Intense Therapeutic Ultrasound for Pain Relief in the Treatment for Chronic Plantar Fasciopathy

Abstract

Background: Intense therapeutic ultrasound (ITU) is an innovative ultrasound-based therapy where sound waves are concentrated into select musculoskeletal tissue. These focused waves generate thermal coagula at a controlled depth and space while preserving surrounding tissues. A multicenter study was conducted evaluating the efficiency, safety, and patient tolerance of ITU for the treatment of chronic plantar fasciitis (CPF) pain. Methods: Seventy-four CPF patients, having failed conservative and/or minimally invasive treatment, participated in the study. Randomized participants either received 2 ITU treatments or 2 sham ITU treatments in addition to standard-of-care therapy. Plantar fascia pain was assessed pretreatment and at 4, 8, 12, and 26 weeks after treatment. Diagnostic ultrasonographic images were analyzed to examine hypoechoic, perifascial lesions whose volumes were calculated until week 12. Function and patient satisfaction were measured using self-reported outcome measures. Results: The treated group reported significant average pain reduction (–26%, –33%, –43%) and hypoechoic lesion volume (–33%, –53%, –68%) at weeks 4, 8, and 12 compared to baseline. Although the control/sham group reported insignificant pain changes at the same time points (–5%, +8%, and +2%) and increased hypoechoic lesion volume (+15%, +28%, +58%). Treated patients reported a significant increase in daily living activities (+28%, +42%, +47%, +40%) compared to the sham/control group (+0.12%, +12%, +3%, +21%). Patient satisfaction remained more than 80% at weeks 8, 12, and 26 for all treatment groups. Conclusion: ITU is an effective pain relief treatment for CPF, which is refractory to either conservative measures or minimally invasive treatments. Level of Evidence: Level II.

A Review of Common Interventions and Preventive Options Used in the Treatment of Plantar Fasciitis

“…In comparison with baseline, the treatment group reported a substantial decrease in average pain (-26%, -33%, -43%) and hypoechoic lesion volume (-33%, -53%, -68%) at weeks 4, 8, and 12. Treating patients reported significantly more daily living activities (+28%, +42%, +47%, +40%) compared to the sham/control group (+0.12%, +12%, +3%, +21%) [21]. However, in terms of pain reduction and functional improvement, a meta-analysis comprising five RCTs found that ESWT is superior to therapeutic ultrasound (MD = −1.36, P = 0.005) [22].…”

Plantar Fasciitis: An Updated Review

“…An RCT compared therapeutic ultrasound to sham ultrasound and found that therapeutic ultrasound was no more effective than the sham group,[ 34 ] while another RCT showed the treated group had significant pain reduction compared to the sham group. [ 35 ] Another RCT found no additional benefit of therapeutic ultrasound when added to stretching exercise in treating PF. [ 36 ] When compared to ESWT, a meta-analysis incorporating 5 RCTs concluded that ESWT is superior to therapeutic ultrasound in pain reduction and functional improvement.…”

Evaluation and Treatment of Chronic Plantar Fasciitis

“…4 It is approved by the FDA for nonoperative brow lifts and has been demonstrated to produce a greater and more rapid reduction in heel pain and perifascial lesion size when compared to sham control. 45…”