Radial extracorporeal shockwave therapy on calcaneal spurs: a randomized controlled trial
Abstract
BACKGROUND The effectiveness of extracorporeal shockwave therapy (ESWT) in handling pain and calcaneal spurs is still controversial, whereas research on the effectiveness of ESWT in the reactive ossification process of calcaneal spurs, involving osteoprotegerin (OPG) and the receptor activator of nuclear factor-kappa B (RANK), does not exist. This study was aimed to assess the effect of ESWT on pain, the length of the spur, plasma OPG and RANK level on the calcaneal spur.
METHODS This study was a randomized controlled trial in patients with calcaneal spurs. ESWT was administered at the pain point by applying 2,000 shocks, at an intensity of 2 bars, given six times with a 7â–10-day interval. The visual analog scale (VAS) data, plasma OPG and RANK level were analyzed using Mann–Whitney U test, whereas spur size was analyzed using chi-square test.
RESULTS One month after therapy at rest (p < 0.001) and when walking after getting up (p = 0.020), the VAS was lower than that in the control group. The plasma OPG level was lower than control group shortly after therapy (p < 0.001). The plasma RANK level was higher than control group shortly after therapy (p < 0.001). ESWT did not affect the reduction of spur measurement (p = 0.382).
CONCLUSIONS ESWT reduced pain, decreased plasma OPG level, and increased plasma RANK level. Although ESWT did not have any effect on spur reduction, it affected plasma OPG and RANK level that play a role in the activity of osteoblasts and osteoclasts.
References
Menz HB, Zammit GV, Landorf KB, Munteanu SE. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? J Foot Ankle Res. 2008;1(1):7. https://doi.org/10.1186/1757-1146-1-7
Kullar JS, Randhawa GK, Kullar KK. A study of calcaneal enthesophytes (spurs) in Indian population. Int J Appl Basic Med Res. 2014;4(Suppl 1):S13-6. https://doi.org/10.4103/2229-516X.140709
Cailliet R. Soft tissue pain and disability. 2nd ed. Philadelphia: F.A. Davis Co; 1988. p. 307-65.
Rogers J, Shepstone L, Dieppe P. Bone formers: osteophyte and enthesophyte formation are positively associated. Ann Rheum Dis. 1997;56(2):85-90. https://doi.org/10.1136/ard.56.2.85
Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl):S1-19. https://doi.org/10.1053/j.jfas.2010.01.001
Toumi H, Davies R, Mazor M, Coursier R, Best TM, Jennane R, et al. Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic. BMC Musculoskelet Disord. 2014;15:87. https://doi.org/10.1186/1471-2474-15-87
Lacey DL, Timms E, Tan HL, Kelley MJ, Dunstan CR, Burgess T, et al. Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell. 1998;93(2):165-76. https://doi.org/10.1016/S0092-8674(00)81569-X
Bezerra MC, Carvalho JF, Prokopowitsch AS, Pereira RM. RANK, RANKL and osteoprotegerin in arthritic bone loss. Braz J Med Biol Res. 2005;38(2):161-70. https://doi.org/10.1590/S0100-879X2005000200004
Kohli SS, Kohli VS. Role of RANKL-RANK/osteoprotegerin molecular complex in bone remodeling and its immunopathologic implications. Indian J Endocrinol Metab. 2011;15(3):175-81. https://doi.org/10.4103/2230-8210.83401
Stuber K, Kristmanson K. Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials. J Can Chiropr Assoc. 2006;50(2):118-33.
Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46(5):348-57. https://doi.org/10.1053/j.jfas.2007.05.011
Gautham P, Nuhmani S, Kachanathu SJ. Plantar fasciitis: a review of literature. Saudi J Sports Med. 2014:14(2):69-73. https://doi.org/10.4103/1319-6308.142347
Cosentino R, Falsetti P, Manca S, De Stefano R, Frati E, Frediani B, et al. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis. Ann Rheum Dis. 2001;60(11):1064-7. https://doi.org/10.1136/ard.60.11.1064
Kumar P, Tripathi L. Challenges in pain assessment: pain intensity scales. Indian J Pain. 2014;28:61-70. https://doi.org/10.4103/0970-5333.132841
Weil LS Jr, Roukis TS, Weil LS, Borelli AH. Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and comparison of results to fasciotomy. J Foot Ankle Surg. 2002;41(3):166-72. https://doi.org/10.1016/S1067-2516(02)80066-7
Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288(11):1364-72. https://doi.org/10.1001/jama.288.11.1364
Thomson CE, Crawford F, Murray GD. The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2005;6:19. https://doi.org/10.1186/1471-2474-6-19
Malay DS, Pressman MM, Assili A, Kline JT, York S, Buren B, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg. 2006;45(4);196-210. https://doi.org/10.1053/j.jfas.2006.04.007
Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015;97(9):701-8. https://doi.org/10.2106/JBJS.M.01331
Dreisilker U. Significance of ESWT in practice. In: Dreisilker U. Shock wave therapy in practice. Enthesiopathies. Heilbronn: Leveho Buchverlag Daniela Bamberg; 2010. p. 16-20.
Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012;2(1):33-7.
Dreisilker U. History: An overview. In: Dreisilker U. Shock wave therapy in practice. Enthesiopathies. Heilbronn: Leveho Buchverlag Daniela Bamberg; 2010. p. 21-7.
Huang HM, Li XL, Tu SQ, Chen XF, Lu CC, Jiang LH. Effects of roughly focused extracorporeal shock waves therapy on the expressions of bone protein-2 and osteoprotegerin in osteoporotic fracture in rats. Chin Med J. 2016;129(21):2567-75. https://doi.org/10.4103/0366-6999.192776
Notarnicola A, Tamma R, Moretti L, Fiore A, Vicenti G, Zallone A, et al. Effects of radial shock wave therapy on osteoblast activities. Musculoskelet Surg. 2012;96(3):183-9. https://doi.org/10.1007/s12306-012-0213-4
Draper DO, Prentice WE. Therapeutic ultrasound. In: Prentice WE. Therapeutic modalities in rehabilitation. Fourth edition. New York: The McGraw-Hill Companies, Inc; 2011. p. 363-416.
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