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Uvod: Plantarni fasciitis je posledica degenerativnih in vnetnih sprememb na izvoru plantarne fascije, za katerega je značilna intenzivna ostra bolečina v medialnem plantarnem delu pete, ki se pojavi zjutraj ob prvih korakih, po daljši neaktivnosti ali dolgotrajni obremenitvi stopala. Zdravljenje plantarnega fasciitisa je predvsem konzervativno, s počitkom in hlajenjem za zmanjševanje bolečine. Uporabljajo se tudi druge metode, kot so vaje za raztezanje, elektroterapija, terapija z laserjem, ultrazvok, ortopedski vložki za v čevlje po meri in injekcijska terapija s kortikosteroidi, trombocitno plazmo in proloterapija. Pred kratkim se je za zdravljenje mišično-skeletnih okvar začela uporabljati obetavna neinvazivna metoda z udarnimi globinskimi valovi, ki se učinkovito spopada s plantarnim fasciitisom. Namen: Namen diplomske naloge je s pregledom literature analizirati učinkovitost uporabe udarnih globinskih valov pri pacientih s plantarnim fasciitisom. Metode dela: Iskanje literature, ki smo jo analizirali, je potekalo v podatkovni bazi PubMed. Glavni vključitveni kriteriji so bili: raziskave, objavljene med letoma 2017 in 2022, raziskave v angleškem jeziku, preiskovanci s plantarnim fasciitisom, uporaba fokusnih ali radialnih udarnih globinskih valov. Rezultati: Glede na vključitvene kriterije je bilo v pregled literature vključenih pet raziskav. V raziskavah so merili učinke na bolečino in funkcijo stopala pacientov s plantarnim fasciitisom. Rezultati so pokazali predvsem kratkoročno statistično pomembno izboljšanje bolečine in funkcije stopala pacientov. Bolečina se je kratkoročno zmanjšala iz 7,4 na 4,5 na vizualni analogni lestvici, dolgoročno pa skoraj ni bilo spremembe, vendar je do zmanjšanja bolečine prišlo iz 6,9 na 6,2 na vizualni analogni lestvici. Funkcija stopala se je kratkoročno izboljšala iz 75,8 na 53,8, dolgoročno skoraj ni prišlo do sprememb, vendar je prišlo do izboljšanja iz 84,4 na 78,3 točke po funkcijskem indeksu za stopalo. Razprava in zaključek: Udarni globinski valovi z visoko jakostjo (maksimalna jakost, ki jo pacient lahko tolerira) in vsaj 7 terapij so se kratkoročno izkazali za učinkovito in varno zdravljene plantarnega fasciitisa. Ker v nobeni raziskavi ni prišlo do popolnega izboljšanja stanja, se priporoča terapijo kombinirati z ostalimi fizioterapevtskimi postopki. V primeru, da se stanje ne izboljšuje, je priporočljiva uporaba injekcijskih terapij kortikosteroidov, trombocitne plazme ali proloterapija. V prihodnjih raziskavah bi bilo treba vključiti večje število preiskovancev, vključiti skupino s placebom ali skupino, ki ne prejema nobenih oblik zdravljenja in daljšega časovnega spremljanja učinkov terapij. Introduction: Plantar fasciitis is a result of degenerative and inflammatory changes at the origin of the plantar fascia and is characterized by intense, sharp pain in the medial plantar part of the heel, which occurs in the morning at first steps, after prolonged inactivity, or after prolonged stress on the foot. Treatment of plantar fasciitis is mainly conservative, with rest and cooling to reduce pain. Other methods, such as stretching exercises, electrotherapy, laser therapy, ultrasound, custom foot orthotics, and injection therapy with corticosteroids, platelet-rich plasma, and prolotherapy, are also used. Recently, a promising non-invasive deep shockwave method has been introduced for the treatment of musculoskeletal disorders, effectively tackling plantar fasciitis. Purpose: The aim of this diploma is to analyze the efficacy of shockwave therapy in patients with plantar fasciitis by reviewing the literature. Methods: The literature we analyzed was searched in the PubMed database. The main inclusion criteria were: studies published between 2017 and 2022 English-language studies subjects with plantar fasciitis and use of focal or radial depth shock waves. Results: According to the inclusion criteria, five studies were included in the literature review. Studies have measured the effects on pain and foot function in patients with plantar fasciitis. The results showed a statistically significant improvement in patients' pain and foot function, especially in the short term. Pain decreased from 7.4 to 4.5 on the Visual Analogue Scale in the short term, and there was almost no change in the long term, but there was a decrease in pain from 6.9 to 6.2 on the visual analogue scale. Foot function improved from 75.8 to 53.8 in the short term, with almost no change in the long term, but there was an improvement from 84.4 to 78.3 points on the Foot Function Index. Discussion and conclusion: High-energy shockwaves (the maximum intensity the patient can tolerate) and at least seven treatments have been shown to be effective and safe in the short term for the treatment of plantar fasciitis. Because no studies have shown that the condition improves completely, it is recommended that the therapy be combined with other physiotherapy treatments. If the condition does not improve, injectable corticosteroid therapy, platelet-rich plasma therapy, or prolotherapy are recommended. Future studies should include a larger number of subjects, a placebo group or a no-treatment group, and a longer-term follow-up of the effects of the treatments.

