Plantar Fasciitis
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Buchbinder (May 20 issue)1 suggests consideration of surgery in chronic cases of plantar fasciitis. It is difficult to understand why the author does not consider extracorporeal shock-wave therapy advisable when dealing with this small subgroup of carefully selected patients with chronic plantar fasciitis. Several placebo-controlled trials have shown a benefit of extracorporeal shock-wave therapy (e.g., allowing immediate full weight bearing without splints), even in the long run,2,3 and virtually no complications. The potential benefit of extracorporeal shock-wave therapy in cases of chronic plantar fasciitis4,5 suggests that adequate regimens of such therapy should be given priority over surgery. There is a need for further research for extracorporeal shock-wave therapy and particularly for surgery.
Jan D. Rompe, M.D.
Johannes Gutenberg University School of Medicine
D-55131 Mainz, Germany
rompe@mail.uni-mainz.de
References
Buchbinder R. Plantar fasciitis. N Engl J Med 2004;350:2159-2166.
Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int 2004;25:290-297.
Rompe JD, Schoellner C, Nafe B. Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg Am 2002;84:335-341.
Speed CA. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. J Bone Joint Surg Br 2004;86:165-171.
Rompe JD, Buch M, Gerdesmeyer L, et al. Musculoskeletal shock wave therapy -- current database of clinical research. Z Orthop Ihre Grenzgeb 2002;140:267-274.
Dr. Buchbinder replies: In the absence of data from controlled trials confirming the benefits of surgery, I suggest in my article that surgery be carefully considered only after conservative therapy for a prolonged period has failed. In contrast, six published randomized, double-blind, placebo-controlled trials have evaluated extracorporeal shock-wave therapy and do not provide substantive support for its use in routine care.
Dr. Rompe refers to two trials to support the contention that extracorporeal shock-wave therapy has a long-term benefit.1,2 One of these trials showed favorable outcomes at six months and five years, although the participants were unblinded. Also, after 12 weeks, patients in both treatment groups who did not have a response to therapy could receive additional treatments (including corticosteroid infiltrations and surgery), which may have led to the confounding of any treatment effects.1
The second trial,2 previously described by Buch et al.,3 was also included in my review. Although a statistically significant difference, favoring the active group, in improvement in morning pain at 12 weeks was reported to be evidence of the efficacy of extracorporeal shock-wave therapy (the mean [±SD] score decreased from 7.7±1.4 to 3.4±2.8 in the active group and from 7.7±1.4 to 4.1±3.1 in the sham group on a 10-cm visual-analogue pain scale, P=0.04), the absolute difference of 0.7 between the groups is of questionable clinical importance. There were no differences between the groups in the other primary efficacy end point, the proportion of participants who had at least a 60 percent improvement in pain during the first minutes of walking in the morning at 12 weeks.
Rachelle Buchbinder, M.B., B.S.
Cabrini Hospital
Malvern, VIC 3144, Australia
rachelle.buchbinder@med.monash.edu.au
References
Rompe JD, Schoellner C, Nafe B. Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg Am 2002;84:335-341.
Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int 2004;25:290-297.
Buch M, Knorr U, Fleming L, et al. Extracorporeal shockwave therapy in symptomatic heel spurs: an overview. Orthpade 2002;31:637-44.
Jan D. Rompe, M.D.
Johannes Gutenberg University School of Medicine
D-55131 Mainz, Germany
rompe@mail.uni-mainz.de
References
Buchbinder R. Plantar fasciitis. N Engl J Med 2004;350:2159-2166.
Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int 2004;25:290-297.
Rompe JD, Schoellner C, Nafe B. Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg Am 2002;84:335-341.
Speed CA. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. J Bone Joint Surg Br 2004;86:165-171.
Rompe JD, Buch M, Gerdesmeyer L, et al. Musculoskeletal shock wave therapy -- current database of clinical research. Z Orthop Ihre Grenzgeb 2002;140:267-274.
Dr. Buchbinder replies: In the absence of data from controlled trials confirming the benefits of surgery, I suggest in my article that surgery be carefully considered only after conservative therapy for a prolonged period has failed. In contrast, six published randomized, double-blind, placebo-controlled trials have evaluated extracorporeal shock-wave therapy and do not provide substantive support for its use in routine care.
Dr. Rompe refers to two trials to support the contention that extracorporeal shock-wave therapy has a long-term benefit.1,2 One of these trials showed favorable outcomes at six months and five years, although the participants were unblinded. Also, after 12 weeks, patients in both treatment groups who did not have a response to therapy could receive additional treatments (including corticosteroid infiltrations and surgery), which may have led to the confounding of any treatment effects.1
The second trial,2 previously described by Buch et al.,3 was also included in my review. Although a statistically significant difference, favoring the active group, in improvement in morning pain at 12 weeks was reported to be evidence of the efficacy of extracorporeal shock-wave therapy (the mean [±SD] score decreased from 7.7±1.4 to 3.4±2.8 in the active group and from 7.7±1.4 to 4.1±3.1 in the sham group on a 10-cm visual-analogue pain scale, P=0.04), the absolute difference of 0.7 between the groups is of questionable clinical importance. There were no differences between the groups in the other primary efficacy end point, the proportion of participants who had at least a 60 percent improvement in pain during the first minutes of walking in the morning at 12 weeks.
Rachelle Buchbinder, M.B., B.S.
Cabrini Hospital
Malvern, VIC 3144, Australia
rachelle.buchbinder@med.monash.edu.au
References
Rompe JD, Schoellner C, Nafe B. Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg Am 2002;84:335-341.
Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int 2004;25:290-297.
Buch M, Knorr U, Fleming L, et al. Extracorporeal shockwave therapy in symptomatic heel spurs: an overview. Orthpade 2002;31:637-44.