With musculoskeletal ultrasound to examine the heel (much like looking obstetrician’s use to examine a fetus), physicians are able to accurately target heel pain.
With the advancement of technology we are able to further our understanding of disease as well as offer innovative treatments.
At the December 08 annual Radiological Society of North America, Luca M. Sconfienza, MD, from University of Genoa in Italy demonstrated 95% efficacy with dry needling followed by cortisone.
Plantar Fasciitis is one of the most common foot problems affecting 1 million people. Patients typically complain of inner heel pain with stiffness in the morning and later throughout the day with weight bearing.
44 patients were treated who had previously failed extra corporeal shockwave therapy. Shock wave therapy works by a similar means through creation of micro trauma that increases blood flow and promotes healing in a deficient ligament or tendon.
A similar procedure is done with platelet rich plasma therapy, which involves needling of the thickened and oxygen deficient plantar fascia under ultrasound guidance. But rather than using cortisone, the patients own growth factors (extracted from their arm from a blood draw) are injected into the area of injury to promote natural healing. Unlike cortisone, platelets & growth factors have no reported ill effects of tendon tearing or rupture, but rather regenerate the tissue.
An article from Jan 08′in the JBJS (Journal of Bone & Joint Surgery), that documented low energy shockwave therapy was effective in treatment of non-healing achilles tendinosis. The randomized controlled trial showed that 64% of patients receiving shock wave(group I) were completely recovered or much improved, versus 28% of those who received an eccentric loading exercise program (group II).
I have been treating many patients lately (more than 50, with various injuries including achilles tendinosis, plantar fasciitis, tennis elbow, & bicep tendonosis with favorable results. I have all patients complete questionnaires 6 weeks after their initial treatment to determine a useful role for shockwave in my practice.