Background The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial. Methods This study is a single-center, randomized double-blind controlled trial, preceded by a case series. All the 232 planned patients of the case series will undergo an up-to-date comprehensive rehabilitation program, including focused extracorporeal shock waves therapy. This rehabilitation program is expected to have a maximum success rate 75%. It is therefore aimed to allocate a minimum of 58 patients with rehabilitation failure into the 1:1 randomized trial. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo an ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (control group). The primary endpoint will be the pain improvement from baseline (month 0) at 3 months on a 0–10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The main secondary endpoints will include the rehabilitation success rate and improvements from baseline at 3, 6, and 12 months of the following outcomes: (i) Single Assessment Numeric Evaluation (SANE) score, (ii) Patient-Rated Tennis Elbow Evaluation (PRTEE) score, (iii) maximal grip strength on Jamar test, and (iv) the ultrasonographic evaluation of the US of the epicondylar tendons. Discussion The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol. Trial registration ClinicalTrials.gov NCT03987256. Registered on 20 August 2019.

Aim: To assess the ultrasound features in patients with plantar fasciopathy before and after extracorporeal shock waves therapy (ESWT), using conventional grey-scale imaging and both strain (SE) and shear wave (SWE) elastosonographic evaluation.Material and method: Consecutive patients of both sexes attending our outpatient’s clinic, with diagnosis of unilateral plantar fasciopathy, were enrolled. Patients were treated with 3 sessions of ESWT once a week, and underwent clinical and ultrasound evaluation at baseline and at one and three months after treatment. Roles and Maudsley score (RM), visual analog scale (VAS) and 17-Italian Foot Function Index (FFI), were used to assess pain and functional improvement.Results: Twenty patients (11 female and 9 male) were enrolled in the study. Contralateral asymptomatic healthy plantar fascia was used as a control. At baseline, SWE velocity (SWEv) showed statistically significant difference between affected 3.8 (1.5; 5.1) m/s and healthy side 4.7 (4.07; 7.04) m/s, (p=0.006); no significant difference was found for strain ratio values (p=0.656). SWEv post hoc test results showed a significant difference from baseline 3.8 (1.5-5.1) m/s and three month 5.23 (4.55-6.74) m/s follow up visit (p=0.003). Significant statistical negative correlation was found between the SWEv and VAS (p=0.001) and positive correlation between the SWEv and FFI (p=0.012).Conclusion: SWE was effective in assessing plantar fascia elasticity and its alteration in fasciopathy. Furthermore, on the basis of the correlation with pain and functional scales, this technique appears to be a useful additional technique to conventional ultrasound for monitoring the efficacy of treatment

Background: Roughly focused extracorporeal shock waves therapy (ESWT) is characterized by a wide focal area, a large therapy zone, easy positioning, and less pain during treatment. The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin (OPG) and bone morphogenetic protein-2 (BMP-2) in osteoporotic fractures in rats. Methods: Seventy-two female Sprague-Dawley (SD) rats, 3 months old, were divided into sham-operated group (n = 6) and an ovariectomized (OVX) group (n = 66). Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation. The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm2, 60 doses/min, and 2000 pact quantities. The contralateral right tibia was left untreated and served as a control. Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blotting analysis. Results: Bone mineral density (BMD) at the proximal tibia, femur, and L5 spine was significantly reduced after ovariectomy. BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group. Meanwhile, bilateral oophorectomy resulted in a lower trabecular bone volume fraction (BV/TV) in the proximal tibia of the sham-OVX animals. Three months after bilateral oophorectomy, BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs (P < 0.001). These data showed that the SD rats became a suitable model of osteoporosis, 3 months after they were OVX. Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group. Compared with the contralateral controls, decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT, followed by a later increase at 7 days, was indicated by real-time PCR and Western blotting analysis. The OPG messenger RNA (mRNA) expression levels peaked at 6 weeks after the shock wave treatment, paired with a much earlier (at 4 weeks) increase of BMP-2, and declined close to normal at 8 weeks. Conclusions: Roughly focused ESWT may promote the expression of OPG and BMP-2 in the osteoporotic fracture area in rats. BMP-2 and OPG may act synergistically and may lead to a significant enhancement of bone formation and remodeling.

