Effect Of Different Frequency Extracorporeal Shock Wave On Plantar Fasciitis

Objective: The aim of this study was to investigate the clinical effect and mechanism of different frequency extracorporeal shock wave on plantar fasciitis.Methods: A total of 184 patients with unilateral onset,course of more than 3 months who were diagnosed with plantar fasciitis were included.This study was randomized,controlled prospective.All patients were divided into four groups with 46 patients in each group with different impact frequencies: Group A: 1 Hz,Group B: 5 Hz,Group C:10 Hz,and Group D:15 Hz.The four groups used Swiss EMS Dolor Clast radial shock wave with 15 mm treatment probe,2000 impacts/times,in 3 sessions,with an interval of 1 week,2.0bar,holding the pressure medium to high and selecting treatment according to the tenderness point on the medial plantar area of the heel.The obtained data were processed statistically before the treatment and 1 week after the end of the 3 treatments by visual analog scale(VAS)for the changes of pain intensity,gait aid training(GAT)for the changes of plantar pressure and gait parameters during walking and ankle posterior foot function score system(AOFAS)for the ankle function of patients.Results: Only 158 patients of 184 patients with plantar fasciitis completed the treatment and follow-up.The follow-up completion rate was 85.87% without 26 patients of the study for various reasons.There was no significant difference in the basic data of the four groups(P>0.05).The VAS score decreased from 5.65±0.97,5.73±0.85,5.97±1.00,5.92±0.87 to 2.37±0.69,0.81±0.32,1.38±0.42,2.29±0.67.They are different significantly before treatment(F=1.121,P=0.342).There was significant difference in VAS score with before and after treatment(t=18.38,P=0.000;t=33.27,P=0.000;t=24.36,P=0.000;t=22.53,P=0.000).The VAS scores of four groups were statistical significance after treatment(F=73.80,P=0.000).The results of each two groups compared showed that group B had the best effect in relieving the pain of plantar fasciitis after treatment.The dynamic plantar pressure changed from 34.66±3.94,34.59±3.81,33.70±3.45,35.68±3.84,to 17.30±2.75,9.82±1.94,11.89±2.37,17.51±3.08.They are different significantly before treatment in four groups(F=2.113,P=0.101).There were significant differences between before and after treatment(t=22.95,P=0.000;t=46.13,P=0.000;t=32.49,P=0.000;t=23.06,P=0.000).The effect was distinct after treatment in the four groups(F=90.80,P=0.000).The results showed that group B had the best effect on improving the plantar pressure with each two groups compared after treatment.Stride length of four groups were from 60.21±5.83,62.29±5.77,61.30±6.12,62.93 ± 6.26 to 113.21±8.19,125.29±9.61,118.81±7.78,112.06±7.74.There was no significant difference before treatment in the four groups(F=1.568,P=0.199).Each stride length was different significantly between before and after treatment(t=22.95,P=0.000;t=46.13,P=0.000;t=32.49,P=0.000;t=23.06,P=0.000).The effect was statistical significance after treatment in four groups(F=90.80,P=0.000).The results showed that group B had the best effect in improving stride length with each two groups compared after treatment.The support phases of four groups changed from 46.88 ±1.93,47.30±2.00,46.59±1.98,46.92±1.89,to 56.22 ± 1.96,64.64 ±1.93,61.17±2.01,58.53±1.95.The pre-treatment swing phases were 53.12±1.93,52.07±2.00,53.41±1.98,53.08±1.89,and the post-treatment swing phases were 43.78±1.96,35.36±1.93,38.83±2.01,41.47±1.95.There was no significant difference in the pre-treatment support phase and swing phase between four groups(F=0.968,P=0.409).The support phase and the swing phase was distinct significantly between before and after treatment in each group(t=18.71,P=0.000;t=44.24,P=0.000;t=32.07,P=0.000;t=21.65,P=0.000).The support phase increases obviously and the swing phase decreases obviously after treatment.There was significant difference after treatment(F=191.527,P=0.000).The results confirmed that group B had the best effect with two groups compared in pairs.The scores of ankle hind foot function were from 52.68±5.33,53.60±5.53,52.36±6.25,53.09±5.73,to 79.60±5.09,88.62± 6.23,83.52±5.27,79.47±4.76.They are statistical significance in the four groups before treatment(F=0.558,P=0.643).The score was different significantly between before and after treatment in each group(t=21.06,P=0.000;t= 29.95,P=0.000;t=26.70,P=0.000;t=22.19,P=0.000).There was significant difference in four groups after treatment(F=24.38,P=0.000).The results showed that group B had the best effect with two groups compared after treatment.Conclusion: 1.Shock waves of different frequencies(1Hz,5Hz,10 Hz,15Hz)had good pain relief effect on plantar fasciitis.Shock wave therapy can be used as an effective means to relieve the pain of plantar fasciitis patients.2.Different frequency shock wave(1Hz,5Hz,10 Hz,15Hz)had significant changes in gait parameters between before and after treatment of plantar fasciitis.The parameters of stride,the ankle foot function and supporting phase were significantly improved after treatment.The parameters of swing phase and the pressure difference of plantar were significantly reduced after treatment.It was confirmed that the treatment of shock wave had a good improvement in the gait of patients with plantar fasciitis.3.Shock wave to treat plantar fasciitis has the best effect in relieving pain,improving gait and optimizing ankle foot function with 5Hz.4.The mid-term and long-term clinical effects of different frequency shockwave on plantar fasciitis need further observation.