Perhaps this might persuade?
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Electrohydraulic high-energy shock-wave treatment for chronic plantar
fasciitis.
Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME.
Skeletal Educational Association, 3435 Habersham Road N.W., Atlanta, GA
30305. [log in to unmask]
BACKGROUND: Plantar fasciitis is a common foot disorder that may be
resistant to nonoperative treatment. This study evaluated the use of
electrohydraulic high-energy shock waves in patients who failed to respond
to a minimum of six months of antecedent nonoperative treatment.
METHODS: A randomized, placebo-controlled, multiply blinded, crossover
study was conducted. Phase 1 consisted of twenty patients who were
nonrandomized to treatment with extracorporeal shock waves to assess the
phase-2 study protocol. In phase 2, 293 patients were randomized and an
additional seventy-one patients were nonrandomized. Following ankle-block
anesthesia, each patient received 100 graded shocks starting at 0.12 to
0.22 mJ/mm(2), followed by 1400 shocks at 0.22 mJ/mm(2) with use of a high-
energy electrohydraulic shock-wave device. Patients in the placebo group
received minimal subcutaneous anesthetic injections and nontransmitted
shock waves by the same protocol. Three months later, patients were given
the opportunity to continue without further treatment or have an additional
treatment. This allowed a patient in the active treatment arm to receive a
second treatment and a patient who received the placebo to cross over to
the active treatment arm. Patients were followed at least one year after
the final treatment.
RESULTS: Treatment was successful in seventeen of the twenty phase-1
patients at three months. This improved to nineteen (95%) of twenty
patients at one year and was maintained at five years. In phase 2, three
months after treatment, sixty-seven (47%) of the 144 actively treated
patients had a completely successful result compared with forty-two (30%)
of the 141 placebo-treated patients (p = 0.008). At one year, sixty-five of
the sixty-seven actively treated, randomized patients maintained a
successful result. Thirty-six (71%) of the remaining fifty-one
nonrandomized patients had a successful result at three months. For all 289
patients who had one or more actual treatments, 222 (76.8%) had a good or
excellent result. No patient was made worse by the procedure.
CONCLUSIONS: The application of electrohydraulic high-energy shock waves to
the heel is a safe and effective noninvasive method to treat chronic
plantar fasciitis, lasting up to and beyond one year.
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