INTRODUCTION: Plantar fasciitis is one of the most common causes of under-surface
heel pain, with a lifetime prevalence of 10%.It is a condition that
is caused by biomechanical overuse resulting in degenerative changes at its
attachment to the calcaneus It most commonly affects people aged 40–60
years and affects both sedentary and active populations.
The plantar fascia is comprised of 3 bands of dense, fibrous
connective tissue on the plantar aspect of the foot. It is a tendinous
aponeurosis or sheet of connective tissue that incorporates the muscles on the
sole of the foot .The bands originate in the medial tubercle of
the calcaneus and terminate at the base of the proximal phalanges. These 3
bands (medial, central, and lateral) are the main parts of the longitudinal
arch, connecting the 3 points of weight-bearing in the foot.
The pathogenesis of plantar fasciitis is like
tendinosis. When there is an overload or excessive strain on the plantar facia,
this produces microtears, activating the inflammatory response. Since the
traumas are repeated at each step, inflammation becomes chronic, and
degenerative changes occur in the plantar fascia, especially in the collagen
fiber.
Risk factors for developing plantar fasciitis can be intrinsic or
extrinsic. Intrinsic factors include age, gender, body weight, heel spurs,
nerve entrapment, systemic disease, biomechanical dysfunction, and genetics.
Extrinsic factors include footwear, sport, lifestyle, foot/ankle/leg
deformities, and occupation. Diagnosis for plantar fasciitis is
clinical and patients typically present with ‘start-up pain’, sharp pain at the
plantar medial aspect of the heel on first walking in the morning and after a period
of rest that gets better after walking for a while. Pain
usually worsens at the end of the day and also with impact sports and
activities. Tenderness on examination is located
at the plantar aspect of the medial calcaneal tuberosity.
This condition usually has a significant impact on a patient’s quality of life during
the time of their symptoms, and although the majority of cases settle over a
period of six to twelve months, at least 10–20 % of patients have ongoing
symptoms that limit them beyond the one year.
A wide variety of conservative therapies can be used to treat
patients with plantar fasciitis. Conservative therapies include rest or
activity modification, stretches, tension night splints, taping, orthotics
proper footwear, footwear inserts such as heel cups or arch supports, and oral
anti-inflammatory agents, it also includes modalities such as shockwave
therapy, ultrasound, and laser therapy.
Extracorporeal shockwave therapy (ESWT) might have a role in
treating patients with chronic plantar fasciitis before consideration of more
invasive procedures. ESWT is the use of inaudible, high-energy sound waves
generated from an external machine placed on the skin that passes through
tissue layers and is thought to promote a healing response.
ESWT has been used in a range
of musculoskeletal disorders, including chronic tendinopathies, and some
evidence of benefit has been shown in patients with chronic plantar fasciitis.
In ESWT, electrohydraulic, piezoelectrical, and electromagnetic
processes produce shock waves. This may disrupt sensory non-myelinated nerve
fibers and induce neovascularization and production of collagen in degenerative
tissues Due to its non-invasive nature,
rapid recovery, and comfort for patients’ daily lives, extracorporeal shock
wave therapy (ESWT) has been commonly used as an alternative treatment choice
for PF for decades.
As treatment options for Plantar Fascitis, both centered shock wave
(FSW) and radial shock wave (RSW) treatments have recently been introduced. RSW
spread from the applicator is
not tissue-focused relative to FSW. (i) The radial technique can be
used to treat the painful region instead of a point, and the advantage of RSW
therapy is the ended treatment area, although there is evidence showcasing the usefulness of focused shockwave therapy for
treatment of plantar fasciitis too.
Matrix Rhythm Therapy (MRT) is the latest advancement in
physiotherapy which uses the basic concept of vibration and massage. MRT was
founded by Dr. Ulrich G. Randoll. It is directly derived from the clinical and
fundamental video microscopic research of Erlangen University ithe n 1990s.
MRT is a cell biological therapy that activates and rebalances
special physiological vibrations of skeletal muscles and the nervous system.
During any disease or derailment, energy metabolism is deficient at the
cellular level and it must be normalized before any adequate therapy.
MRT reactivates the cell metabolism and normalizes the physiological process by
depth-effective rhythmical phase synchronous magneto-mechanical oscillations.
MRT is modulated between 8-12 Hz of frequency. In this process of oscillation
and vibration, cells are stimulated and entire re tissue is rhythmically resynchronized.The
contracted areas of musculature will be inductively relaxed by increased
circulation which increases oxygenated blood followed by ATP synthesis and
dissolution of the tension. The immediate effect can be seen as relaxation of
tissue, muscle and fascia. This relaxation remains longer and maintained as the
metabolic process at the cellular level are regulated and oxygen supply to
cells is improved.
This therapy is simple and carries no side effects. Therapy is
administered via an electrically powered oscillator (resonator) with an
asymmetric treatment head (cam-type) which produces the mechanical oscillations
that are generated by magnetic sinusoidal phase-synchronized field, and these
oscillations are then supplied by the treatment head to the affected area.
In summary, this study aims to
contribute valuable insights to the field of musculoskeletal medicine by
evaluating and comparing Extracorporeal Shock Wave Therapy and Matrix Rhythm
Therapy in the context of plantar fasciitis treatment. The results of this
research endeavor will potentially inform healthcare practitioners and patients
alike, guiding them toward the most appropriate and effective treatment choice
for this debilitating condition.
NEED FOR STUDY:
There are various
treatment options available for plantar fasciitis, including physical therapy,
orthotics, corticosteroid injections, and surgical interventions. Shockwave
therapy and matrix rhythm therapy are two emerging non-invasive treatments in
the field of physiotherapy.While both shockwave therapy and matrix rhythm
therapy have been used to treat plantar fasciitis, there is lacunae of
well-designed, comparative studies that directly compare these therapies in
terms of pain reduction, range of motion and functional recovery in individuals
with this condition.
A comparative study
can provide robust evidence to inform healthcare professionals, leading to more
informed and effective treatment choices.The findings of the study can empower
patients by providing them with information about the relative benefits and
risks of different treatment options, allowing them to make more informed
decisions about their care. |