The correlation between outcome of extracorporeal shock wave therapy and findings of MR images for chronic plantar fasciitis

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The correlation between outcome of extracorporeal shock wave therapy and findings of MR images for chronic plantar fasciitis Masahiro Maki 1), Kazuya Ikoma 1), Shuhei Morifusa 2), Masamitsu Kido 1),

1 The correlation between outcome of extracorporeal shock wave therapy and findings of MR images for chronic plantar fasciitis Masahiro Maki 1), Kazuya Ikoma 1), Shuhei Morifusa 2), Masamitsu Kido 1), Yusuke Hara 1), Toshikazu Kubo 1) 1) Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine. 2) Department of Orthopedics, Rakuwakai Marutamachi Hospital SINCE 1949

2 The correlation between outcome of extracorporeal shock wave therapy and findings of MR images for chronic plantar fasciitis Masahiro Maki, Kazuya Ikoma, Shuhei Morifusa, Masamitsu Kido, Yusuke Hara, Toshikazu Kubo Our disclosure is in the Final AOFAS Program Book. We have no potential conflicts with this presentation.

3 Background There are a few reports that investigated the ability to predict the therapeutic effect following extracorporeal shock wave therapy (ESWT) 2) from the MR image findings prior to ESWT. Our purpose To compare the MR image findings prior to ESWT and the therapeutic effect 6 months following ESWT, and investigate whether or not a therapeutic effect may be presumed from the MR image findings.

4 Patients and Methods > 46 patients 50 feet # All patients had not effective conservative therapy over three months. > Mean age: 55.3 y.o. (from 16 to 79 y.o.) > Mean duration of symptoms: 23.8 months (from 4 to 240 months) > Device for ESWT: Epos Ultra device (Dornier MedTech Japan, Inc.) # All patients recieved 3800 shocks (3500 shocks at 0.36 mj/mm 2 ) for a total of 1300 mj/mm 2.

>Clinical evaluation: Visual Analogue Scale (VAS) # Clinical success

1,3). >Radiological evaluation: MR images before ESWT # The

recovery (STIR) images in the sagittal plane.

5 >Clinical evaluation: Visual Analogue Scale (VAS) # Clinical success was defined as 50% improvement of VAS after a sixmonth follow-up 1,3). >Radiological evaluation: MR images before ESWT # The following findings were investigated on the short tau inversion recovery (STIR) images in the sagittal plane. 2,4) bone marrow edema thickened plantar fascia soft tissue edema intrasubstance increased signal intensity

6 Results MR image findings before ESWT and clinical success after ESWT Thickness of PF 5.1 ± 3.2 mm 4.5 ± 2.3 mm HSIA in the PF 36 feet 2 feet Edema in the vicinity of PF 41 feet 4 feet BME of the calcaneus 11 feet 2 feet PF, plantar fascia; HSIA, high signal intensity area; BME, bone marrow edema

7 Multiple logistic regression analysis between the presence of improved symptoms and the four items among the MR image findings OR p value 95% CI for OR Lower Upper Thickness of PF HSIA of PF Edema in the vicinity of PF BME of the calcaneus OR, Odds ratio; CI, confidence interval; Logistic regression analysis of the presence of improved symptoms and the four items among the MRI findings revealed a positive correlation between the presence of improved symptoms and HSIA in the PF upon MRI

8 Discussion Prediction of satisfactory outcome by MR images 2) before ESWT (48 feet) thickened plantar fascia intrasubstance increased intensity No significant correlation soft tissue edema bone marrow edema Significant correlation Maier et al. 2) reported that the presence of bone marrow edema was good predictive variable for a satisfactory clinical outcome of ESWT. But there were a few patients with bone marrow edema before ESWT in our study.

9 Edema in the vinicity of PF HSIA in the PF BME inflammation Thickness of PF angiofibroblastic hyperplasia Berkowitz et. al (1991) We guess the presence of inflammation was good predictive variable for a satisfactory clinical outcome of ESWT.

10 Conclusions We investigated the relationship between MRI findings before ESWT and the treatment outcome of ESWT. An HSIA in the PF predicted symptom improvement more easily than other MRI findings. References 1) Hammer DS et al.: Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: A 2-year follow-up. Foot Ankle Int 24 (11): , ) Maier M. et al.: Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs: Prediction of outcome by magnetic resonance imaging. J Rheumatology 27(10): , ) Theodore GH. et al.: Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int 25 (5): , ) Zhu F. et al.: Chronic plantar fasciitis: acute changes in the heel after extracorporeal highenergy shock wave thrapy Observations at MR Imaging. Radiology 234 (1): , ) Berkowitz JF. et al. Plantar fasciitis: MR imaging. Radiology 179: 665, 1991

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Load Response of the Hindfoot Bones in patients with the Ankle Osteoarthritis : in vivo D study Hara Y, Ikoma K, Kido M, Imai K, Maki M, Takatori R, Tokunaga D, Inoue N,, Kubo T Department of Orthopaedics,