New non-invasive therapy for refractory plantar fasciitis

It affects 10 percent of the population

Plantar fasciitis (PF) is the most common cause of heel pain , affecting 10 percent of the population. Although its etiology is not clear, the logical degeneration with age and a sport or postural abuse would explain the painful symptoms. The presence of perifascial hypoechoic lesions, observed with ultrasound, is more frequent in patients with heel pain. The most common symptoms of plantar fasciitis are pain with the first steps of the morning, when starting an intense activity and at the end of the day. Diagnosis by imaging may be necessary in case of atypical symptoms or refractory to treatment. The ultrasound quantifies the thickness of the plantar fascia and evaluates any perifascial lesion or edema. Several studies have shown that those affected have a thicker fascia (usually> 4.0 mm).

In addition to inflammation, hypoechoic lesions are seen in nearly 70 percent of patients with PF. Diagnostic ultrasound is also used to evaluate the effectiveness of treatments such as extracorporeal shock wave therapy, NSAIDs and Botox injections. The combination of rest, ice, stretching and anti-inflammatory is the initial treatment in most patients and has been proven effective in 90 percent of cases in less than two months. However, 10 percent failin conservative management and continue with symptoms beyond 12 months (refractory plantar fasciitis). Surgery -the partial release of the plantar fascia or the gastrocnemius muscle- is an option in these patients, although it is not always resolutive.

An invisible scalpel
One of the recent innovations to address refractory plantar fasciitis is the intense ultrasound therapy that the American company Guided Therapy Systems has brought to Spain and Europe in the hands of Ardent Sound through the Actisound device. It acts like an invisible scalpel , accurately administering small thermal ablations in tendons, ligaments and other soft tissues to stimulate the growth of collagen and the regeneration of connective tissue.

Unlike other energy sources such as lasers, microwaves and radiofrequency, high intensity ultrasound is the only one that can penetrate safely through the intermediate tissue and focus at a specific point and form within the body. This allows to administer direct treatments to depths of 15 mm and without surgery . The small thermal ablations initiate the healing process, restarting and improving the production of growth tissue. “The physiopathological mechanism of the device is equivalent to the traditional forms of tendon surgery,” says Juan Antonio Corbalán, a specialist in Physical Education and Sports Medicine, after having tried this therapy. It can be applied in consultation by orthopedic surgeons, sports medicine doctors, rehabilitation doctors, rheumatologists, primary care physicians or podiatrists.

In refractory cases, anti-inflammatories or steroid injections only temporarily reduce pain, without addressing the underlying lesion. And procedures such as shock waves, tenotomy or PRP can be painful and expensive. Designed to focus on musculoskeletal injuries and the transdermal and non-invasive administration of medications, the Actisound system provides a no-hassle solution in less than 10 minutes, reducing pain and inflammation in approximately 48-72 hours and repairing soft tissues in 4-12 weeks. Three multicentre clinical trials have shown that more than 80 percent of chronic patients (with an average duration of persistent pain of 15.7 months) could benefit from a significant reduction in pain combined with greater functionality and mobility, compared with traditional methods. In Spain, Luis Fernández, from the Clínica Cemtro, in Madrid, is going to start a trial to extend the indication to the patellar tendon .