Abstract
Calcaneal spur and plantar fasciitis are the most common causes of plantar heel pain. There are many effective physical modalities for treating this musculoskeletal disorder. So far, the are no clear recommendations confirming the clinical utility of high-intensity laser therapy (HILT) in the management of painful calcaneal spur with plantar fasciitis. This study aimed to evaluate the effectiveness of HILT in pain management in patients with calcaneal spur and plantar fasciitis. A group of 65 patients was assessed for eligibility based on the CONSORT guidelines. This study was prospectively registered in the Australian New Zealand Clinical Trial Registry platform (registration number ACTRN12618000744257, 3 May 2018). The main eligibility criteria were: cancer, pregnancy, electronic and metal implants, acute infections, impaired blood coagulation, cardiac arrhythmias, taking analgesic or anti-inflammatory medications, non-experience of heel pain, or presence of other painful foot conditions. Finally, 60 patients were randomly assigned into two groups: study group (n = 30, mean age 59.9 ± 10.1), treated with HILT (7 W, 149.9 J/cm2, 1064 nm, 4496 J, 12 min), and placebo-controlled group (n = 30, mean age 60.4 ± 11.9), treated with sham HILT therapy. Both groups received ultrasound treatments (0.8 W/cm2, 1 MHz frequency, 100% load factor, 5 min). Treatment procedures were performed once a day, five times per week for three weeks (total of 15 treatment sessions). Study outcomes focused on pain intensity and were assessed before (M1) and after (M2) the treatment as well as after 4 (M3) and 12 (M4) weeks using the Visual Analogue Scale (VAS) and the Laitinen Pain Scale (LPS). According to VAS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.5 pts, M1 and M3 by 3.7 pts, and M1 and M4 by 3.2 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease (p < 0.001) between M1 and M2 by 3.0 pts, M1 and M3 by 3.4 pts, and M1 and M4 by 3.2 pts. According to LPS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.9 pts, M1 and M3 by 4.2 pts, and M1 and M4 by 4.0 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease between M1 and M2 by 3.2 pts (p = 0.002), M1 and M3 by 4.0 pts (p < 0.001), and M1 and M4 by 3.9 pts (p < 0.001). However, there were no statistically significant differences between the groups in VAS and LPS (p > 0.05). In conclusion, the HILT does not appear to be more effective in pain management of patients with calcaneal spurs and plantar fasciitis than the conservative standard physiotherapeutic procedures.
Highlights
A thorough analysis of the abundant literature addressing high-intensity laser therapy (HILT) at the cellular and tissue level reveals several interesting and documented developments that may lay a plausible foundation for therapeutic mechanisms in many disease entities [1,2,3,4,5,6]
It was confirmed by a large number of clinical papers that demonstrate the usefulness of HILT in terms of musculoskeletal disorders [9,10,11,12]
There are no clear recommendations confirming the effectiveness of HILT procedures in heel spur and plantar fasciitis management
Summary
A thorough analysis of the abundant literature addressing high-intensity laser therapy (HILT) at the cellular and tissue level (experimental work, in vitro, and animal experiments) reveals several interesting and documented developments that may lay a plausible foundation for therapeutic mechanisms in many disease entities [1,2,3,4,5,6].Laser irradiation offers a specific dose of energy (photons) to the areas of the tissue to be treated. Researchers demonstrate the effect of laser beam at the cellular level is manifested by increased production of ATP, increased activity of membrane enzymes, increased synthesis of DNA and RNA, and acceleration of electrolyte exchange between the cell and the surrounding areas. The phenomena described above constitute the basis for the described analgesic and anti-inflammatory mechanisms [7,8]. It was confirmed by a large number of clinical papers that demonstrate the usefulness of HILT in terms of musculoskeletal disorders [9,10,11,12]. It should be noted that there are still some reports that are critical of laser therapy [13,14,15]
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