Ultrasonographic evaluation of low energy extracorporeal pulse activated therapy (EPAT) for chronic plantar fasciitis

Foot Ankle Int. 2012 Mar;33(3):202-7. doi: 10.3113/FAI.2012.0202.


Background: Ultrasonographic measurement of the plantar fascia can be used to objectively diagnose plantar fasciitis. The purpose of this study was to determine the long-term effectiveness of Extracorporeal Pulse Activated Therapy (EPAT) for the treatment of plantar fasciitis using ultrasonographic measurement as an objective outcome measure, with a minimum followup of 12 months.

Methods: Patients with chronic recalcitrant plantar fasciitis were prospectively recruited and underwent EPAT. Ultrasound measurement of the plantar fascia and patient-rated pain scores were collected before treatment and at followup (minimum of 12 months post-treatment). Twenty-five subjects (35 feet) met the inclusion criteria. The average followup time was 29.4 +/- 13.1 (M +/- SD; range, 12 to 54) months.

Results: The average thickness of the plantar fascia of the symptomatic heels was 7.3 +/- 2.0 mm before treatment and 6.0 +/- 1.3 mm after treatment (p < 0.001). The average change in thickness of the treated heels was -1.3 mm (-0.8 to -1.8 mm; 95% CI, p < 0.0001). No correlation was found between length of followup and change in ultrasound measured plantar fascia thickness (r = -0.04, p = 0.818).

Conclusion: For patients with a greater than 12-month history of heel pain, EPAT can effectively decrease plantar fascia thickness as demonstrated objectively by ultrasound evaluation and reduce patient-reported pain. No relationship between length of followup and change in plantar fascia thickness was found after 12 months.

MeSH terms

  • Adult
  • Aged
  • Fasciitis, Plantar / diagnostic imaging*
  • Fasciitis, Plantar / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Prospective Studies
  • Ultrasonic Therapy / methods*
  • Ultrasonography