Ultrasonographic Evaluation of Low Energy Extracorporeal Pulse Activated Therapy (EPAT) for Chronic Plantar Fasciitis
Background: Ultrasonographic measurement of the plantar fascia can be used to objectively diagnose plantar fasciitis. The purpose of this study was to determine the long-term effectiveness of Extracorporeal Pulse Activated Therapy (EPAT) for the treatment of plantar fasciitis using ultrasonographic measurement as an objective outcome measure, with a minimum followup of 12 months. Methods: Patients with chronic recalcitrant plantar fasciitis were prospectively recruited and underwent EPAT. Ultrasound measurement of the plantar fascia and patient-rated pain scores were collected before treatment and at followup (minimum of 12 months post-treatment). Twenty-five subjects (35 feet) met the inclusion criteria. The average followup time was 29.4 ± 13.1 (M ± SD; range, 12 to 54) months. Results: The average thickness of the plantar fascia of the symptomatic heels was 7.3 ± 2.0 mm before treatment and 6.0 ± 1.3 mm after treatment ( p < 0.001). The average change in thickness of the treated heels was −1.3 mm (−0.8 to −1.8 mm; 95% CI, p < 0.0001). No correlation was found between length of followup and change in ultrasound measured plantar fascia thickness ( r = −0.04, p = 0.818). Conclusion: For patients with a greater than 12-month history of heel pain, EPAT can effectively decrease plantar fascia thickness as demonstrated objectively by ultrasound evaluation and reduce patient-reported pain. No relationship between length of followup and change in plantar fascia thickness was found after 12 months. Level of Evidence: IV; Case Series