Energy Extracorporeal Shock Wave Therapy Research Articles

Double screw versus angular stable plate fixation of scaphoid waist nonunions in combination with intraoperativeextracorporeal shockwave therapy (ESWT).

Over the past years, different fixation techniques focused on rotational stability in order to increase stability and stimulate union rates. Additionally, extracorporeal shockwave therapy (ESWT) has gained importance in the treatment of delayed and nonunions. Purpose of this study was to compare the radiological and clinical outcome of two headless compression screws (HCS) and plate fixation in scaphoid nonunions, in combination with intraoperative high energy ESWT. Thirty-eight patients with scaphoid nonunions were treated by using a nonvascularized bone graft from the iliac crest and stabilization with either two HCS or a volar angular stable scaphoid plate. All patients received one ESWT session with 3000 impulses and energy flux per pulse of 0.41mJ/mm2 intraoperatively. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O'Brien (Mayo) Wrist Score. To confirm union, a CT scan of the wrist was performed. Thirty-two patients returned for clinical and radiological examination. Out of these, 29 (91%) showed bony union. All patients treated with two HCS compared to 16 out of 19 (84%) patients treated by plate showed bony union on the CT scans. The difference was not statistically significant.However, at a mean follow-up interval of 34months, no significant differences could be found in ROM, pain, grip strength and patient-reported outcome measurements between the two HCS and plate group. Height-to-length ratio and capitolunate angle improved significantly in both groups compared to preoperative. Scaphoid nonunion stabilization by using two HCS or angular stable volar plate fixation and intraoperative ESWT results in comparable high union rates and good functional outcome. Due to the higher rate for a secondary intervention (plate removal), HCS might be preferable as first choice, whereas the scaphoid plate fixation should be reserved for recalcitrant (substantial bone loss, humpback deformity or failed prior surgical intervention) scaphoid nonunions.

The Effects of Three and Six Sessions of Low Energy Extracorporeal Shockwave Therapy on Graft Incorporation and Knee Functions Post Anterior Cruciate Ligament Reconstruction.

Introduction:One session of high energy extracorporeal shockwave therapy (ESWT) was found to improve the healing of anterior cruciate ligament (ACL) after reconstruction in animal and human studies. This study investigated the effects of three and six sessions of low energy ESWT on graft incorporation and knee functions post ACL reconstruction in humans.Materials and methods:Thirty participants with ACL injuries were recruited and assigned equally into three groups with 10 participants per group (n=10). Participants in the control group received physiotherapy alone without low energy ESWT. Participants in the 3ESWT group underwent three sessions of low energy ESWT (one session per week) combined with physiotherapy, and participants in the 6ESWT group received six sessions of low energy ESWT (one session per week) combined with physiotherapy. However, five participants were lost to follow-up. Evaluations of graft incorporation of the tibial tunnel using magnetic resonance (MRI) and Lysholm score were carried out before ACL reconstruction and after six months post ACL reconstruction.Results:The number of grafts with partial incorporation in the tibia tunnel in 6ESWT was significantly higher compared with the number of grafts with non-incorporation at six months post-operatively, X2 (1, N=9) =5.44, p =0.02. However, there was no significant difference between frequencies of graft incorporation in tibia tunnel in the control and 3ESWT groups, X2 (1, N=7) =3.57, p =0.06 and X2 (1, N=9) =2.78, p =0.10, respectively at 6 months postoperatively. Lysholm scores were significantly higher at 6 months post ACL reconstruction compared to the baseline value for each group (p<0.002, respectively). However, there was no significant difference in the Lysholm score between each group (F = 2.798, p = 0.083).Conclusions:Six sessions of low energy ESWT improved graft incorporation in the tibial tunnel. Both three and six sessions of low energy of ESWT does not affect the knee function score at six months post ACL reconstruction.

