| Purpose:To explore the influence of extracorporeal shock wave therapy on the changes of fascia thickness and elastic modulus in patients with chronic plantar fasciitis,and to find the intervention period for the treatment of chronic plantar fasciitis,so as to provide a theoretical basis for clinical revealing of the stress mechanism of plantar fasciitis and possible mechanisms in the treatment.Materials and Methods:A total of 75 patients with chronic plantar fasciitis meeting the inclusion criteria were selected and randomly divided into five groups A,B,C,D and E with 15 patients in each group.All groups were treated with focused shock wave,and the pressure of each group was set as group A(l.0bar),group B(2.0bar),group C(2.5bar),group D(3.0bar),and group E(3.5bar),respectively.Group A was the control group,and the treatment mode was 2000 shock/time with the frequency of 10 Hz.The energy flux density(EFD)was 0.25 m J/mm2,the treatment probe was 15 mm,and the treatment course was once per week,with a total of 6 treatments.No medication or other physical therapy during treatment;The changes of elastic modulus of fascia,fascia thickness,plantar pressure,pain degree(VAS score)and ankle-posterior foot function score(AOFAS score)were recorded dynamically before treatment(T0),2 weeks(T1),4 weeks(T2),6 weeks(T3),8 weeks(T4),3 months(T5),6 months(T6),12 months(T7).The clinical efficacy of each group was determined 1 year after treatment.Results:There were no significant differences in mean age,BMI,sex ratio,heel site and course of disease among all groups(P>0.05).Before treatment,VAS score,AOFAS score,plantar pressure difference,elastic modulus of fascia and fascia thickness were not significantly different among all groups(P>0.05).With the extension of extracorporeal shock wave treatment time,VAS score,plantar pressure difference and fascia thickness were gradually decreased,while AOFAS score and fascia elastic modulus were gradually increased,with statistical significance(P<0.05).With the increase of extracorporeal shock wave pressure(1.0bar～3.0bar)after treatment,VAS score,plantar pressure difference and fascia thickness gradually decreased,while AOFAS score and fascia elastic modulus gradually increased,with statistical significance(P<0.05).VAS score,plantar pressure difference,fascia thickness,AOFAS score and elastic modulus of fascia at 3.5bar were similar to those at 3.0bar(P>0.05).With the increase of extracorporeal shock wave pressure,the elastic modulus of plantar fasciitis in patients with chronic plantar fasciitis also increased gradually,showing a positive correlation.The thickness of plantar fascia decreased gradually,showing a negative correlation,and the R-values were 0.4003 and-0.3899,respectively,with statistical significance(P<0.05).At the last follow-up,the clinical effective rate of group A,group B,group C,group D and group E were 73.33%,80.00%,86.67%,93.33% and 93.33%,respectively.With the increase of extracorporeal shock wave pressure,the clinical efficacy of patients was gradually improved,and the difference was statistically significant(P<0.05).Conclusion:(1)In the intervention treatment of chronic plantar fasciitis,extracorporeal shock wave pressure is closely related to clinical efficacy.With the increase of extracorporeal shock wave pressure,the pain degree and the thickness of plantar fasciitis in patients with plantar fasciitis gradually decrease,and the elastic modulus of plantar fasciitis and ankle-posterior foot function improve,among which 3.0bar is the optimal intervention pressure for extracorporeal shock wave treatment.(2)Extracorporeal shock wave therapy can improve pain and hind foot function by improving the elastic deformation capacity of plantar fascia in patients with chronic fasciitis.The molecular mechanism needs further study. |
