EKSTRAKORPOREAL ŞOK DALGA TEDAVİ (ESWT) UYGULAMASININ PLANTAR FASİİTİS KAYNAKLI TOPUK AĞRISINA ERKEN VE ORTA DÖNEM ETKİSİ

Yıl 2012, Cilt: 19 Sayı: 2, 37 - 42, 30.06.2012

Şeyhmus Kaplan Mustafa Serbest Cem Çetin Ali Erdoğan

Öz

Amaç: Topuk ağrısı olan, Plantar fasiitis tanılı hastalarda ESWT tedavisinin, ağrı şiddeti ve hassasiyet üzerine olan kısa ve orta dönem etkilerinin araştırılması amaçlandı.

Hastalar ve yöntem: Klinik olarak plantar fasiitis tanısı almış, semptomları 6 haftadan uzun süren 28'i kadın, 13'ü erkek olmak üzere toplam 41 hasta çalışmaya dahil edildi. Tüm hastalara 15 Hz frekans, 2.0 Barr yoğunluk ve 2000 atım/seans olmak üzere birer hafta ara ile toplam 3 seans ESWT tedavisi uygulandı. Hastaların ağrı şiddetleri tedavi öncesi ve her tedaviden bir hafta sonra ve son tedavi seansından 3 ay sonra olmak üzere 10 santimetrelik Vizüel Ağrı Skalası (VAS) ile değerlendirildi.

Bulgular: Tedavi sonrası 1. haftadan itibaren tüm VAS skoru değerleri tedavi öncesine göre anlamlı olarak daha düşük saptandı (p < 0,001) (tedö VAS ort; 75.34, haf1 VAS ort; 49.43, haf2 VAS ort; 38.53, haf3 VAS ort; 23.04, ay3 VAS ort; 20.39). Son tedavi seansından 1 hafta sonra (haf3) değerlendirilen VAS skoru ile tedavi bitiminden 3 ay sonra (ay3) değerlendirilen VAS skoru arasında istatistiksel anlamlı bir fark (23.04 ± 16.41; 20.39, ± 22.98, p>0,001) yoktu.

Sonuç: 2000'er atım olarak uygulanan, 3 seans düşük enerjili şok dalga tedavisi, kronik plantar fasiitis kaynaklı topuk ağrısının tedavisinde etkili ve güvenli bir yöntemdir.

Anahtar Kelimeler

Plantar fasiit, topuk dikeni, Vizüel Aðrý Skalasý (VAS)

