Maudsley Score Research Articles

Extracorporeal Shock Wave Therapy (ESWT) vs. Exercise in Thumb Osteoarthritis (SWEX-TO): Prospective Clinical Trial at 6 Months

Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. The aim of the study is to investigate the clinical effects of shock wave treatment in patients suffering from arthritis of the first finger. A prospective clinical study was designed, in which 72 patients affected by rhizarthrosis were randomized to treatment with shock waves or exercises; in both groups an immobilization brace was used on the first finger. At recruitment and at 1, 3 and 6 months, patients received assessments of pain (VAS), functionality (FIHOA) and disability (DASH); furthermore, the perception of improvement was monitored during follow-ups (Roles and Maudsley Score). In both groups there was a significant improvement in all scores in the comparison between recruitment and 6 months. The perception of improvement was statistically better in the shock wave group than in the exercise group at 1, 3 and 6 months. The regression analysis showed that the reduction of VAS and DASH were statistically influenced by shock wave treatment (p < 0.001). Both therapies are effective in managing patients suffering from arthritis of the first finger, but the shock wave treatment could ensure greater persistence of improvements.

Treating Plantar Fasciitis: Platelet-Rich Plasma or Corticosteroids? A Single-Center Clinical Trial

Background: Plantar fasciitis (PF) is one of the leading causes of heel discomfort worldwide. There is no definitive treatment available for PF; however, two primary therapies are under investigation: Local injection of either corticosteroids or platelet-rich plasma (PRP). There are disagreements regarding the precise and effective dosage of these therapeutic approaches and their superiority over each other. Objectives: This study was conducted to compare the effects of corticosteroids and PRP in the treatment of PF. Methods: In this single-center clinical trial, 30 patients were divided into two groups (PRP vs. corticosteroids), with 15 patients in each group. In addition to receiving medication treatment, participants were given daily exercise regimens. The PRP group had a mean age of 44.07 ± 8.21 years, while the corticosteroid group had a mean age of 44 ± 9.85 years. The efficacy of these interventions was assessed primarily using the Numeric Pain Rating Scale (NPRS), the Roles and Maudsley score (RM), and the Foot and Ankle Disability Index (FADI). Results: Over a 3-month period, the NPRS decreased in the corticosteroid group from 7.07 ± 0.95 to 3.69 ± 1.43, and in the PRP group from 7.76 ± 0.92 to 3 ± 1.68 (P < 0.001). The FADI improved in the corticosteroid group from 54.84 ± 8.33 to 75.76 ± 11.96, and in the PRP group from 49.3 ± 10.11 to 78.15 ± 16.76 (P < 0.001). Plantar fascia thickness decreased in the corticosteroid group from 5.03 ± 0.62 to 4.51 ± 0.59, and in the PRP group from 5.43 ± 0.91 to 4.38 ± 1.04 (P < 0.001). The results indicated that both groups demonstrated significant improvement in the first three months. Although the PRP group showed greater improvement than the corticosteroid group after three months, the differences between the two groups were not statistically significant. Conclusions: Our results showed that the effects of corticosteroid injections subside after one month, whereas PRP has more stable effects over time.

The Role of Bone Edema in Plantar Fasciitis Treated with Temperature-Controlled High-Energy Adjustable Multi-Mode Emission Laser (THEAL) and Exercise: A Prospective Randomized Clinical Trial.

Plantar fasciitis is one of the most common causes of foot pain; in 35% of cases, it is also associated with bone edema of the heel. The aim of this study was to investigate the relationship between bone edema and the outcomes of temperature-controlled high-energy adjustable multi-mode emission laser (THEAL) and/or exercises in patients with plantar fasciitis. A prospective randomized clinical trial was designed, in which 48 patients suffering from plantar fasciitis, with or without bone edema, were treated with temperature-controlled high-energy adjustable multi-mode emission laser and exercises (the laser group) or with exercises only (the control group). The patients were evaluated at recruitment (T0) and at 2 (T1) and 6 months (T2), monitoring pain (with the Visual Analogue Scale), functionality (with the Foot Function Index), perception of improvement (with the Roles and Maudsley Score), and fascia thickness (with ultrasound examination). In both groups, there was a significant improvement in pain, functional recovery, perception of remission, and a reduction in plantar fascia thickness at T1 and T2. The laser group presented statistically better values at T2 for the Roles and Maudsley Score (z: 2.21; 0.027). The regression analysis showed that a greater reduction in fascia thickness occurred in the laser group (p-value: 0.047). In conclusion, the two conservative treatments were effective in patients suffering from plantar fasciitis, even in the presence of bone edema, but with lesser results.

