Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial
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2017
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Abstract
We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm2; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm2); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles–Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p =.006 and p =.012, respectively), with no significant difference between the LLLT and ESWT groups (p >.05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes. © 2017 American College of Foot and Ankle Surgeons
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Adult , Aged , Chronic Disease , Extracorporeal Shockwave Therapy , Fasciitis, Plantar , Female , High-Energy Shock Waves , Humans , Low-Level Light Therapy , Magnetic Resonance Imaging , Male , Middle Aged , Treatment Outcome , Young Adult , nonsteroid antiinflammatory agent , adult , aged , American Orthopaedic Foot and Ankle Society ankle hindfoot scale , Article , bone marrow edema , clinical effectiveness , controlled study , extracorporeal shock wave therapy , female , follow up , foot orthosis , functional assessment , heel pain , heel tenderness index , home physiotherapy , human , intermethod comparison , low level laser therapy , major clinical study , male , musculoskeletal disease assessment , musculoskeletal system parameters , nuclear magnetic resonance imaging , nuclear magnetic resonance scanner , outcome assessment , plantar fasciitis , prospective study , randomized controlled trial , Roles Maudsley score , shock wave generator , shock wave therapy , soft tissue disease , soft tissue edema , therapy effect , treatment duration , treatment response , ultrasound therapy , visual analog scale , chronic disease , comparative study , diagnostic imaging , high-energy shock wave , middle aged , plantar fasciitis , treatment outcome , young adult