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Scientific Articles   |    
Plantar Fascia-Specific Stretching Versus Radial Shock-Wave Therapy as Initial Treatment of Plantar Fasciopathy
Jan D. Rompe, MD1; Angelo Cacchio, MD2; Lowell Weil, Jr., DPM3; John P. Furia, MD4; Joachim Haist, MD5; Volker Reiners, MD5; Christoph Schmitz, MD6; Nicola Maffulli, MD, MS, PhD, FRCS(Orth), FFSEM(UK)7
1 OrthoTrauma Evaluation Center, Oppenheimer Strasse 70, D-55130 Mainz, Germany. E-mail address: profrompe@web.de
2 Department of Physical Medicine and Rehabilitation, University of Rome “La Sapienza,” p. le A. Moro, 00185 Rome, Italy
3 Weil Foot & Ankle Institute, Golf River Professional Building, 1455 Golf Road, Des Plaines, IL 60016
4 SUN Orthopaedics and Sports Medicine, 900 Buffalo Road, Lewisburg, PA 17837
5 Orthopädie im Gesundheitszentrum, Am Damm 17, 55232 Alzey, Germany
6 E.M.S. Electro Medical Systems S.A., chemin de la Vuarpillière, 1260 Nyon, Switzerland
7 Institute of Health Sciences Education, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, Mile End, London E1 4DG, United Kingdom
View Disclosures and Other Information
Disclosure: One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Electro Medical Systems). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Victor R. Prisk, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.
Investigation performed at Orthopädie im Gesundheitszentrum, Alzey; OrthoTrauma Praxisclinic, Grünstadt; and OrthoTrauma Evaluationszentrum, Mainz, Germany

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Nov 03;92(15):2514-2522. doi: 10.2106/JBJS.I.01651
A commentary by Victor R. Prisk, MD, is available here
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Abstract

Background: 

Whether plantar fascia-specific stretching or shock-wave therapy is effective as an initial treatment for proximal plantar fasciopathy remains unclear. The aim of this study was to test the null hypothesis of no difference in the effectiveness of these two forms of treatment for patients who had unilateral plantar fasciopathy for a maximum duration of six weeks and which had not been treated previously.

Methods: 

One hundred and two patients with acute plantar fasciopathy were randomly assigned to perform an eight-week plantar fascia-specific stretching program (Group I, n = 54) or to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II, n = 48). All patients completed the seven-item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire. Patients were evaluated at baseline and at two, four, and fifteen months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first few steps of walking in the morning) on this index, and satisfaction with treatment.

Results: 

No difference in mean age, sex, weight, or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with plantar fascia-specific stretching than for those managed with shock-wave therapy (p < 0.001), as well as individually for item 2 (p = 0.002). Thirty-five patients (65%) in Group I versus fourteen patients (29%) in Group II were satisfied with the treatment (p < 0.001). These findings persisted at four months. At fifteen months after baseline, no significant between-group difference was measured.

Conclusions: 

A program of manual stretching exercises specific to the plantar fascia is superior to repetitive low-energy radial shock-wave therapy for the treatment of acute symptoms of proximal plantar fasciopathy.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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