Role of platelet-rich plasma in insertion tendinitis

Background: Platelet-rich plasma (PRP) helps in the treatment of various insertion tendinitis, and the recurrence rate will be low. In this study, we used intralesional injections of autologous PRP for the treatment of insertion tendinitis. Aims and Objectives: Assessment of pain relief following PRP treatment for insertion tendinitis and ascertaining the efficacy of PRP as a treatment option for insertion tendinitis. Materials and Methods: The study was done at Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022, including 100 patients were applied for the treatment of PRP. We assessed patients before treatment and at three follow-up time points: 2, 4, and 6 months after the end of treatment. During each evaluation, three parameters were noted: Victorian Institute of Sports Assessment- Achilles (VISA-A) score, the Visual Analog Scale, and patient satisfaction according to the roles and Maudsley score. Results: This was a prospective trial by study design conducted on 100 patients, which included 44 patients with plantar fasciitis and 56 patients with tennis elbow. The response to PRP injection in patients with plantar fasciitis was assessed by the VISA-A score. The pre-injection VISA-A score of patients with plantar fasciitis was 56.82 (mean with SD of 18.015), which improved to 65.45 in the 2nd month (mean with SD −18.857), 4th month with 69.77 (mean with SD–19.823), and at 6 months 71.82 (mean with SD–20.829). Statistical analysis with an analysis of variance test gave a P=0.001. In our study, the patients had gradual sequential improvement in VISA-A score throughout the follow-up, with maximum improvement from the pre-injection score were observed in 2 months (65.45 with SD 18.85). Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of insertion tendinitis.

Predictive Prognostic Factors in Non-Calcific Supraspinatus Tendinopathy Treated with Focused Extracorporeal Shock Wave Therapy: An Artificial Neural Network Approach.

The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient's quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant-Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient's initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT.

Usefulness of a Cementless Highly-Porous Acetabular Cup in Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty.

Total hip arthroplasty in patients with rheumatoid arthritis is difficult and leads to worse implant survival and higher risk for complications compared to osteoarthritis. Poor periacetabular bone quality might challenge the stability of the acetabular cup. Contemporary 3D-printed highly-porous titanium cup designs have become the benchmark for cementless implants; however, their usefulness in rheumatoid arthritis is still unclear. The purpose of this study was to assess the short-term results of the use of a highly-porous 3D-printed acetabular titanium cup in patients with rheumatoid arthritis. We studied a consecutive series of RA patients who underwent cementless THA between 2019 and 2020 in our center with the same 3D-printed highly-porous titanium acetabular cup. All patients were evaluated prospectively for a minimum 3-year follow-up with the Harris hip score, VAS and Roles and Maudsley score. Radiographic assessment focused on evidence of cup osseointegration. 37 RA patients, mean age at surgery of 51.3 years, were included. Mean follow-up was 3.2 years (3 to 4 years). By the last follow-up visit, the Harris hip score had increased significantly from 37.8 to 88.5, VAS had decreased from 6.1 to 1.0 and excellent satisfaction for 31 patients. All 5 Moore's radiographic signs were present in 35 hips, with only 4 signs present in the remaining 2 hips, thus indicating complete osseointegration of all cups. There were no complications on the acetabular side but one intraoperative proximal calcar fracture. 3D-printed highly porous implants used in primary THA worked well in patients with rheumatoid arthritis, showing excellent osseointegration and good clinical results in the short term.

