Short-Term Outcome of Focused Shock Wave Therapy for Sural Myofascial Pain Syndrome associated with Plantar Fasciitis: a Randomized Controlled

Abstract

Background. This study aims to describe prevalence and clinical features of the sural myofascial pain syndrome (SMPS) in a population affected by plantar fasciitis and to investigate if a shock wave treatment extended to the gastrocnemius-soleus trigger points is more effective in speeding up the improvement of heel pain and sural myofascial pain than a standard treatment exclusively targeted at the plantar fascia. Methods. Among 81 subjects affected by plantar fasciitis, 55 showed concomitant SMPS and were randomized to receive focused shock wave therapy for the plantar fascia and for gastrocnemius-soleus trigger points or for the plantar fascia only. We monitored heel pain (FFI-A) and foot function (FFI-B) using the Foot Function Index. Pressure pain threshold (PPT) and Delta-PPT of the gastrocnemius-soleus trigger points was assessed with a digital algometer. Outcome measures were monitored in a follow-up four weeks after the treatment. Results. The prevalence of SMPS resulted to be 67.9%. At the follow-up, no statistical significance in the comparisons between groups was found for FFI-A and FFI-B total score and also for PPT and Delta-PPT values, despite comparisons within the study group (follow-up versus baseline) showed a significant reduction of FFI-A total score (p < 0.001), FFI-B total score (p = 0.029) and Delta-PPT values (p = 0.018), with a consensual increase of PPT values (p = 0.017). Conclusions. We pointed out a high prevalence of sural trigger points in subjects affected by plantar fasciitis. In a short-term perspective, the extension of a focused shock wave treatment to the gastrocnemius-soleus trigger points resulted to be a safe but ineffective option in reducing heel pain and sural myofascial pain, if compared to a standard treatment.

Efficacy of Extracorporeal Shockwave Therapy on Pain and Function in Myofascial Pain Syndrome

“…The characteristics of the included studies are shown in Supplementary Appendix 2 (Supplemental Digital Content 3, http://links.lww.com/PHM/C68). Of the 27 RCTs included, 12 compared ESWT against a control ESWT, [17][18][19][20][21][22][23][24][25][26][27][28] and 18 compared ESWT, [17][18][19][20][21][22]26,[29][30][31][32][33][34][35][36][37][38][39] with other interventions. Most of the trials included two arms, except for six trials, which were three-armed studies.…”

“…In terms of the treated area, 22 studies were carried out on patients with cervical and shoulder complaints, three studies were conducted on the leg/foot region, 25,27,28 and two trials were conducted on the lumbar spine region. 22,30 On the duration of pain, eight studies reported no data on this variable, 19,20,23,28,32,33,38 five studies reported between zero days and 3 mos of pain duration, 18,24,29,33,34 and 14 studies reported that their sample had a duration of pain longer than 3 mos.…”

“…The protocols and parameters for the application of ESWT were heterogeneous. Eighteen studies used radial ESWT, [17][18][19][20][21]26,[28][29][30][31][33][34][35][36][37][38][39] with a dose range of 1.2 to 4 bar or 0.056 to 0.2 mJ/mm 2 ; the number of pulses applied to the TPs ranged between 300 and 1500, and the frequency ranged from 1 to 20 Hz. On the other hand, nine trials used focused ESWT, 19,[22][23][24][25]27,[32][33][34] with a dose range of 0.056 to 0.26 mJ/mm 2 ; the number of pulses applied to the TPs ranged between 400 and 700, and the frequency ranged from 1 to 10 Hz.…”

“…18,24,31,33,34 The follow-up periods differed among the studies. An immediate postintervention assessment was conducted in all the trials except that of Moghtaderi et al 40 at 3-9 wks after the intervention in four studies 17,25,29,30,39 and after 10-24 wks in 10 trials. 32,34,35 An assessment of the adverse effects and/or complications was specifically stated in 10 of the 27 included studies, in which none reported any adverse effects (see Supplementary Appendix 2, Supplemental Digital Content 3, http:// links.lww.com/PHM/C68).…”

Therapeutic Exercise in Plantar Fasciitis: A Systematic Review with Meta-Analysis

“…But conservative treatment stands out as the main method of choice, aiming to reduce the inflammatory process and pain (4,5), as well as stimulating the remodeling of collagen tissue (6). The use of night splints (7), extracorporeal shock wave treatment (ESWT) (8), steroid injections and platelet-rich plasma (9) are all therapies that have been adopted, as well as modalities offered by physiotherapy, how manual therapy, electrostimulation, laser, ultrasound, cryotherapy, and kinesiotherapy. Kinesiotherapy, Muscles, Ligaments and Tendons Journal 2024;14 (1) Therapeutic Exercise in Plantar Fasciitis based on the active stretching of the gastrocnemius muscle and plantar fascia, can improve painful symptoms.…”