14-6-2019

1

Workshop Fyzzio NT-e

Niek Vink

Nieknt-enl

Diagnose en behandeling van een plantaire fasciopathie

Even voorstellen

14-6-2019

2

Revalidatie van een tendinopathische pees

bull Primaire interventiebull Pees belasten is essentieel niet teveel ontlasten

bull Mechanotransductie

bull Dit item moet dus altijd in zitten combineren met

Secundaire interventies

Oefentherapie hoogste mate van evidentie

Bron BJSM 2009 Khan

Revalidatie van een tendinopathische pees

bull Primaire interventiebull Pees belasten is essentieel niet teveel ontlasten

bull Mechanotransductie

bull Dit item moet dus altijd in zitten combineren met

Secundaire interventies

Gecombineerd met

bull Secundairbull Chronisch (gt 3 maanden) dan regeneratieve interventie

bull Shockwave therapie

bull Percutane electrolyse (epte)

bull Oefentherapie voor actieve houdingscorrectie (ingezakt voetgewelf navicular drop)

bull Steunzolen statiek schoeisel

bull Medicatie

bull Taping en andere passieve modaliteiten

bull Etc

14-6-2019

3

Aandoening Consensus Aandoening Consensus

Tendinopathieeumln 3 Morton-Neuroom 2 gt 3

Synovitis 3 Haglund deformiteit 2

Tendovaginitis 3 Lig deltoideum 1 gt 2

Dislocatie peroneii 3 Lig Calcaneonaviculare (spring lig) 1 gt 2

Calcificerende tendinitis 3 Benige avulsies 2

Retrocalcaneare bursitis 3 Loose bodies 1 gt 2

Distensie gewrichtskapsel 3 Enkelgewricht instabiliteit 2

Lig Tibiofibulaire anterior 3 Plantaire plaat 2

Lig calcaneofibulaire 3 Kraakbeenschade 0 gt 1

Fasciitis plantaris 3 Lig Tibiofibulaire posterior 0

Ganglia (cysten) 3 Intra-articulaire aandoeningen 0

Consensus ESSR tav indicatie voor MSU 0 = niet geindiceerd 1= Geindiceerd mits er geen andere beeldvormende techniek geschikt is 2= MSU is gelijk aan andere beeldvormende technieken 3 = MSU is de eerste keuze voor onderzoek

Het begint met een diagnose Echografie enkelvoet

Sconfienza et al Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal

Radiology (ESSR) consensus Eur Radiol (2018)

Rood = verandering consensus of nieuwkomer op de lijst tov consensus 2012

Electrolyse

Therapie - regeneratieve therapievormen

14-6-2019

4

Therapie - oefeningen

Therapie - Belasting opbouwen

14-6-2019

5

bull Werking

bull Evidentie

Shockwave

Shock Wave Behandeling

Micro-damaging disorganisatie verlaagde cell-viability

Toegenomen cel-metabolisme (calcium resorptie)

Proliferatie en Remodulatie = Regeneratie

Pijnvermindering en functieverbetering = Herstel

Werking ndash regeneratieve prikkel + pijndemping

14-6-2019

6

Evidentie

- Veel onderzoeken

van varieumlrende

kwaliteit

- 2018 systematic

review in BR J

Sports Med

bull Werking

bull Evidentie

Percutane electrolyse

14-6-2019

7

bull Chemische reactie agv de elektrolyse door alkalische reactie bij kathode

bull Beiumlnvloeden PH waarde ndash basisch

bull Lokale fysiologische ontstekingsreactie door oa VEGFVEGF 2 factoren

bull Fibroblasten stimuleren door mechanotransuctie (naaldrotatie)

bull Vrijkomen van PPAR-Y na 10-14 dagen (pro-inflammatoire cytokines naar

beneden brengen)

bull MMPrsquos en TIMPrsquos in balans krijgen

Werking regeneratieve prikkel + pijndemping

Prospective Randomized Trial of Electrolysis for

Chronic Plantar Heel Pain

Foot Ankle Int 2018 May 1

Fernaacutendez-Rodriacuteguez T12 Fernaacutendez-Rolle Aacute1 Truyols-Domiacutenguez

S1 Beniacutetez-Martiacutenez JC3 Casantildea-Granell J3

BACKGROUND

Chronic plantar heel pain (CPHP) is a common condition with high prevalence rates and a projected cost of treatment of US$192 to US$376 million There are several

therapeutic approaches and there is increased interest in treatments aimed at the regeneration of tissues with poor healing potential Our purpose was to investigate the

effectiveness of ultrasound-guided percutaneous needle electrolysis in chronic plantar heel pain