Evaluation of the efficacy of trigger points combined with extracorporeal shock waves in the treatment of plantar fasciitis: heel temperature and plantar pressure

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain. Among conservative treatments, extracorporeal shock wave therapy (ESWT) is considered effective for refractory PF. Studies have shown that applying ESWT to the trigger points (TrPs) in the triceps surae may play an important role in pain treatment in patients with PF. Therefore, the purpose of this study was to combine the concept of trigger points and ESWT to explore the effect of this combination on plantar temperature and pressure in patients with PF.MethodsAfter applying inclusion and exclusion criteria, 86 patients with PF were recruited from the pain clinic of Huadong Hospital, Fudan University and randomly divided into experimental (n = 43) and control groups (n = 43). The experimental group was treated with extracorporeal shock waves to treat the medial heel pain point and the gastrocnemius and soleus TrPs. The control group was only treated with extracorporeal shock waves at the medial heel pain point. The two groups were treated twice with an interval of 1 week. Primary measurements included a numerical rating scale (NRS) score (overall, first step, heel pain during daily activities), and secondary measurements included heel temperature, Roles–Maudsley score (RMS), and plantar pressure. All assessments were performed before treatment (i.e., baseline) and 6 and 12 weeks after treatment.ResultsDuring the trial, 3 patients in the experimental group withdrew from the study, 2 due to interruption of the course of treatment by the COVID-19 epidemic and 1 due to personal reasons. In the control group, 3 patients fell and were removed due to swelling of the heel. Therefore, only 80 patients with PF were finally included. After treatment, the two groups showed good results in NRS score (overall, first step, heel pain during daily activities), RMS, and plantar temperature, especially in the experimental group, who showed a significantly better effect than the control group.ConclusionESWT of the heel combined with the triceps trigger point of the calf can more effectively improve the pain, function and quality of life of refractory PF than ESWT of the heel alone. In addition, ESWT of the heel combined with the triceps trigger point of the calf can effectively reduce the skin temperature of the heel on the symptomatic side, indicating that the heel temperature as measured by infrared thermal imaging may be used as an independent tool to evaluate the therapeutic effect for patients with chronic PF. Although extracorporeal shock waves combined with TrPs treatment can cause changes in the patients’ gait structure, plantar pressure is still difficult to use as an independent tool to evaluate the therapeutic effect for PF.Trial registrationRegistered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 12/17/2021 with the following code: ChiCTR-INR-2,100,054,439.

Effectiveness of using H. Kitaoka (AOFAS) scale, FFI (Italian version), Roles and Maudsley score, VAS in patients with flatfoot

Assessment of the functional capacity of the foot requires adequate tools depending on a specific nosology. Objective: to investigate the possibility of using evaluation scale of H. Kitaoka (American Orthopaedic Foot and Ankle Society (AOFAS)), Foot Function Index (FFI) (Italian version), Roles and Maudsley score, visual analog scale (VAS) in patients with flatfoot. Materials and methods. Clinical and X-ray examinations of 63 patients (78 feet) who had flatfoot were performed. Their average age was 42.5 ± 2.0 (9–72) years. X-ray and clinical indicators were used: horizontal and vertical talo-metatarsal angles (TMA), angle of valgus deviation of the calcaneus, body mass index. The assessment of the functional state of the foot was carried out according to the H. Kitaoka (AOFAS) scale, FFI (Italian version), Roles and Maudsley score, VAS. The strength of the relationship between indicators was studied ­using Pearson’s pairwise correlations; a correlation regression analysis was performed on models where the indicators of rating scales were the dependent variables. Results. There was an inverse correlation between the foot function score (AOFAS) and the age and TMA, a direct correlation between the FFI and the age and body mass index, a direct dependence of functional insufficiency (Roles and Maudsley score) and pain level (VAS) on age. A sufficient degree of correlation (0.5–0.75) was found between the applied scales. Conclusions. Sufficient criterial and construct validity of the AOFAS scale, FFI (Italian version), Roles and Maudsley score, VAS was found when used in patients with flatfoot. The use of selected scales is an adequate tool for assessing functional capacity in patients with flatfoot.

Medial or Lateral, That Is the Question: A Retrospective Study to Compare Two Injection Techniques in the Treatment of Knee Osteoarthritis Pain with Hyaluronic Acid.