BONE METABOLISM MARKERS IN RESPONSE TO THREE AND SIX SESSIONS OF LOW ENERGY EXTRACORPOREAL SHOCKWAVE THERAPY IN INDIVIDUALS WITH POST ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Precise information on the effects of extracorporeal shockwave therapy (ESWT) on biochemical status in humans is still lacking. Hence, this study investigated the effectiveness of three or six sessions of low energy ESWT on serum bone metabolism markers in individuals who have undergone post anterior cruciate ligament (ACL) reconstruction. Participants with ACL injuries were assigned into three groups (n=10 per group), i.e. physiotherapy alone without ESWT (control), three sessions of ESWT combined with physiotherapy (3ESWT), and six sessions of ESWT combined with physiotherapy (6ESWT) groups. Serum bone metabolism markers, i.e. osteocalcin (OCN), human Cross Linked C-telopeptide of Type 1 Collagen (CTX1), calcium, and phosphorus were measured at weeks 0, 2, 9, 12, and 6 months post ACL reconstruction. Serum OCN and CTX1 concentrations within the 3ESWT and 6ESWT groups across the five measurements were not significantly different. However, serum calcium concentrations at weeks 2, 9, and 12 were significantly higher compared to their respective baseline values for all three groups. Shockwave therapy had no significant effect on bone resorption and formation markers postoperatively. Six sessions of shockwave therapy (6ESWT) elicited the highest serum calcium level at week 12 post-operatively among all the groups. More studies are warranted to substantiate these findings.

Low energy extracorporeal shock wave therapy combined with low tension traction can better reshape the microenvironment in degenerated intervertebral disc regeneration and repair

BACKGROUND Low-tension traction is more effective than high-tension traction in restoring the height and rehydration of a degenerated disc and to some extent the bony endplate. This might better reshape the microenvironment for disc regeneration and repair. However, the repair of the combination of endplate sclerosis, osteophyte formation, and even collapse leading to partial or nearly complete occlusion of the nutrient channel is greatly limited. PURPOSE To evaluate the effectiveness of low-intensity extracorporeal shock wave therapy (ESWT) combined with low tension traction for regeneration and repair of moderately and severely degenerated discs; to explore the possible mechanism of action. STUDY DESIGN Animal study of a rat model of degenerated discs. METHODS A total of 35 6-month old male Sprague-Dawley rats were randomly assigned to one of five groups (n = 7, each group). In Group A (model group), caudal vertebrae were immobilized using a custom-made external device to fix four caudal vertebrae (Co7 - Co10) while Co8 - Co9 underwent 4 weeks of compression to induce moderate disc degeneration. In Group B (experimental control group), as in Group A, disc degeneration was successfully induced after which the fixed device was removed for 8 weeks of self-recovery. The remaining three groups of rats represented the intervention Groups (C - E): after successful generation of disc degeneration in Group C (com - 4w/tra - 4w) and Group D (com - 4w/ESWT), as described for group A, low-tension traction (in-situ traction) or low-energy ESWT was administered for 4 weeks (ESWT parameters: intensity: 0.15Mpa; frequency: 1Hz; impact: 1000 each time; once/week, 4 times in total); Group E (com - 4w/tra - 4w/ESWT): disc degeneration as described for group A, low-tension traction combined with low-energy ESWT was conducted (ESWT parameters as Group D). After experimentation, caudal vertebrae were harvested and disc height, T2 signal intensity, disc morphology, total glycosaminoglycan content, gene expression, structure of the Co8 - Co9 bony endplates and elastic moduli of the discs were measured. RESULTS After continuous low-tension traction, low energy ESWT intervention or combined intervention, the degenerated discs effectively recovered their height and became rehydrated. However, the response in Group D was weaker than in the other intervention groups in terms of restoration of intervertebral disc height, while Group E was superior in disc rehydration. Tissue regeneration was evident in Groups C - E using different interventions. No apparent tissue regeneration was observed in the experimental control group (Group B). The histological scores of the three intervention groups (Groups C - E) were lower than those of Groups A or B (p 0.05). Compared with the intervention groups (Groups C - E), total GAG content of the nucleus pulposus (NP) in Group B did not increase significantly (p > 0.05). There was also no significant difference in the total GAG content between Groups A and B (p > 0.05). Of the three intervention groups, the recovery of NP GAG content was greatest in Group E. The expression of collagen I and II, and aggrecan in the annulus fibrosus (AF) was up-regulated (p CONCLUSIONS Low energy ESWT combined with low tension traction provided a more stable intervertebral environment for the regeneration and repair of moderate and severe degenerative discs. Low energy ESWT promoted the regeneration of disc matrix by reducing MMP-3, MMP-13, and ADAMTS-4 resulting in inhibition of collagen degradation. While axial traction promoted the recovery of height and rehydration of the IVD, combined with low energy ESWT, the micro-nano structure of the bony endplate underwent positive reconstruction, tension in the annulus of the AF and nuclear stress of the NP declined, and the biomechanical microenvironment required for IVD regeneration and repair was reshaped.

