| 제목 |
Long-term outcome of Extracorporeal Shock Wave Therapy for Painful Plantar Fibromatosis |
| 소속 |
Kangbuk Samsung Medical Center, Department of Rehabilitation Medicine1 |
| 저자 |
Jin Tae Hwang1*, Kyung Jae Yoon1, Jong Geol Do1, Kun Woo Kim1, Jae Hyeoung Choi1, Yong Taek Lee1† |
Introduction
Plantar fibromatosis is uncommon proliferative disease in plantar fascia that is often associated with palmar and penile fibromatosis. Symptoms include the pain, tenderness and palpable lump in the foot sole, which can lead to walking disability. Previous studies have shown that extracorporeal shock wave therapy (ESWT), which is commonly used as an effective therapeutic option for chronic plantar fasciitis, can be also applied therapeutically to various forms of fibromatosis such as palmar and penile fibromatosis. The purpose of this study is to evaluate the long-term therapeutic effect of ESWT in plantar fibromatosis and to compare its result with plantar fasciitis.
Methods and Materials
Medical charts of 170 patients (198 feet) with plantar fibromatosis or plantar fasciitis confirmed by ultrasonography (US) were reviewed. Subsequently, total 84 feet (16 feet for plantar fibromatosis; 68 feet for plantar fasciitis) who underwent ESWT for lasting pain more than 3 months and “Poor” or “Fair” grade in Roles-Maudsley score (RMS) despite the conventional conservative treatment were included. A maximum of 12 sessions of ESWT (0.10-0.14 mJ/mm2; 900 shocks, weekly) was conducted until the RMS reached “Good” or “Excellent” grade.
Numeric rating sacle (NRS) and RMS were evaluated at short-term follow-up (one week after all ESWT sessions) and long-term follow-up (mean 35 months after ESWT). In plantar fibromatosis group, follow-up US was conducted at long-term follow up. A more than 50% reduction in the NRS and “good” or “excellent” in RMS were regarded as treatment success.
Results
Repeated measures ANOVA demonstrated that NRS and RMS point improved with time after ESWT up to long-term follow-up (time effect, p<.001). On the other hand, the group interaction was not significant, which means there was no significant difference of the therapeutic effect for pain reduction and functional improvement between two groups (p=0.828 for NRS; 0.923 for RMS). The success rate was 68.8% (11 feet) at short-term and long-term follow-up in the plantar fibromatosis group, and 63.2% (43 feet) at short-term follow-up and 75% (51 feet) at long-term follow-up in plantar fasciitis group. In long-term follow-up US, mean thickness of fibromas was significantly reduced from 4.1±1.2 mm to 2.8±1.2 mm while there was no significant change in mean length (12.9±4.7 mm; 12.7±4.7 mm) and width (8.9±4.0 mm; 8.4±3.4 mm).
Conclusion
Low-energy ESWT appears to have a long-term effect for subjective pain and performance in the plantar fibromatosis equivalent to plantar fasciitis. In terms of morphologic change of fibroma, long-term follow-up US showed no definite change except the reduction of thickness. |
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Fig 1. Flow chart of the study
Fig 2. Outcomes of subjective pain and function (NRS and RMS)
Fig 3. Morphologic change of fibroma (length, width and thickness)
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