Background: Mild-to-moderate knee osteoarthritis (KOA) can be successfully treated using intra-articular hyaluronic acid (IA-HA). The medial infrapatellar (MIP) approach and lateral infrapatellar (LIP) approach are two of the most used techniques for performing IA-HA, but it is still not clear which one is preferable. Objectives: The study aims to find the best knee injection technique between MIP and LIP approaches. Methods: In total, 161 patients were enrolled, divided into two groups (MIP or LIP). Each technique was performed once a week for three weeks. Patients were evaluated using the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Roles and Maudsley Score (RMS) at T0 (before the first injection), T1 (one week after the third injection) and T2 (six months after). Results: NRS, KOOS and RMS showed a statistically significant improvement in both groups at all the detection times, without significant differences. No differences were detected between the groups in terms of systemic effect effusions, while the MIP group presented a mildly higher number of bruises in comparison with the LIP group (p = 0.034). Conclusions: Both the IA-HA techniques are equally effective in measured outcomes. The MIP approach seems to produce some local and transient side effects. So, the choice of the LIP or MIP approach depends on the operator's skill and experience.

Effectiveness of corticosteroid injection vs platelet rich plasma (PRP) injection in the treatment of plantar fasciitis

Introduction: Plantar fasciitis is one of the most common causes for inferior heel pain in adults. Many noninvasive and invasive treatment modalities are available for its treatment. Local injection of corticosteroid and Platelet-rich plasma (PRP) is usually used in the treatment of chronic plantar fasciitis not responding to noninvasive conservative treatments. Objectives: To compare the efficacy of local injection of corticosteroids and platelet rich plasma (PRP) in the treatment of plantar fasciitis. Methodology: Patients diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study and randomly allocated into 2 groups of 38 each (Group A and Group B). Patients were treated with local corticosteroid injection in group A and autologous PRP injection in group B. Clinical assessment was done prior to the injection and at 3 weeks and 3 months following the injection, which included visual analog pain scale (VAS), subjective rating using the modified Roles and Maudsley score (MRMS), functional outcome score by the Foot function Index (FFI). Results: The mean age, sex and body mass index was comparable for both groups. Postinjection, there was significant improvement (p < 0.05) of visual analog score (VAS), modified Roles and Maudsley score (MRMS), Foot Function Index in both the groups. However, there was no significant difference (p > 0.05) in improvement of VAS, MRMS and FFI when compared between the 2 groups. Conclusion: This study revealed that the treatment of plantar fasciitis with steroid or PRP injection was equally effective in patients who do not respond to conservative treatment.

Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy?

We aimed to compare the effectiveness of ESWT (Extracorporeal Shock Wave Therapy) and RFA (Radiofrequency Thermal Ablation) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. Patients who apply to Orthopedics and Traumatology and Physical Medicine and Rehabilitation departments with a complaint of heel pain are included in this retrospective study. We included patients diagnosed with calcaneal spurs who received treatment with ESWT (n = 80) and RFA (n = 79) between 1 August 2021 and 1 September 2022. All patients were evaluated using the Visual Analog Scale (VAS), Foot Function Index (FFI), and the Roles and Maudsley score (RM) before and after treatment. An evaluation was performed on average 6 months after treatment. This study included 79 RFA patients (34 females and 45 males) with a mean age of 55.8 ± 9.6 years and 80 ESWT patients (20 females and 60 males) with a mean age of 49.1 ± 9.5 years. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups (z: -4.98, z: -5.18, respectively, p < 0.001). The reductions in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, although the scores after treatment were lower in the RFA group. This study demonstrates that ESWT and RFA significantly reduced pain, disability, and activity restriction in the treatment of plantar fasciitis in patients with calcaneal spurs. ESWT proved particularly effective in alleviating pain, whereas RFA had more pronounced effects on reducing disability and activity limitations. The choice of treatment should be based on the patient's specific complaints.

The Efficacy of Temperature-Controlled High-Energy Polymodal Laser Therapy in Tendinopathy of the Shoulder