Extracorporeal Shockwave Therapy for the treatment of scaphoid delayed union and nonunion: a retrospective analysis examining the rate of consolidation and further outcome variables

Operative procedures are considered gold standard in the treatment of scaphoid nonunion, albeit their considerable complexity and the risk of intraoperative complications. High energy extracorporeal shockwave therapy (ESWT) offers a non-invasive treatment option for scaphoid nonunion. The aim of this study was to explore the rate of bony consolidation and further outcome variables in patients with delayed union of scaphoid fractures and scaphoid nonunion treated with ESWT. Due to delayed union (21) or nonunion (21) of a scaphoid fracture 42 patients (37 men, and 5 women) with an average age of 48,3 (15-66) years underwent ESWT followed by immobilization in a forearm cast including the proximal phalanx of the thumb for 6 to 8 weeks. In 13 patients the fracture was initially treated, 8 with immobilization, 5 with screw fixation. In 5 of the 29 patients without an initially treatment, the fracture resp. nonunion was secondarily treated with screw fixation (2) or a medial femur condyle (3) but failed to heal. 10 to 12 weeks after the ESWT bony healing was controlled with computed scanning in the long axis of the scaphoid. If 50 % of diameter of the scaphoid showed trabecula bony healing was considered. Factors with potential influence on bony healing (site of the fracture/nonunion, scapholunate angle, patient´s age, Body Mass Index, smoking and alcohol consume) were analyzed. In addition, 34 patients underwent a clinical follow-up examination including DASH and Mayo Wrist Score, pain analyzes (VAS). Seventy-one per cent of patients showed scaphoid fracture consolidation using ESWT. In 7 out of 8 patients with conservative treatment and in 4 out of 5 patients with screw fixation of the initial fracture bony healing was achieved. From the 5 patients with secondary surgical treatment of the scaphoid only 1 patient, treated with a medial femur condyle, failed to heal the scaphoid. 15 out of the 24 initially non-treated scaphoid fractures healed. The time between ESWT and the documented bony healing averaged 8.4 months (256 days). Neither fracture site, nor the scapholunate angle, alcohol and tobacco use, as well as biometric factors, such as age and BMI had influence on the success rate of the ESWT. Side effects of the ESWT were limited to local skin irritations and petechial bleedings. ESWT has a positive effect regarding bony healing of scaphoid fracture with delayed fracture healing and nonunion with a success rate of 71 %. The complication rate is low, and the clinical results regarding wrist motion and pain are satisfying. Further investigations are necessary to evaluate the input of fracture/nonunion characteristics like the morphological appearance on bony healing.

Еffect of radial extracorporeal shock wave therapy on the healing of experimental bone defect

The favorable effect of low energy extracorporeal shock wave therapy (ECSHVT) on reparative osteogenesis has repeatedly discussed in the scientific literature. However, the mechanisms of influence of this factor on bone are not investigated. Objec­tive:to explore the mechanism of action of low energy ECSHVT for reparative regeneration of bone tissue. Methods: the study performed in 85 adult rabbits, male (weight from 2.9 to 3.4 kg), which were divided into three groups: intact (5 animals), control (40) and research (40). Research group rabbits in the area of trauma (penetrating perforated rum defect diameter 2.5 mm proximal tibial metaphysis) received 4 sessions of ECSHVT intervals of 4 days with a frequency of 1–4 Hz strokes, work­ing pressure 1–5⋅105 5 Pa 2 thousand. Strikes for the procedure with a maximum energy of 0.48 mJ. After 2, 15, 30 and 45 days after injury made X-morphological and biochemical (collagen, glycosaminoglycans — GAG) study of bone regenerate. Re­sults: on the background of posttraumatic catabolic phase pe­riod (day 2) in control and experimental animal groups found reduction of collagen and GAG 29.1 and 32.6 % respectively, p &lt; 0.001. Against the background of the anabolic phase of post­traumatic period (15, 30 and 45th days) stated increase col­lagen and GAG content in both groups of animals in research and figure was higher by 6,8–12,7 % and 11,2–15% respectively (p &lt; 0.05). As a result radiomorphological studies revealed that ECSHVT influence on reparative osteogenesis occurs due to mi­crocirculation disorders of bone — vasodilation, increased per­meability of the vessel walls, blood cells out of the capillaries. Conclusion: activation of the biosynthesis of collagen and GAG dentified under the influence of ECSHVT and changes in blood circulation accompanied by strengthening bone, forming mas­sive areas of endosteal regenerate bone that provided fusion of metaphysial defect of the tibia.