[Resumen] Objetivo. Realizar un análisis de la evidencia científica existente sobre la eficacia de la terapia por ondas de choque extracorpóreas en el tratamiento de la fascitis plantar. Material y método. Para la elaboración de la presente revisión bibliográfica se ha realizado una búsqueda de la literatura científica publicada en las bases de datos PubMed, Scopus, PEDro, CINAHL, SportDiscus y Cochrane, entre los meses de febrero y mayo del año 2016. La selección de los artículos se ha realizado en base al objetivo del trabajo, siendo acotados los resultados únicamente a ensayos clínicos. Asimismo, se han limitado según el año de publicación, desde el año 2011 hasta la actualidad, y conforme al idioma, descartando aquellos redactados en otro lenguaje que no fuese inglés, español o portugués. Resultados. Tras la aplicación de los criterios de inclusión y exclusión se han seleccionado un total de 20 estudios, de los cuales 10 son ensayos clínicos controlados aleatorizados, 8 ensayos clínicos, 1 ensayo clínico controlado no aleatorizado y 1 ensayo clínico aleatorizado no controlado. Su investigación se ha realizado atendiendo al tipo de estudio, objetivo, tamaño muestral, parámetros utilizados a la hora de aplicar las ondas de choque, metodología, sistema de medición de los resultados y resultados obtenidos. La ESWT en el tratamiento de la FP crónica muestra mejoría en cuanto a los resultados de las escalas EVA, RMS y AOFAS, así como una reducción del engrosamiento de la fascia plantar. Los mejores resultados se obtuvieron al combinar la aplicación de las ondas de choque con un estiramiento específico de la fascia plantar y del tríceps sural. Conclusión. Existe evidencia científica significativa sobre la eficacia de la terapia por ondas de choque extracorpóreas en el tratamiento de la fascitis plantar crónica. Se han registrado resultados satisfactorios a corto, medio y largo plazo en cuanto a reducción de dolor, mejora de la funcionalidad y reducción del engrosamiento de la fascia plantar. Su empleo en esta patología parece ser efectivo. [Abstract] Objective. Make an analysis of existing scientific evidence about the efficacy of extracorporeal shock waves therapy in fasciitis plantar treatment. Methods. For preparing this bibliographic review it has been performed a search of the scientific literature published in PubMed, Scopus, PEDro, CINAHL, SportDiscus y Cochrane, between February and May of 2016. The selection of the articles was made based on the objective of the work, limiting results to only clinical trials. Likewise, it has been limited by year of publication, from 2011 until now, and related to language, dismissing those written in a language different from English, Spanish or Portuguese Outcomes. After application of exclusion and inclusion criteria there has been selected a total of 20 studies of which 10 are randomized controlled clinical trials, 8 clinical trials, 1 not randomized controlled clinical trial and 1 randomized uncontrolled clinical trial. Its analysis was performed focusing in the study type, objective, sample size, shock waves configuration parameters, methodology, measuring system and obtained results. ESWT in chronic FP treatment show improvement in the results of VAS, RMS, and AOFAS scales, as well as a reduction in the thickening of the plantar fascia. The best results were obtained by combining shock waves therapy with a specific stretch of the plantar fascia and sural triceps. Conclusions. There is significative scientific evidence about the efficacy of extracorporeal shockwave therapy in chronical fasciitis plantar treatment. There have been successful results at short, middle and long term as to pain reduction, better functionality and reduction in the thickening of the plantar fascia. Its use in this pathology seems effective Traballo fin de grao (UDC.FCS). Fisioterapia. Curso 2015/2016.