Rotator cuff tendinopathy is a common diagnosis among patients with shoulder pain and dysfunction. Laser therapy is recommended for the treatment of this tendon disease due to the possibility of increasing tissue biostimulation. The aim of this study was to investigate the effects of HELT (high-energy laser therapy) in relation to the wavelengths of 650 nm, 810 nm, 980 nm, and 1064 nm administered. The study design was prospective and observational. Thirty patients with shoulder tendinopathy were recruited and treated in one of two high-energy laser therapy groups (5 Watt/cm2, 450 Joule, super-pulsed mode). Group A received a high-energy laser therapy protocol with a single wavelength (1064 nm); group B received a high-energy laser therapy program with four wavelengths (650 nm, 810 nm, 980 nm, and 1064 nm). Pain (VAS), function (ASES), and disability (DASH) were monitored at the time of recruitment (T0), 1 month later (T1), and 6 months later (T2). Roles and Maudsley scores were also evaluated at T1 and T2. Both protocols resulted in improvement of pain and in functional and disability recovery at the two times of assessment, without statistically significant differences. In group B, treated with the four wavelengths, a trend emerged, bordering on statistical significance, for a greater reduction in pain. The high-energy laser proved to be an effective therapy for the treatment of rotator cuff tendinopathy. The possibility of modulating the choice of wavelengths could allow the customization of the protocol in relation to the patient's clinical condition.

Efficacy of two intensive and spaced protocols of theta burst transcranial magnetic stimulation in treatment-resistant depression: a double-blind randomized trial

IntroductionDepression is the disease with the greatest burden of disability. Despite pharmacological options, up to 30% of depressions are considered resistant to treatment (RTD). Theta burst transcranial magnetic stimulation (TBS) on the dorsolateral prefrontal cortex allows the application of shorter protocols and with longer-lasting effects than conventional TMS. Its implementation in the Public Health System requires the design of efficient, cost-effective and accessible protocols for patients.ObjectivesThe objective of this project is to assess the efficacy and safety of two intensive and spaced protocols (unilateral and bilateral) of 1800 pulses TBS compared to sham stimulation in outpatients with unipolar and bipolar TRD in a public hospital.MethodsThis project is the 1st double-blind placebo-controlled RCT with TBS in Spain. It is now in the recruitment phase. Patients receive a total of 22 sessions of 1800 pulses in 6 weeks: 5 days/week the 1st and 2nd weeks (10 sessions) and 3 sessions/week the following weeks (12 sessions). Patients are randomized into three groups: i) bilateral, ii) left unilateral, and iii) sham. The main variable is the change in the HDRS-17 score at the end of treatment compared to baseline. The results were analyzed with a general linear model of HDRS, using time as the intrasubject factor and randomization group as the intersubject factor, using resistance to treatment (Maudsley Score) and diagnosis (bipolar, unipolar) as covariates.ResultsPreliminary results from 13 participants (nbil=4, nuni=4, nsham=5) reveal a significant effect of (group x time) on HDRS change (p= 0.020) with no influence of Maudsley Score or diagnosis. The bilateral group presented a greater decrease in the HDRS with a mean difference of 4,38 points [CI95% 0,17-8,58), (p=0.043)] with respect to the unilateral group and a difference of 8.23 [CI95% 4,24-12,21)(p =0.001)] compared to the sham group.Table 1:Sample description. Data shown are means and standar deviations. In bold significant diferences p&lt;0,05.Bilateral TBS(n=4)UnilateralTBS(n=4)ShamTBS(n=5)Age [M (SD)]55,50(5,80)48,50(16,86)56,40(5,86)Male: Female [n]0:42:23:2Depression:Bipolar disorder [n]3:13:14:1Length of depresive episode (months) [M (SD)]12,00(4,08)16,50(6,61)15,00(5,83)Current number of antidepressants [M (SD)]2,00(0,82)1,75(0,50)2,60(0,55)Maudsley score [M (SD)]7,00(1,82)8,75(1,5)7,90(1,30)Basal HDRS basal [M (SD)]16,00(1,82)19,75(4,03)20,40(3,21)Final HDRS [M (SD)]5,75(3,30)10,75(3,10)17,80(2,49)Response /Remission[n (%)]3:3 (75%)2:0(50:0%)0:0 (0%)Image:ConclusionsThe results demonstrate the preliminary efficacy of intensive TBS protocols relative to sham.Disclosure of InterestNone Declared

Efficacies of extracorporeal shockwave therapy and low-level laser therapy in patients with plantar fasciitis