The Effect of Low Dose Extracorporeal Shock Wave Therapy (ESWT) on Plantar Fasciitis: A Trial Study in Queen Mary Hospital: 低劑量體外衝擊波治療(ESWT)對足底筋膜炎的影響 - 在瑪麗醫院的試用研究

Background/PurposeTo assess the efficacy of low-energy extracorporeal shockwave therapy (ESWT) for the treatment of plantar fasciitis. MethodsThis was a prospective case series study that was performed at the Department of Orthopaedics, Queen Mary Hospital, Hong Kong. Twenty-one symptomatic feet in 16 patients with persistent symptoms of plantar fasciitis despite 3 months of conservative treatment were recruited in November 2008. All patients received five sessions of low energy ESWT and their corresponding 10-point visual analogue scale scores were recorded before and after each treatment sessions for each symptomatic foot. The patients were assessed for up to 6 months post-treatment. ResultsThe mean visual analogue scale scores reduction for pain on first step in the morning, daily activities, and heel compression test were 2.62 (44.3%), 3 (38.3%), and 1.6 (36.8%), respectively, post-treatment. The analgesic effect was maintained in 52.3% (n = 11) of the patients at 6 months post treatment. ConclusionLow energy ESWT was shown to be an effective outpatient treatment option for patients with plantar fasciitis.

In Vitro Effects of Extracorporeal Shockwave Therapy (ESWT) on Proliferation and Metabolic Activity of Adult Human Keratinocytes

Background: The objective of the presented study is to investigate in vitro effects of low energy extracorporeal shockwave therapy (ESWT) on the keratinocytes and their metabolic and proliferative properties for their therapeutic applications. Materials: Primary culture of keratinocytes was isolated from clinical samples and after passaging into 12 flasks exposed to the various number of ESWT impulses (n=25, 50 and100impulses) in combination with several frequencies (1, 3 or 5Hz) and distances from the applicator head (5, 6 or 7cm with corresponding energy flux densities (EFD)=0.04, 0.025 and 0.015 mJ/mm2, respectively) using modified water bath at constant temperature 37°C. Flasks were assigned to receive one combination of treatment parameters. The individually tested distances/EFD with the various impulse numbers and frequencies were summarised to experimental series. Cell viability was measured using trypan blue, cell cytotoxicity was measured using lactate dehydrogenase assay, and cell metabolic activity was measured by level of glucose metabolism. Results: Our results indicate that low energy ESWT has both cytotoxic and stimulating effects on the keratinocytes. These effects depend on number of impulses, distance from the applicator head, and frequency. A proliferationstimulating effect and a higher viable cell count could be observed for a distance of 5 cm with 100 impulses at 1 Hz and EFD=0.04 mJ/mm2. Conclusion: Our results indicate that ESWT (EFD=0.04 mJ/mm2, 100 impulses, 1Hz at 5 cm) augmented proliferative capacity of keratinocytes in vitro. These promising results grant further investigation and have practical potential in keratinocyte research and production.

