Turkish Journal of Physical Medicine and Rehabilitation 2017 , Vol 63 , Num 1

Efficacy of different doses of radial extracorporeal shock wave therapy in patients with painful calcaneal spur

Okan Küçükakkaş 1 ,Bengi Öz 1 ,Hikmet Koçyiğit 1
1 Atatürk Eğitim ve Araştırma Hastanesi Katip Çelebi Üniversitesi Fizik Tedavi ve Rehabilitasyon Kliniği, İzmir, Türkiye DOI : 10.5606/tftrd.2017.23590 Objectives: This study aims to investigate the efficacy of radial extracorporeal shock wave therapy (rESWT) on pain and functional capacity in the treatment of patients with calcaneal spur and to compare the efficiency of different energy densities of rESWT.

Patients and methods: Ninety patients with heel pain for at least three weeks who were radiologically diagnosed with calcaneal spur, admitted to our policlinic between June 2014 and February 2015, were included in the study. Patients were randomly and equally assigned to placebo (control group), low and medium dose groups. They were evaluated through the visual analog scale (VAS) for pain score (resting, stretching, pression), maximum standing/walking time, Roles & Maudsley (RM) score, Foot Function Index (FFI) and the American Orthopedic Foot and Ankle Society (AOFAS) score at pretreatment, at three and 12 weeks.

Results: Calcaneal spur was more common in women, in patients with high body mass index (BMI) and patients who work in a standing position. While the improvement in VAS pression, FFI and AOFAS pain scores of low and medium dose groups were higher than that of the placebo group in the third week, there was no significant difference between these two groups. The improvement in these scores was higher in medium dose group than the low dose group, and it was higher in the low dose group than the placebo group in the 12th week. The patients in medium dose group gained better scores in AOFAS total, FFI disability, activity limitation and total scores than the other two groups and they only gained better scores in maximum walking time and AOFAS function than the control group in the 12th week. Except for AFI total, these scores showed no significant difference between the low dose group and the placebo group in the 12th week. Intragroup RM and AOFAS and maximum standing/walking time showed significant improvement from the baseline.

Conclusion: In conclusion, the improvement in pain was found to be better in therapy groups compared to the control group in the early period and also medium dose group had better gain in both pain and functional capacity compared to others in the medium phase. However, there are no clear guidelines for choosing density in rESWT therapy yet. Therefore we should optimize the density high enough so that the patients can tolerate it and low enough to prevent side effects. Keywords : Calcaneal spur; different energy densities; radial extracorporeal shock wave therapy