Regulation in vascularity after extracorporeal shock wave therapy in individuals with proximal plantar fasciitis

Vascular changes have been observed in patients with plantar fasciitis, and modulation in vascularity is detected in individuals with tendinopathy after extracorporeal shock wave therapy (ESWT). If treatment should be prescribed based on the stage of the disease, vascularization could be one of the determining factors in delineating a treatment protocol.;This project consisted of 5 inter-related studies. In study 1, a quantitative vascularity index (VI) was defined using Power Doppler Ultrasonography. It delineated the minimum detectable difference of 0.68% and cut-off point of 2.60% for identifying individuals with and without unusual vascularization. Study 2 evidenced vascularization and thickened plantar fascia in the patient group than able-bodied controls. It also explored relationships between the duration of the disorder with vascularity and fascia thickness. Study 3 assessed regulation in vascularity after 3 or 6 sessions of ESWT and with no intervention. Immediate after ESWT, regulation in vascularity was observed in 60% of the patients studied. Down-regulation was observed in vascularized patients after 6 sessions of ESWT. Vascularity was up-regulated in non-vascularized patients after either 3 or 6 sessions. The influence of pre-intervention vascularization on treatment planning was explored in study 4. A baseline VI score >1.55% was a strong predictor of unsuccessful recovery with only 3 sessions of ESWT, but 62.50% of patients with a baseline VI score <3.25% recovered successfully after 6 sessions. In study 5, factors affecting treatment success were investigated. Regression of vascularity was continued to 6 months post intervention, and 91.67% patients with excellent treatment results had normal vascularity.;The 3 main conclusions from this project are: 1) ESWT can modify the vascularity in 60% of patients, but the direction of regulation depends on the baseline vascularization and the number of treatment sessions. 2) Individuals with increased vascularization could not reach a satisfactory result after only 3 sessions of ESWT; 6 sessions of ESWT could improve about 60% of vascularized patients at 1 month follow-up. 3) The regression of vascularity after ESWT continues to 6 months post-intervention. Patients' baseline vascularization together with treatment protocol are two factors that affect treatment effectiveness in terms of pain reduction.