Pressure pain threshold and visual analogue scale changes in the high and low energy extracorporeal shock wave

Objective: This study aims to investigate high energy and low energy extracorporeal shockwave therapy (ESWT) and which one is more effective for shoulder pain. Design: Single blind randomized controlled trial. Methods: Fifty two subjects with upper trapezius (UT) trigger point (TrP) participated in this study. They were allocated to high energy (n=26) and low energy group (n=26). This study applies ESWT and investigates the changes of pressure pain threshold (PPT) and visual analogue scale (VAS). The high and low energy groups received focused piezo electric type ESWT 4 Hz, 1,000 pulses and 0.351 and 0.092 mJ/mm2 respectively. Outcome measures of PPT and pain was measured by algometer and pain VAS. These measurements were performed before and after treatment. Results: The PPT value was significantly increased in both groups after treatment (p<0.05) and VAS scores were significantly decreased after treatment in both groups (p<0.05). However, there were no significant differences between groups. Conclusions: ESWT is an effective treatment for the application of the UT TrP. Although there were significant effects of extracorporeal shock wave therapy on PPT and VAS scores, there were no signficant differences between high and low energy extracorporeal shock wave therapy.

Low Energy Extracorporeal Shockwave Therapy for the Treatment of Myositis Ossificans in a Case of Cerebro Vascular Accident

A 40 year old male Cerebro Vascular Accident (CVA) patient with right hemiplegia was treated with low energy extracorporeal shockwave therapy (ESWT) for myositis ossificans at right hip and right elbow. After six sitting of low energy ESWT along with other remedial exercises it was observed that the restricted ROM at his right hip and elbow were improved. The functional ability of the patient was also improved. The finding of this case report encouraged us to conclude that low energy ESWT combined to a correct rehabilitation therapy can be a modality of choice for the treatment of myositis ossificans.

Paper 218: High Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Insertional Achilles Tendinopathy

Paper 218: High Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Insertional Achilles Tendinopathy

Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

BackgroundThere is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in calcific tendinopathy of the rotator cuff, but the best current evidence does not support its use in non-calcifying tendinopathy. We conducted a randomized placebo-controlled trial to investigate the efficacy and safety of low energy ESWT for non-calcifying tendinopathy of the rotator cuff.Methods20 patients with non-calcifying supraspinatus tendinopathy (NCST) were randomized to an active or a sham treatment group. Physical, blood, roentgenographic, and MRI examinations of the shoulder were conducted to verify that patients met the inclusion and exclusion criteria. These examinations were repeated six and twelve weeks after treatments. Effectiveness was determined by comparison of the mean improvement in the Constant and Murley score (CMS) between the treatment and the placebo groups at three months. Safety was assessed by analyzing the number and severity of adverse events.ResultsAll the patients completed the investigation protocol. At the final follow-up, significant improvement in the total CMS score and most of the CMS subscales was observed in the ESWT group when compared to the baseline values. Significantly higher total CMS, and significantly higher scores for CMS pain and ROM were observed in the ESWT group when compared to the placebo. No serious adverse events were noted after ESWT.ConclusionsPatients suffering from NCST may benefit from low energy ESWT, at least in short-term. The application protocol of ESWT is likely to play a key-role in a successful treatment. Future investigations should be undertaken on the long-term effects of this technique for the treatment of NCST.Trial registrationCurrent Controlled Trials ISRCTN41236511

Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat

De-focused low energy extracorporeal shock wave therapy (ESWT) has been widely used in various clinical and experimental models for the treatment of painful conditions such as epicondylitis and plantar fascitis and also bone and wound healing. There is evidence that ESWT improves the metabolic activity of various cell types, e.g. chondrocytes and endothelial cells but little is known about its effects on nervous tissue. The aim of this study was to investigate whether ESWT improves the regeneration of injured nerves in an experimental rat model.Sprague–Dawley rats received an 8mm long homotopic nerve autograft into the right sciatic nerve, fixed with epineurial sutures. Two experimental groups were set up: the group 1 animals received ESWT (300 impulses, 3Hz) immediately after nerve grafting whereas the group 2 (control) animals received only nerve autografts. Serial CatWalk automated gait analysis, electrophysiological studies and morphological investigations were carried out. The survival time was either 3weeks or 3months.At 6 to 8weeks of survival the ESWT group of animals exhibited a significantly improved functional recovery relative to the controls. Electrophysiological observations at 3weeks after surgery revealed marked values of amplitude (3.9±0.8mV, S.E.M.) and compound nerve action potential (CNAP, 5.9±1.4mV·ms, S.E.M.) in the ESWT group, whereas there were no detectable amplitudes in the control group. This finding was accompanied by significantly greater numbers of myelinated nerve fibres in the middle of the graft (4644±170 [S.E.M., ESWT] vs 877±68 [S.E.M., control]) and in the distal stump (1586±157 [S.E.M., ESWT] vs 308±29 [S.E.M., control]) of ESWT animals relative to the controls 3weeks after surgery. Three weeks after surgery the nerve grafts of control animals contained great numbers of phagocytes and unmyelinated nerve fibres, while the ESWT nerve grafts were filled with well-myelinated regenerating axons. There was no significant difference between the numbers of endoneural vessels in the ESWT and the control nerves. Three months after surgery, no significant differences were observed in the functional and electrophysiological data. Equally high numbers of myelinated axons distal to the graft could be found in both groups (7693±673 [S.E.M., ESWT] vs 6090±716 [S.E.M., control]).These results suggest that ESWT induces an improved rate of axonal regeneration, this phenomenon probably involving faster Wallerian degeneration, the improved removal of degenerated axons and a greater capacity of the injured axons to regenerate.

Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy: A pilot study

Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be ascertained. Aim of this pilot study was to investigate if patient guided Piezo-electric, focused ESWT, without local anesthesia is a safe and well tolerated treatment which improves pain and function in patients with patellar tendinopathy. Nineteen male athletes with severe chronic patellar tendinopathy received 3 patient guided focused medium to high energy ESWT treatments at a weekly interval. Before and after 3 months VISA-P and VAS (pain) scores were recorded. Data on side effects and complications of treatment were also collected. No serious complications were reported and patients tolerated the treatment well. Mean VISA-P score improved from 36.1 to 50.1 (p < 0.05), VAS decreased from to 7.2 to 3.7 (p < 0.05). Patient guided Piezo-electric ESWT without local anesthesia is a safe and well tolerated treatment which should be considered as a treatment for patients with patellar tendinopathy.

WITHDRAWN. Interventions for treating plantar heel pain.

Ten percent of people may experience pain under the heel (plantar heel pain) at some time. Injections, insoles, heel pads, strapping and surgery have been common forms of treatment offered. The absolute and relative effectiveness of these interventions are poorly understood. The objective of this review was to identify and evaluate the evidence for effectiveness of treatments for plantar heel pain. We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (September 2002), the Cochrane Central Register of Controlled Trials Register (The Cochrane Library issue 3, 2002), MEDLINE (1966 to September 2002), EMBASE (1988 to September 2002) and reference lists of articles and dissertations. Four podiatry journals were handsearched to 1998. We contacted all UK schools of podiatry to identify dissertations on the management of heel pain, and investigators in the field to identify unpublished data or research in progress. No language restrictions were applied. Randomised and quasi-randomised trials of interventions for plantar heel pain in adults. Two reviewers independently evaluated randomised controlled trials for inclusion, extracted data and assessed trial quality. Additional information was obtained by direct contact with investigators. No poolable data were identified. Where measures of variance were available we have calculated the weighted mean differences based on visual analogue scale (VAS) scores. Nineteen randomised trials involving 1626 participants were included. Trial quality was generally poor, and pooling of data was not conducted. All trials measured heel pain as the primary outcome. Seven trials evaluated interventions against placebo/dummy or no treatment. There was limited evidence for the effectiveness of topical corticosteroid administered by iontophoresis, i.e. using an electric current, in reducing pain. There was some evidence for the effectiveness of injected corticosteroid providing temporary relief of pain. There was conflicting evidence for the effectiveness of low energy extracorporeal shock wave therapy in reducing night pain, resting pain and pressure pain in the short term (6 and 12 weeks) and therefore its effectiveness remains equivocal. In individuals with chronic pain (longer than six months), there was limited evidence for the effectiveness of dorsiflexion night splints in reducing pain. There was no evidence to support the effectiveness of therapeutic ultrasound, low-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating surgery, or radiotherapy against a randomly allocated control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices. Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar heel pain has not been established in randomised controlled trials.At the moment there is limited evidence upon which to base clinical practice. Treatments that are used to reduce heel pain seem to bring only marginal gains over no treatment and control therapies such as stretching exercises. Steroid injections are a popular method of treating the condition but only seem to be useful in the short term and only to a small degree. Orthoses should be cautiously prescribed for those patients who stand for long periods; there is limited evidence that stretching exercises and heel pads are associated with better outcomes than custom made orthoses in people who stand for more than eight hours per day.Well designed and conducted randomised trials are required.

