Impact of shock waves on the size of calcification in the presence of calcaneal spur and plantar fasciitis: doctoral dissertation

Abstract

Introduction: Plantar fasciitis is a disorder of foot function associated with heel pain. In patients with plantar fasciitis, a common associated finding may be the presence of a heel spur. However, plantar fasciitis can also exist without a heel spur. A heel spur can also be asymptomatic, meaning it can persist with no signs of plantar fasciitis. One of the reasons for conducting this research is that data in the literature on the impact of shock waves on the size of calcifications in plantar fasciitis is sparse. The aim: The aim of the research was to investigate the impact of the shock wave on the size of the calcifications and the pain intensity in the presence of a heel spur as well as the connection between the size of the heel spur and the pain intensity before and after the application of the shock wave therapy. Material and methods: The research was conducted as a prospective study with a duration of one year. The study includes 129 subjects of both sexes, who were divided into two groups according to the randomization. In the experimental group, 67 patients were treated with shock waves, while in the control group, 62 patients were treated with classic methods of physical therapy. Treatment outcomes were monitored using VAS score and heel spur size. Results: The size of calcifications in patients in the experimental group was statistically significantly smaller after 5 therapies compared to before treatment, and it was statistically significantly smaller after 10 therapies than after 5 therapies. In subjects from the experimental group, the VAS score values were lower after 5 treatments, while after 10 they were statistically significantly lower compared to the VAS score values at the start of treatment. Conclusions: The application of shock waves led to a reduction in heel spurs and a reduction in pain perception in the subjects of our study. However, the reduction in heel spur size caused by the application of the mechanical shock wave was not correlated with the reduction in pain intensity.

Uvod: Plantarni fascitis predstavlja poremećaj funkcije stopala koji je praćen bolom u peti. Kod pacijenata sa plantarnim fascitisom, vrlo čest udružen nalaz može biti prisustvo petnog trna. Međutim, plantarni fascitis može postojati i bez prisutnog petnog trna. Takođe, petni trn može biti asimptomatski, odnosno može perzistirati bez znakova plantarnog fascitisa. Jedan od razloga za izvođenje ovog istraživanja je taj što su podaci u literaturi o uticaju mehaničkog udarnog talasa na veličinu kalcifikata u okviru plantarnog fascitisa oskudni. Cilj rada: Ciljevi istraživanja bili su da se ispita uticaj mehaničkog udarnog talasa na veličinu kalcifikata i intezitet bola kod prisustva petnog trna, kao i međusobna povezanost veličine petnog trna i inteziteta bola pre i nakon primene terapije mehaničkim udarnim talasom. Materijal i metode: Istraživanje je sprovedeno kao prospektivna studija u trajanju od jedne godine. U studiju je bilo uključeno 129 ispitanika oba pola koji su metodom randomizacije podeljeni u dve grupe. U eksperimentalnoj grupi bilo je 67 pacijenata i oni su lečeni mehaničkim udarnim talasom, dok je u kontrolnoj grupi bilo 62 pacijenta koji su lečeni klasičnim metodama fizikalne terapije. Ishodi tretmana praćeni su VAS skorom i veličinom petnog trna. Rezultati: Veličina kalcifikata kod ispitanika eksperimentalne grupe posle 5 terapija bila je statistički značajno manja u odnosu na pre tretmana, dok je veličina kalcifikata posle 10 terapija bila statistički značajno manja u odnosu posle 5 terapija. Kod ispitanika iz eksperimentalne grupe vrednosti VAS skora bile su manje posle 5 tretmana, dok su posle 10 tretmana bile statistički značajno manje u poređenju sa vrednostima VAS skora na početku lečenja. Zaključak: Primena mehaničkog udarnog talasa dovela je do smanjenja kako petnog trna tako i do smanjenja osećaja bola kod ispitanika u našem istraživanju. Međutim, smanjenje veličine petnog trna koje je uzrokovala primena mehaničkog udarnog talasa nije bilo u korelaciji sa smanjenim intenziteta bola.