OBJECTIVE: To investigate the effect of acetic acid shockwave phonophoresis on spur morphology, foot pain, and function in patients with calcaneal spurs.
DESIGN: A double-blinded, randomised clinical trial.
SETTING: Outpatients physical therapy clinics.
PARTICIPANTS: One hundred forty-seven patients with calcaneal spurs, 18-65 years old, were randomly allocated to three equal groups.
INTERVENTION: The study group (A) received acetic acid shockwave phonophoresis plus conventional physical therapy. The study group (B) received shockwave therapy plus conventional physical therapy. The control group received conventional physical therapy programme only. Interventions were applied twice a week for 3 weeks.
OUTCOME MEASURES: Calcaneal spur width, calcaneal spur length, pain intensity level, pain pressure threshold and foot and ankle ability measure activities of daily living subscale were measured at baseline, after 3 weeks of interventions and after 4 weeks of follow-up with no intervention.
RESULTS: Between-group differences were observed for calcaneal spur width and length, pain intensity, pain pressure threshold and function after 3 weeks favouring Group A (p < 0.001). Mean differences (95% CI) between study groups were -1.11 mm (-1.46, -0.77) for spur width; -1.34 mm (-1.67, -1.01) for spur length; -20.71 mm (-24.66, -16.77) for pain; 1.45 kg/cm2 (1.05, 1.85) for pain pressure threshold; and 12.16 points (9.24, 15.09) for function after 3 weeks.
CONCLUSIONS: Acetic acid shockwave phonophoresis combined with exercise clinically and statistically improves calcaneal spur width, length, pain intensity, pain pressure threshold and foot function more than shockwave therapy alone or conventional physical therapy. This method might be considered an effective, feasible, safe, non-invasive and locally applicable treatment for heel spurs.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
Rehab Clinician (OT/PT) rater
The study results provide favorable outcomes for acetic acid extracorporeal shock wave phonophoresis for heel spur treatment compared to shock wave or conventional physical therapy alone. Although the study was well designed, caution is required not only because of short term follow up, as reported by the authors, but also another important limitation that needs consideration is that all study groups were treated by one clinician i.e., the primary author. Generalizability has not been shown and multi-clinic long term trials are warranted.
Rehab Clinician (OT/PT) rater
"Unfortunately, the minimal clinically important differences in spur length and width have not been reported." ... stated by the authors. The gold standard to Roentgen stereophotogrammetric analysis would be an appropriate means of recording measurement difference. There appears no statement in this article regarding the determination and establishment of measurement error. Thus, an unknown component of measurement contains an error that raises concerns around the validity of the measurements and the clinical validity of the reported findings.
Rehab Clinician (OT/PT) rater
This is an interesting study with results that suggest positive effects in a number of domains from using acetic acid shockwave phonophoresis on heel spurs. As an orthopaedic and sports physiotherapist, this will assist me in educating clients, colleagues, and referral sources on potential treatments for symptomatology suspected to stem from calcaneal osteophytes.
, McMaster University