Kaynakça

• Özdemir H, Ürgüden M, Özgörgen M, Gür S. Topuk yað yastýðý kalýnlýðý ve elastisitesi ile topuk aðrýsý arasýndaki iliþki. Acta Orthop Traumatol Turc 2002;36:429-28.
• Yüzer S, Sever A, Gürçay E, Ünlü E, Çakcý A. Topuk Dikeni Tedavisinde Lazer Tedavisi ve Steroid Enjeksiyonunun Etkinliðinin Karþýlaþtýrýlmasý. Türk Fiz Týp Rehab Derg 2006;52(2):68-71.
• Melegati G, Tornese D, Bandi M. The influence of local steroid injections, body weight and the length of symptoms in the treatment of painful subcalcaneal spurs with extracorporeal shock wave therapy. Clinical Rehabilitation 2002; 16: 789-794.
• Porter M, Shadbolt B. Intralesional Corticosteroid Injection Versus Extracorporeal Shock Wave Therapy for Plantar Fasciopathy. Clin J Sport Med 2005;15:119–124.
• Ogden JA, Alvarez R, Levitt R, Cross GL, Marlow M. Shock wave therapy for chronic proximal plantar fasciitis. Clin Orthop Relat Res 2001; Jun; (387):47- 59.
• Schon LC. Plantar fasciitis/ heel pain. In: Pfeffer GB, Frey CC, Anderson RB, et al., editors. Current practice in foot and ankle surgery, Vol. 1. New York: McGraw- Hill; 1993; 243-261.
• Mücke R, Schönekaes K, Micke O, Seegenschmiedt MH, Berning D, Heyder R. Low-Dose Radiotherapy for Painful Heel Spur. Strahlenther Onkol 2003;179:774-8.
• Rompe JD, Decking J, Schoellner C, Nafe B. Shock Wave Application for Chronic Plantar Fasciitis in Running Athletes: A Prospective, Randomized, Placebo-Controlled Trial. The American Journal of Sports Medicine 2003;31(2) :268-75.
• Tallia AF, Cardone DA. Diagnostic and Therapeutic Injection of the Ankle and Foot. American Fam
• Physician 2003;68(7) :1356-62.
• Toker S, Kýlýnçoðlu V, Güven M, Özkan N K, Gülcan E, Aksakallý E, Akman B. Kalkaneal Spur’un (topuk dikeni) lokal kortikosteroid ve anestezik madde enjeksiyonu ile tedavisinin erken ve orta dönem sonuçlarý. Göztepe Týp Dergisi 2008;23(2):59-62.
• Younger ASE, Sangeorzan BJ. Pain in the leg, ankle and foot. In: John DL,editor.Bonica’s management of pain. Philadelphia: Lippincott, Williams &Wilkins; 2001.p. 1614-1646.
• Miller MD. Reviev of orthopedics .Philadelphia: WB Saunders Company; 1992.p. 107-119.
• Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of non-operative treatment. Foot Ankle Int 1994;15:531–535.
• Dietrich S,Adam F,Kreutz A,Rupp S,Kohn D,Seil R.Ultrasonographic evaluation at 6-month follow-up plantar fasciitis after extracorporeal shock wave therapy.Arch Orthop Trauma Surg 2005; 125:6-9.
• Henney JE. From the Food and Drug Aministration: shock wave for heel pain. JAMA 2000; 284: 2711.
• Chaussy C, Eisenberger F, Wanner K. The use of shock waves for the destruction of renal calculi without direct contact. Urol Res 1976;181:352–357.
• 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.
• Buch M, Knorr U, Fleming L, Theodore G, Amendola A, Bachmann C et al. Extracorporeal shockwave therapy in symptomatic heel spurs. An overview. Orthopade 2002; 31: 637–44.
• Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes – a prospective, randomized, placebo controlled trial. Am J Sports Med 2003; 31: 268–75.
• Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A.Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a r a n d o m i z e d c o n t r o l l e d t r i a l . J A M A 2002;288(11):1364–72.
• Haake M, Buch M, Schoellner C, Goebel F, Vogel M, Mueller I, et al. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ 2003; 12;327(7406):75-77.
• 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; 21:937–940.
• Kudo P, Dainty K, Clar?eld M, Coughlin L, Lavoie P, Lebrun C. Randomized, Placebo-Controlled, Double- Blind Clinical Trial Evaluating the Treatment of Plantar Fasciitis with an Extracorporeal Shockwave Therapy (ESWT) Device: A North American Confirmatory
• Study. J Orthop Res 2006; 24(2):115-23.
• Rompe JD, Schoellner C, Nafe B. Evaluation of Low- Energy Extracorporeal Shock-Wave Application for Treatment of Chronic Plantar Fasciitis. J Bone Joint Surg Am 2002; 84-A(3):335-41.
• Cosentino R, Falsetti P, Manca S, Stefano De R, Frati E, Frediani B, Baldi F, Selvi E, Marcolongo R. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis. Ann Rheum Dis 2001;60:1064–67.
• Heller KD, Niethard FU. Using extracorporeal shockwave therapy in orthopaedics?a meta-analysis. Z Orthop Ihre Grenzgeb 1998;136:390-401.
• Perlick L, Boxberg W, Giebel G. High energy shock wave treatment of the painful heel spur. Unfallchirurg 1998;101:914-8.
• Kumai T, Benjamin M. Heel Spur Formation and the Subcalcaneal enthesis of the Planter Fascia. J Rheumatol 2002;29:1957-64.
• Prichasuk S,Subhadrabandhu T.The relationship of Pes Planus and Calcaneal Spur to Plantar Heel Pain.Clin Orthop 1994;306:192-6.
• Du Vries HL. Heel spur (Calcaneal Spur). Arch Surg 1957;74:536.
• Williams PL,Smibert JG, Cox R,Mitchell R,Klenerman L.Imaging study of the painful heel syndrome.Foot Ankle 1987;7:345.
• Khuns JC.Changes in elastic adipose tissue.J Bone Joint Surg (Am) 1949;31:541-548
• Campbell JW, Inman VT.Treatment of plantar fasciitis and calcaneal spurs with the UC-BL shoe insert. Clin Orthop 1974; 103:57-62.
• Lapidus PW,Guidotti FP.Painful heel:report of 323 patients with 364 painful heels. Clin Orthop 1965;39:178-85.
• Onwuanyi ON. Calcaneal spurs and plantar heel pad pain. The Foot 2000; 10: 182–85.
• Cornwall MW,McPoil TG.Plantar fasciitis:etiology and treatment. J Orthop Sports Phys Ther 1999;29:757- 60.
• Tornese D,Mattei E,Lucchesi G,Bandi M,Ricci G,Melegati G. Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study. Clinical Rehabilitation 2008; 22: 780–87.
• Barret SL, Day SV, Pignetti T, Egly BR.Endoscopic heel anatomy: analysis of 200 fresh frozen specimens. J Foot Ankle Surg 1995; 34:51–56.
• Buch M, Schlangmann BA, Lubbers C, Trager D,Siebert WE. Results of shock wave therapy of calcaneal spurs from the Orthopedic Hospital in Kassel: influence of various parametres on the outcome In: Siebert W, Bunch M, editors.Extracorporeal shock waves in orthopedics. Berlin: Springer, 1998: 30–35.
• Valchanou VD,Michailov P.High Energy Shock Waves in the treatment of delayed and nonunion of fractures.Int
• Orthop 1991; 15:181-184.
• Mouzopoulos G, Stamatakos M, Mouzopoulos D, Tzurbakis M. Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review. Skeletal Radiol. 2007 Sep;36(9):803-11.
• Ogden JA, Alvarez RG, Marlow M. Shockwave therapy for chronic plantar fasciitis: a meta-analysis. Foot Ankle Int. 2002;23:301–308.