A Comparison of the Analgesic Efficacies of Ultrasound and Shock Wave Therapy in the Patients With Calcaneal Spur
Condition: Heel Spur
MeSH terms: Heel Spur
Study type: Observational

Summary: 
      Heel spur is a troublesome disorder. Its formation is accompanied by pain in the area of heel
      and it makes walking limited or even impossible.

      The aim of the study is to analyze analgesic efficacy of ultrasound and shock wave therapy in
      patients with heel spur.

      The study included 52 patients of both sexes, aged 38-86 (average 57.39) with plantar heel
      spur confirmed radiographically. The patients were randomly divided into two groups;in Group
      1 the patients underwent ultrasound procedure (10 treatments)and in Group 2 - radial shock
      wave procedure(6 treatments). The researchers assessed pain three times (prior to the
      therapy, after the first and then the second week of treatment). In order to do this they
      used a modified form of the Laitinen pain indicators questionnaire (results expressed in
      points) and VAS - visual analogue scale (results given in milimeters). The results were
      statistically analyzed. In the studied periods of time a decrease in pain was observed (both
      in the Laitinen questionnaire and in the VAS scale). The most rapid change was noted in both
      the groups after the first week of treatment. Ultrasound and shock wave therapies show a
      comparably significant analgesic efficacy in patients with heel spur. Shock wave therapy has
      an advantage over ultrasound therapy. A smaller number of procedures is required to obtain
      comparable results, which makes the therapy less expensive. No side effects were observed
      during and after the treatment.
    

Detailed description: 
      The study was conducted on a group of 52 patients of both sexes, aged 38-86 years (mean
      57.39; SD-11.5) with a plantar calcaneal spur confirmed by X-ray images. Patients were
      treated in the Department of Physical Medicine and Rehabilitation Day Unit of the University
      Hospital im. WAM - Central Veterans Hospital in Lodz and Municipal Health Clinic of
      Andrespol. In order to compare the effectiveness of the two forms of physiotherapy,
      ultrasound and radial shock wave therapy, the patients were randomly assigned (using a simple
      randomization) into two groups:

        -  Group 1 - ultrasound therapy group: 22 patients aged 38-86 years (mean 58.64; SD-12.99),

        -  Group 2 - radial shock wave group: 30 patients aged 40-71 years (mean 56.13; SD-10.02).

      Ultrasound (US) was performed with a BTL 5840 S device, using labile technique, targeting the
      calcaneal tumor and attachment of the plantar aponeurosis (pain points); the power setting
      was 1,5 W/cm2, 80% fill factor, at a frequency of 1 MHz (head 4cm2). The duration of a single
      treatment was four minutes, and the coupling substance used was paraffin oil. Treatment
      sessions were performed daily Monday through Friday for a period of two weeks in a series of
      10 treatments.

      The shock wave therapy (SWT) was performed on the affected area using a BTL-5000 SWT device
      connected to a 15 mm diameter applicator according to the producer's recommendations; during
      therapy, 2000 strokes were applied with a frequency of 10 Hz and a capacity of 2.5 bar.
      Therapy took place for two weeks in a series of 6 treatments with a two-day interval between
      treatments.

      In addition, all patients underwent kinesitherapy - exercises to strengthen the muscles that
      bending plantar and supinated foot to improve the mobility of the feet and to maintain the
      normal longitudinal arch of the foot. SPR orthopedic inserts with a pit on the painful area
      was used to support the longitudinal foot arch and relieve the medial ridge of the calcaneal
      tumor.

      In all patients, pain intensity was assessed three times: before therapy, and after the first
      and second week of treatment. A modified form of the Laitinen indicators of pain
      question-shem was used [12]. On the basis of their subjective feelings, patients evaluated
      pain intensity, frequency of occurrence, use of analgesics, and the impact of pain on their
      physical activity. In addition, pain intensity was also assessed on the Huskisson visual -
      analogue scale (VAS) [13]; patients marked a point on a 100 mm line which corresponded to the
      current pain sensations - the results being given in millimeters.

      The results were analyzed by Student's t-test for dependent and independent tests, with a
      significance level of p <0.05. The results are presented as arithmetic mean and standard
      deviation.
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        The study was conducted on a group of 52 patients of both sexes, aged 38-86 years (mean
        57.39; SD-11.5) with a plantar calcaneal spur confirmed by X-ray images. Patients were
        treated in the Department of Physical Medicine and Rehabilitation Day Unit of the
        University Hospital im. WAM - Central Veterans Hospital in Lodz and Municipal Health Clinic
        of Andrespol. In order to compare the effectiveness of the two forms of physiotherapy,
        ultrasound and radial shock wave therapy, the patients were randomly assigned (using a
        simple randomization) into two groups:

          -  Group 1 - ultrasound therapy group: 22 patients aged 38-86 years (mean 58.64;
             SD-12.99),

          -  Group 2 - radial shock wave group: 30 patients aged 40-71 years (mean 56.13;
             SD-10.02).
      
Keywords: calcaneal spur; shock wave therapy; ultrasound therapy