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Hi, I am thinking of buying an ultrasound therapy unit to use in my practice. I keep reading conflicting data regarding the uses of 1mhz and 3mhz. I wondered if anyone has good expeience is the use of both. IdeallyI need some general rules eg- which for plantar fasciitis or which for deep and which for superficial. Hopefully someone can give me some advice based on experience rather than 6 weeks worth of research :) . Thanks.
Before you shell out for this piece of equipment speak to your local Physio dept on the benefits of Ultrasound to t/t soft tissue inflammation.
I think you will find that they will persuade you of the merits of not buying one and its loss of favour as a modality of t/t for soft tissue inflammation.
I stand to be corrected on this, but wasn't there an RCT many years ago on ultrasound in PF and for half the machine was turned off and there was no difference between the groups.
Despite being called "fasciitis", it is NOT an inflammatory process .... its degenerative process and should be called "fasciosis".
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
For what it's worth I have toiled for several years trying to treat this condition with modalities, primarily Ultrasound, to little avail. I would not recommend pruchasing one to help patients. The reimbursement for ultrasound treatment is also very poor as a FYI.
If I could bring one thing up regarding this condition - I am a bit tired of having patients arrive for outpatient therapy and report they are doing their plantar fascia stretches as the doctor told them. I ask them to demonstrate and they are nothing more than a gastrocnemius muscle belly stretch (runner's standing stretch) and a soleus stretch (same technqiue with knee bent). What is so difficult about stretching the plantar fascia through some dorsiflexion and forefoot rotation?
I think the evidence is very clear on plantar fasical stretching:
DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.
J Bone Joint Surg Am. 2003 Jul;85-A(7):1270-7.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
My question was not one of exercise validity but one of clinical practice as I do not see plantar fascia specific stretching being prescribed. Perhaps it is a US problem.
I was going to recommend the paper Craig noted...but scrolled down the thread and he's already posted it. There definitely was an improvement in VAS scales compared to muscle stretches.
I stand to be corrected on this, but wasn't there an RCT many years ago on ultrasound in PF and for half the machine was turned off and there was no difference between the groups.
Despite being called "fasciitis", it is NOT an inflammatory process .... its degenerative process and should be called "fasciosis".
Hi Craig, I know I'm a little late with this thread... but I was really interested in your description of plantar fasciitis as a degenerative process rather than an inflammatory one. I understand that the fascia itself may undergo degenerative changes as a longterm result of the condition, but isn't an ongoing inflammatory response generated in the tissues by the constant microtrauma at the site of the fascial insertion to the calcaneal tubercle? And isn't the reason behind "first step" pain in the mornings a result of the overnight inflammatory response and pooling of fluids in the tissue spaces? I know this is what I was taught in my training, and the inflammation in the local tissues can be seen and palpated on feet in the clinical setting.
Would like to hear more on your thoughts about this.
The authors review histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis. Findings include myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. Histologic findings are presented to support the thesis that "plantar fasciitis" is a degenerative fasciosis without inflammation, not a fasciitis. These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture. (J Am Podiatr Med Assoc 93(3): 234-237, 2003)
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Here at La Trobe, Dr Jill Cook has done extensive research into achilles and patellar tendinopathy which suggests that overuse syndromes of tendons are not inflammatory (see Time to abandon the tendonitis myth BMJ editorial). One of the current theories is that a degenerative process involving formation of new blood vessels (neovascularisation) may be responsible for the pain (ref). A similar process may be taking place within the plantar fascia.
Ultrasound therapy for plantar fasciitis
I know this is what I was taught in my training, and the inflammation in the local tissues can be seen and palpated on feet in the clinical setting. 
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