BackgroundVarious conservative treatment methods can be administered in the early stages of plantar fasciitis (PF). The aim of the treatment is to enable the patient to return to the physical activity as soon as possible. AimIn this study it was aimed to compare efficacies of Extracorporeal Shockwave Therapy (ESWT) and Low-Level Laser Therapy (LLLT) on patients with PF. DesignA local prospective cross-sectional study SettingDepartment of Physical Medicine and Rehabilitation Outpatient Clinic of Sakarya University, Faculty of Medicine PopulationPatients aged 18–70 years, having ongoing heel pain for at least 3 months, and not using oral and/or parenteral corticosteroids in the last 6 months. MethodsA total of 40 patients with PF included in the current study. Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), American Orthopedic Foot and Ankle Association Score (AOFAS) and Foot Function Index (FFI) questionnaire were performed for all patients. ESWT and LLLT groups comprised of 22 (55%) and 18 (45%) patients, respectively. ResultsWe found significant improvements in scores based on the VAS, RMS, AOFAS, FFI in patients with PF and it was sustained for 3 months (p = 0.001, for all scores). While decrease in scores based on the VAS and FFI in LLLT group was statistically more significant compared to ESWT group (p = 0.014, p = 0.013), there was statistically less significant decrease in scores on the AOFAS in LLLT group than that of ESWT group (p = 0.032). ConclusionsThe results of this study indicated significant improvements in terms of pain, functional status and daily life activities following the administration of either of the treatments. Furthermore, LLLT was found to be significantly more effective for alleviating pain than ESWT in the treatment of PF.

Tarsal coalition resections: a long-term retrospective analysis of 97 resections in 78 patients

BackgroundResection of tarsal coalitions provides good patient satisfaction scores, reduced pain, and improved long-term function in both athletic and non-athletic populations. This study aimed to determine when athletic patients undergoing resection of a tarsal coalition were able to return to their desired activity, and whether they experienced a decreased desired activity level (DDA).MethodsData on a total of 78 patients who underwent 97 tarsal coalition resections (49 talocalcaneal coalitions, 47 calcaneo-navicular, 14 cuboid-navicular, and three cuneo-navicular; some patients had more than one coalition) operated between January 2001 and June 2020 were prospectively collected. To subjectively assess outcomes, the Roles and Maudsley score (RM) was utilized.ResultsAt an average follow-up from the index procedure of 33.6 ± 41.5 months, return to activity for the entire cohort was 18.3 ± 9.6 weeks. Post-RM was 1.3 ± 0.6.ConclusionSurgical excision of tarsal coalitions produced favorable results, with most patients able to return to their desired activity level.Level of evidenceIV.

Effect of Extra-corporeal Shock-wave Therapy in the Management of Chronic Plantar Fasciitis

Plantar fasciitis is a progressive degenerative condition of the plantar fascia which is reported to be one of the most common causes of lower heel pain in adults. Extracorporeal Shock Wave Therapy is being used for the management of plantar fasciitis now a day. The aim of the study was to find out the effects of Extracorporeal Shock-wave therapy in patients with chronic plantar fasciitis. A randomized clinical trial was conducted from May to October 2015, on 60 patients aged more than 18 years with plantar fasciitis attending in the department of Physical Medicine and Rehabilitation (PMR) in the Dhaka Medical College Hospital (DMCH) to observe the effectiveness of Extracorporeal shock-wave therapy (ESWT) in the treatment of plantar fasciitis and its therapeutic outcomes.60 patients were allocated randomly into intervention group (Group A) and control group (Group B). Data were composed through face to face interview using a questionnaire based on 1.Visual analogue scale, 2.Modified Roles and Maudsley score, and 3.100-point Scoring System for Plantar Fasciitis. But after 8 weeks, score was found lower in Group A than Group B (p&lt;0.05).The usual total pain score was higher in 100-point Scoring System for Plantar Fasciitis (p&lt;0.001) after 8 weeks of treatment as well average function score (0.001) in Group A. Patient satisfaction was also found higher in Group A by using Modified Roles and Maudsley score. Extracorporeal shock-wave therapy showed effective, so it can be suggested for the patients. Bangladesh Med J. 2021 May; 50(2) : 1-8

A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis

IntroductionPlantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population.ObjectivesTo compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment.Materials and methodsThe study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections. Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness.DiscussionIn this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up.ConclusionThis study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.

