Shock-wave therapy may help heel pain

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Shock-wave therapy may help heel pain

NEW YORK, Apr 12 (Reuters Health) - Low-energy acoustic " shock-wave

therapy " appears to be an effective treatment for heel pain due to

chronic plantar fasciitis and may help patients avoid surgery, according

to a recent report by German researchers.

The use of such therapy for musculoskeletal disorders is controversial,

lead author Dr. Jan D. Rompe and colleagues note. However, there have

been some reports suggesting that it could be beneficial for patients

with chronic plantar fasciitis.

Plantar fasciitis is heel pain that is usually worse first thing in the

morning or after a period of inactivity; it is also often worse when

walking bare foot. The pain is due to inflammation of the plantar

fascia, a band of tissue that supports the bottom of the foot during

walking. As many as 6 million people may suffer from plantar fasciitis.

The investigators, from Johannes Gutenberg University in Mainz, looked

at 97 patients with chronic plantar fasciitis who were treated with one

of two shock-wave regimens. All the patients had tried a number of

different treatments with little success, including anti-inflammatory

drugs, shock-absorbing shoe inserts, stretching exercises, night

splints, casts, corticosteroid injections, physical therapy, icing,

ultrasound and radiation therapy.

Patients in group I received three applications of 1,000 impulses of

low-energy shock waves, while those in group II received three

applications of 10 impulses. Because the shock waves are considered to

be low-energy, anesthesia is unnecessary, " although the treatment is

unpleasant, " according to the report in The Journal of Bone and Joint

Surgery. The US Food and Drug Administration has approved a device that

delivers high-energy acoustic shock waves for treating plantar

fasciitis, but anesthesia is necessary for the treatment.

At 6 months, those in group I had better function and less pain than

those in group II. Five years later, the differences were less

pronounced, but outcomes were still better in group I.

The researchers say the difference is due to the fact that many patients

in group II had, by that time, undergone surgery that led to major

improvements.

At 5 years, fewer patients in group I (13%) had undergone surgery than

patients in group II (58%), the authors note.

While the results are promising, " additional controlled studies are

still needed to verify the results of this study and to define the

precise role of this new modality in the treatment of chronic plantar

fasciitis, " the investigators note.

SOURCE: Journal of Bone and Joint Surgery 2002;84-A:335-341.