Materials and Methods

• Group II Placebo treatment: sham treatment using a sound reflecting pad, energy flux density 0.16 mJ/mm2, 2100 impulses, three times at weekly intervals.

Inclusion Criteria

For the current study, chronic heel pain was defined as symptoms of moderate to severe heel pain in the involved foot at the origin of the proximal plantar fascia on the medial cal-caneal tuberosity (Fig. 5.1).

The pain had to have persisted for at least 12 months before enrolling in the study, in patients covering a running distance of at least 30 miles per week before symptoms occurred. All patients had failed to respond to at least three attempts at conservative treatment, including at least two prior courses of intervention with physical therapy, the use of orthotics, and at least one prior course of pharmacological treatment, over a period of more than 6 months.

Exclusion Criteria

Exclusion criteria were: dysfunction in the knee or ankle, local arthritis, generalized polyarthritis, rheumatoid arthritis, ankylosing spondylitis, Reiter syndrome, neurological abnormalities, nerve entrapment syndrome, history of previous plantar fascial surgery, age under 18 years, pregnancy, infections (Fig. 5.2) or tumors, history of spontaneous or steroid-induced rupture of the plantar fascia, bilateral heel pain, participation in a workman's compensation program, receiving systemic thera

Fig. 5.2 Infection at the insertion of the plantar fascia after repeated corticosteroid injections (a Bone scintigraphy; b MRI).

Fig. 5.2 Infection at the insertion of the plantar fascia after repeated corticosteroid injections (a Bone scintigraphy; b MRI).

peutic anticoagulants, and receiving nonsteroidal antiinflammatory drugs (NSAIDs) for any chronic conditions.

Group I

Group I, receiving a total of 6300 impulses of an energy flux density of 0.16 mJ/mm2, consisted of 10 women and 12 men, with a mean age of 50 years and a mean duration of pain of 20 months.

Fig. 5.1 Radiologically proven heel spur.

Group II

Group II, receiving sham treatment, consisted of 13 women, and 10 men, with a mean age of 50 years and a mean duration of pain of 18 months.

Fig. 5.1 Radiologically proven heel spur.

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