Anconeus muscle flap transfer for failed surgical treatment of recalcitrant chronic lateral epicondylitis

Chronic lateral epicondylitis can be a painful and functionally limiting condition of the elbow. Non-operative and standard surgical treatment results can vary. Moreover, outcomes for patients who have failed previous surgical treatment are limited. We report our experience using the anconeus muscle flap transfer in comparison to standard surgical treatment and report our clinical results. We performed a retrospective case series of 19 patients with chronic lateral epicondylitis and failure of previous treatments that were managed with anconeus muscle flap transfer. There were 11 males and 8 females, with a mean age of 44 years (range 19–72); 13 were on the right side and 6 on the left. The average time from diagnosis to the surgical procedure was over 1 year (1–10 years) and the average follow-up period was 3.7 years (1–14 years). The average pain preoperatively was 6.61 and decreased postoperatively to 1.89 (range 0–10) (P < 0.0001). Complete flexion, extension and rotation of the elbow were present in all patients except one with a 5° extension lag. The average muscle strength was 4.5/5 and grip strength almost equivalent to the contralateral arm. No infection or other postoperative complications were observed. Patients were evaluated using the Roles and Maudsley score and demonstrated excellent results for 14 patients, good for 4, and poor for 1. The average time for return to work was 2.8 months (1–7 months). Ninety-five percent of patients were satisfied with the flap transfer and pain improvement. The anconeus muscle flap transfer is a safe and acceptable procedure providing satisfactory results for chronic lateral epicondylitis of the elbow. This procedure can be useful for treating patients with continued pain after previous standard surgical release.

Comparison of the effectiveness of radial extracorporeal shock wave therapy and supervised exercises with neuromuscular inhibition technique in lateral epicondylitis: A randomized-controlled trial.

Objectives The aim of this study was to evaluate and compare the effects of radial extracorporeal shock wave therapy (rESWT) and supervised exercises with neuromuscular inhibition (NMI) technique in improving pain, function, and grip strength in the treatment of patients with lateral epicondylitis (LE). Patients and methods A total of 50 patients with LE (11 males, 30 females; median age: 46 years; range, 23 to 57 years) whose symptoms persisted for at least three months between February 2015 and August 2015 were included in the prospective, randomized-controlled, clinical study. The patients were divided into two groups as the rESWT group (n=25) receiving a total of three rESWT sessions (once per week with 1.8 bar pneumatic pressure, 10 Hz frequency, and with 2,000 pulses) and the exercise group (n=25) receiving supervised exercises with NMI (three times per week for three weeks). Pain and function were evaluated using Visual Analog Scale, the total Patient-Rated Tennis Elbow Evaluation, the Roles and Maudsley score, while the grip strength was evaluated using a hand dynamometer at one and three months after treatment compared to baseline. Results A significant improvement was observed in all outcome criteria at one and three months after treatment, compared to baseline, in both the rESWT and exercise groups (p<0.05). There was no significant difference in terms of the changes in the outcome criteria between the groups (p>0.05). Conclusion The rESWT seems to provide no significantly superior benefit than supervised exercises with NMI at least until the three months in the treatment of LE.

Evaluation of plantar fasciitis improvement after shock wave therapy in calcaneal spur patients by musculoskeletal ultrasonography

BackgroundPlantar fasciitis due to calcaneal spur is a common cause of heel pain and functional disability, and its management presents a huge challenge for clinicians which results sometimes in unpleasant clinical outcomes. The efficacy of extracorporeal shock wave therapy (ESWT) as an alternative therapeutic option to surgical management after failure of conservative treatment has been addressed. Our aim was to evaluate the efficacy of ESWT in the treatment of plantar fasciitis in calcaneal spur patients using ultrasonography.ResultsThe mean plantar fascia (PF) thickness was statistically significantly higher in the calcaneal spur patient group (5.66 ± 1.14 mm) than in the healthy control group (2.40 ± 0.35 mm), (P = 0.001). Significant PF thickness reduction, visual analog scale (VAS), and Roles and Maudsley score (RMS) improvement were observed (P < 0.001) after 4 sessions of ESWT.ConclusionPF thickness increases significantly in calcaneal spur patients and responds to treatment. ESWT decreases the thickness of the PF and improves pain and function significantly.