Shock Waves in the Treatment of Stress Fractures

In soccer players, lower extremity stress fractures are common injuries and are the result of repetitive use damage that exceeds the intrinsic ability of the bone to repair itself. They may be treated conservatively but this may cause long-term complications, such as delayed union, muscle atrophy and chronic pain. Stress fractures that fail to respond to this management require surgical treatment, which is also not without risks and complications. Extracorporeal shock wave therapy (ESWT) has been used successfully on fracture complications, such as delayed union and nonunion. As such, we want to examine ESWT in the management of stress fractures. In this article, we present a retrospective study of 10 athletes affected by chronic stress fractures of the fifth metatarsus and tibia that received three to four sessions of low-middle energy ESWT. At the follow-up (8 wk on average), the clinical and radiography results were excellent and enabled all players to gradually return to sports activities. These reports show that ESWT is a noninvasive and effective treatment for resistant stress fractures in soccer players. (E-mail: b.moretti@ortop2.uniba.it (B.M.), angelanotarnicola@yahoo.it (A.N.))

High Energy Extracorporeal Shock Wave Therapy as a Treatment of Insertional Achilles Tendinopathy (SS-70)

High Energy Extracorporeal Shock Wave Therapy as a Treatment of Insertional Achilles Tendinopathy (SS-70)

The Safety and Efficacy of High Energy Extracorporeal Shock Wave Therapy in Active, Moderately Active, And Sedentary Patients With Chronic Plantar Fasciitis

The Safety and Efficacy of High Energy Extracorporeal Shock Wave Therapy in Active, Moderately Active, And Sedentary Patients With Chronic Plantar Fasciitis

Extracorporeal shock wave therapy in runners with a symptomatic heel spur

The aim of this paper is to assess the benefit to treat plantar fasciitis with low-dose energy extracorporeal shock wave therapy (ESWT) and the efficacy of such treatment to abate the painful symptoms allowing a rapid return to the running activity. Our study included 54 running athletes treated for plantar fasciitis associated with a heel spur who received four sessions (once weekly) of low-dose ESWT, and followed prospectively on average 45 days, 6 and 24 months after their last session. The clinical results were excellent in 59% of cases, good in 12%, satisfactory in 21% and distinctly unsatisfactory in 8%. No patient was observed a significant modification of the heel spur at the follow-up X-ray. The ultrasound examination at 24 months showed a disappearance of the inflammation signs in 61% of cases. A strong correlation between ultrasound improvement and clinical results were found. Low-energy ESWT seems to be a good mean to treat plantar fasciitis in runners with a 71% of good or excellent results and a persistent improvement lasting 24 months. A randomized multicentric study seems to be necessary to define the type of energy that should be used in the future to treat plantar fasciitis, in particular in the athletic patients, to allow a faster return to sports activities.

The Safety and Efficacy of High Energy Extracorporeal Shock Wave Therapy in Active, Moderately Active, and Sedentary Patients with Chronic Plantar Fasciitis

Extracorporeal shock wave therapy was investigated in patients with chronic plantar fasciitis. Fifty-three patients (60 heels) were treated with a single ses sion of shock wave therapy. Sixteen patients (19 heels) were active, 21 (22 heels) were moderately active, and 16 (19 heels) were sedentary. Twelve weeks post-treatment, mean visual analog scores improved from 9.2 to 2.4 (P < .05), RAND-Physical Functioning score improved from 40.4 to 91.5 (P < .05), and RAND-Pain score improved from 33.3 to 90 (P < .05). Fifty heels (83.3%) were assigned an excellent or good result. Extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis.