y, Liu J, et al. Comparison of efficacy of shock-wave therapy versus corticosteroids in plantar fasciitis: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2019;139(4):529-36.
• Uğurlar M, Sönmez MM, Uğurlar ÖY, Adıyeke L, Yıldırım H, Eren OT. Effectiveness of four different treatment modalities in the treatment of chronic plantar fasciitis during a 36-month follow-up period: A randomized controlled trial. J Foot Ankle Surg. 2018;57(5):913-8.
• Ozan F, Koyuncu Ş, Gürbüz K, Öncel ES, Altay T. Radiofrequency thermal lesioning and extracorporeal shockwave therapy: A comparison of two methods in the treatment of plantar fasciitis. Foot Ankle Spec. 2017;10(3):204-9.