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Treatment of plantar fasciitis (plantar myoapon├ęvrosite) wave of electrohydraulic high-energy shock.

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Treatment of plantar fasciitis (plantar myoapon├ęvrosite) wave of electrohydraulic high-energy shock.

The effectiveness of the treatment of chronic plantar fasciitis (plantar myoapon├ęvrosite) by extracorporeal shock wave (ODCE) was evaluated in 289 patients between 1996 and 2003, through a randomized, double-blind, placebo and cross.
The three main inclusion criteria were selected failure to at least six months of adequate medical treatment (including minimum physiotherapy, orthotics and various local or systemic anti-inflammatory drugs), pain felt by the patient greater than or equal to 5 on the VAS when the pressure exerted by the examiner on the plantar fascia, a pain felt by the patient than or equal to 5 on the VAS after the first 5 minutes of walking in the morning.
All patients received after anesthetic block 1500 shock waves at an intensity of 18 kv at a frequency of 2 Hz, giving a total of 324.25 Joules energy, applied to the maximum area of ??pain in a radius of 1 cm. For the placebo group, a fluid-filled bag is placed in the probe of the device to absorb the shock waves.
Patients were followed for 12 months. They completed a self-assessment questionnaire: rest pain, pain during daily activities, level of recreational activity and ability to work and were regularly assessed by the examiners. 4 success criteria were used: pressure pain and pain in the early morning not reduced by more than 50%, the pain diminished activity of at least 2 points on the VAS, absence of drug intake. A second application was proposed in case of failure.
The results of the study showed 76.8% good and excellent results at 12 months of treatment, with a significant difference compared to placebo. The average age of patients was 48.6 years, 2 women for every man. A heel spur present in 50-60% of heel pain persists after treatment and does not influence the result. Response to treatment was better in patients with a duration of shorter symptoms. No patient was worse.
In conclusion, the treatment of plantar fasciitis is primarily medical, it is satisfactory in 90% of cases. The following regimen may be adopted: first-line orthotics, Stout, to a relaxation of the plantar fascia, associated with NSAID therapy; second-line local infiltration, after eliminating other causes of heel pain and a corrected hyperuricemia; third for the ODCE, one or two sessions with a specialized therapist. Many devices on the market delivering different types of shock waves: infrared, acoustic, radial, electro hydraulic. Only the latter, used in lithotripsy, delivers ODCE of "high energy".
 

Doctor Yves GUGLIELMETTI. - 17 septembre 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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