Comparative Effectiveness of Radial Extracorporeal Shockwave Therapy and Ultrasound-Guided Local Corticosteroid Injection Treatment for Plantar Fasciitis.

BACKGROUND: We compared the long-term clinical and ultrasonographic effects of radial extracorporeal shockwave therapy (rESWT) versus ultrasound-guided corticosteroid injection treatment in patients with plantar fasciitis unresponsive to conservative therapy. METHODS: Seventy-two patients with unilateral plantar fasciitis were randomized to receive either rESWT (three times once per week) (n = 36) or corticosteroid treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n = 36). The primary outcome measures were visual analog scale (VAS) and Foot Function Index (FFI) scores. Secondary outcome measures included the heel tenderness index (HTI) score and plantar fascia thickness (PFT) as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment. RESULTS: Significant improvements were observed in the rESWT group in VAS, HTI, and FFI scores and PFT at the end of treatment and were maintained during follow-up. Posttreatment improvements in VAS, HTI, and FFI scores and PFT were also seen in the corticosteroid group but were not maintained for VAS and FFI scores after the completion of therapy and were lost at 1 and 6 months, respectively. No serious treatment-related complications occurred. CONCLUSIONS: Both rESWT and corticosteroid injection therapy are effective modalities for treatment of chronic plantar fasciitis. However, rESWT seems to be superior to corticosteroid injection therapy due to its longer duration of action.

The reliability of the clinical examination for detecting Baker's cyst in asymptomatic fossa.

OBJECTIVE: To compare physical examination and ultrasonographic (US) examination for detecting Baker's cyst (BC) in asymptomatic popliteal fossa. METHODS: Popliteal fossa was examined in a total of 220 knees in 110 patients with knee pain/osteoarthritis (OA) and non-OA individuals. Clinical examination was performed by two independent physicians and US examination was performed by a third blinded physician. RESULTS: Examiner A found 25 BC, examiner B found 30 BC in 220 knees examined (κ = 0.35; 95% CI; 0.14-0.56) and inter-observer reliability was moderate. When US examination taken as the reference, receiver operating characteristic analysis revealed an area under the curve of 0.58 (95% CI; 0.51-0.65) for examiner A and 0.57 (95% CI; 0.50-0.64) for examiner B, showing a weak agreement between physical examination and US assessment. CONCLUSION: This study demonstrates that many patients may have BCs without any symptoms at the popliteal fossa and clinical examination of the popliteal fossa could not accurately detect BC. US examination of the popliteal fossa should be performed to detect BCs and this may recover the diagnosis.