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Three Part Question

In [adults with plantar fasciitis] does [Ultrasound] improve [pain and function].

Clinical Scenario

A 38 year old female presents with a 4 month history of plantar fasciitis. You wonder whether ultrasound will be beneficial in the treatment of plantar fasciitis, but before deciding on treatment you check the evidence first.

Search Strategy

Medline 1966-10/07, Cinahl 1982-10/07, Amed 1985-10/07, Embase 1996-10/07, BNI 1994-10/07, via the ADITUS interface. In addition the Cochrane database, Pedro database, and Pub Med database were also searched.
Medline, Cinahl, Amed, Embase, BNI, Pub Med [(plantar fasciitis or plantar heel pain or heel pain) AND (ultrasound or therapeutic ultrasound)] LIMIT to humans AND english language AND information added since 20020101.

Search Outcome

222 papers were retrieved and after reading the abstracts, a total of 2 papers were considered relevant to the question. One was a Cochrane review last up-dated 2003. There was only one paper published since that time. This was discounted as it was a poor quality paper - narrative review. Both reviews described the same randomised controlled trial of ultrasound in the treatment of plantar fasciitis,which is the only relevant paper. There have been no further papers published since the Cochrane review.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Crawford, F., Snaith, M. 1996 UK	N=19 with 26 episodes of heel pain (7 bilateral). 2 groups: Group 1: True ultrasound Group 2: Placebo ultrasound.	Double Blinded Placebo Randomised Controlled Study.	Pain: Visual Analogue Scale.	Treatment group improved by 30% following treatment and placebo group improved by 25%. But results were not statistically significant. Complete resolution of pain did not occur in any episode. Pain worsened in four episodes (two in group 1 and two in group 2). Pain stayed the same in two episodes (one in group 1 and one in group 2).	Only VAS used as outcome measure . Small sample size. 7 Patients had received steroid injections since the onset of their heel pain. Standardised ultrasound dose given making generalisability to clinical settings difficult. No intention-to-treat analysis.

Clinical Bottom Line

Ultrasound is no more effective than placebo in the treatment of plantar fasciitis.

References

1. Crawford,F., Snaith,M. How effective is therapeutic ultrasound in the treatment of heel pain? Annals of the Rheumatic Diseases 1996; 55: 265-267