Elastosonographic evaluation after extracorporeal shockwave treatment in plantar fasciopathy

Abstract

Aim: To assess the ultrasound features in patients with plantar fasciopathy before and after extracorporeal shock waves therapy (ESWT), using conventional grey-scale imaging and both strain (SE) and shear wave (SWE) elastosonographic evaluation.Material and method: Consecutive patients of both sexes attending our outpatient’s clinic, with diagnosis of unilateral plantar fasciopathy, were enrolled. Patients were treated with 3 sessions of ESWT once a week, and underwent clinical and ultrasound evaluation at baseline and at one and three months after treatment. Roles and Maudsley score (RM), visual analog scale (VAS) and 17-Italian Foot Function Index (FFI), were used to assess pain and functional improvement.Results: Twenty patients (11 female and 9 male) were enrolled in the study. Contralateral asymptomatic healthy plantar fascia was used as a control. At baseline, SWE velocity (SWEv) showed statistically significant difference between affected 3.8 (1.5; 5.1) m/s and healthy side 4.7 (4.07; 7.04) m/s, (p=0.006); no significant difference was found for strain ratio values (p=0.656). SWEv post hoc test results showed a significant difference from baseline 3.8 (1.5-5.1) m/s and three month 5.23 (4.55-6.74) m/s follow up visit (p=0.003). Significant statistical negative correlation was found between the SWEv and VAS (p=0.001) and positive correlation between the SWEv and FFI (p=0.012).Conclusion: SWE was effective in assessing plantar fascia elasticity and its alteration in fasciopathy. Furthermore, on the basis of the correlation with pain and functional scales, this technique appears to be a useful additional technique to conventional ultrasound for monitoring the efficacy of treatment

Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial

“…In this study, we recorded results consistent with the literature for the application of ESWT in the medial insertion of plantar fascia 50 . We achieved similar to better results in terms of foot pain, disability and time needed for recovery with the release of proximal myofascial points using the fascial manipulation method.…”

A comparison between the efficacy of eccentric exercise and extracorporeal shock wave therapy on tendon thickness, vascularity, and elasticity in Achilles tendinopathy: A randomized controlled trial

“…This is the first research to show the efficacy of ESWT on the structural properties of AT. Altivi et al[ 14 ] reported that the thickness and stiffness of plantar fascia increased with three sessions of ESWT in patients with plantar fasciopathy. Additional studies are needed to investigate the relationship between ESWT and tendon stiffness.…”

“…[ 13 ] Many studies have investigated the relationship between EE and tendon structure; however, the number of studies investigating tendon structure following ESWT is limited. [ 14 ] In preclinical studies, increased vascularization was reported in the bone-tendon junction with the use of ESWT; however, tendon neovascularization with ESWT has not been demonstrated in clinical studies. [ 15 , 16 ] To our knowledge, there is no clinical trial examining the efficacy of ESWT on tendon thickness and stiffness in midportion AT.…”

Shear Wave Elastographic Study of the Myotendinous Junction of the Medial Gastrocnemius

“…[16][17][18][19][20] Shear wave elastography (SWE), a recently developed, noninvasive ultrasound (US) imaging technique, has been used to assess the mechanical properties of muscles and tendons. [21][22][23][24][25][26][27][28] It provides information on tissue elasticity and stiffness by using an impulse generated by the transducer with the shear wave propagating at a higher speed in stiffer tissues 29 and seems to be able to detect modifications of tissue elasticity earlier than conventional B-mode US. 30,31 The aim of our study was to evaluate the characteristics of the medial gastrocnemius MTJ with SWE in a resting position and during muscle contraction in healthy people.…”

“…The evaluation of the muscle‐tendon unit stiffness has been studied thoroughly in the literature by different methods . Shear wave elastography (SWE), a recently developed, noninvasive ultrasound (US) imaging technique, has been used to assess the mechanical properties of muscles and tendons . It provides information on tissue elasticity and stiffness by using an impulse generated by the transducer with the shear wave propagating at a higher speed in stiffer tissues and seems to be able to detect modifications of tissue elasticity earlier than conventional B‐mode US .…”