METHODS

A total of 73 patients with a clinical and ultrasonographic diagnosis of plantar heel pain unrelated to systemic inflammatory disease who had not received any other treatment in

the previous 6 months on the affected foot were randomly allocated to receive either ultrasound-guided percutaneous needle electrolysis of the fascia (experimental group n

= 39) or placebo puncture (control group n = 34) The primary outcome was pain scored with an 11-point numeric pain rating scale (0 = no pain 10 = maximum pain)

Secondary outcomes were function and disability measured by the 21-item activities of daily living subscale of the Foot and Ankle Ability Measure questionnaire and fascia

thickness measured by ultrasound Outcomes were measured at 1 12 and 24 weeks

RESULTS

The mixed-model analysis of covariance observed significant group x time interactions from all variables pain in numeric pain rating scale ( P lt 001) FAAM Activities of Daily

Living Subscale scale ( P lt 002) and ultrasonographic measures of the plantar heel ( P lt 002) Patients in the experimental group had better results posttreatment at 12 and

24 weeks compared with the control group

CONCLUSION

With chronic plantar heel pain ultrasound-guided percutaneous needle electrolysis

improved pain and function This treatment may also decrease fascia thickness

14-6-2019

2

Revalidatie van een tendinopathische pees

bull Primaire interventiebull Pees belasten is essentieel niet teveel ontlasten

bull Mechanotransductie

bull Dit item moet dus altijd in zitten combineren met

Secundaire interventies

Oefentherapie hoogste mate van evidentie

Bron BJSM 2009 Khan

Revalidatie van een tendinopathische pees

bull Primaire interventiebull Pees belasten is essentieel niet teveel ontlasten

bull Mechanotransductie

bull Dit item moet dus altijd in zitten combineren met

Secundaire interventies

Gecombineerd met

bull Secundairbull Chronisch (gt 3 maanden) dan regeneratieve interventie

bull Shockwave therapie

bull Percutane electrolyse (epte)

bull Oefentherapie voor actieve houdingscorrectie (ingezakt voetgewelf navicular drop)

bull Steunzolen statiek schoeisel

bull Medicatie

bull Taping en andere passieve modaliteiten

bull Etc

14-6-2019

3

Aandoening Consensus Aandoening Consensus

Tendinopathieeumln 3 Morton-Neuroom 2 gt 3

Synovitis 3 Haglund deformiteit 2

Tendovaginitis 3 Lig deltoideum 1 gt 2

Dislocatie peroneii 3 Lig Calcaneonaviculare (spring lig) 1 gt 2

Calcificerende tendinitis 3 Benige avulsies 2

Retrocalcaneare bursitis 3 Loose bodies 1 gt 2

Distensie gewrichtskapsel 3 Enkelgewricht instabiliteit 2

Lig Tibiofibulaire anterior 3 Plantaire plaat 2

Lig calcaneofibulaire 3 Kraakbeenschade 0 gt 1

Fasciitis plantaris 3 Lig Tibiofibulaire posterior 0

Ganglia (cysten) 3 Intra-articulaire aandoeningen 0

Consensus ESSR tav indicatie voor MSU 0 = niet geindiceerd 1= Geindiceerd mits er geen andere beeldvormende techniek geschikt is 2= MSU is gelijk aan andere beeldvormende technieken 3 = MSU is de eerste keuze voor onderzoek

Het begint met een diagnose Echografie enkelvoet

Sconfienza et al Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal

Radiology (ESSR) consensus Eur Radiol (2018)

Rood = verandering consensus of nieuwkomer op de lijst tov consensus 2012

Electrolyse

Therapie - regeneratieve therapievormen

14-6-2019

4

Therapie - oefeningen

Therapie - Belasting opbouwen

14-6-2019

5

bull Werking

bull Evidentie

Shockwave

Shock Wave Behandeling

Micro-damaging disorganisatie verlaagde cell-viability

Toegenomen cel-metabolisme (calcium resorptie)

Proliferatie en Remodulatie = Regeneratie

Pijnvermindering en functieverbetering = Herstel

Werking ndash regeneratieve prikkel + pijndemping

14-6-2019

6

Evidentie

- Veel onderzoeken

van varieumlrende

kwaliteit

- 2018 systematic

review in BR J

Sports Med

bull Werking

bull Evidentie

Percutane electrolyse

14-6-2019

7

bull Chemische reactie agv de elektrolyse door alkalische reactie bij kathode

bull Beiumlnvloeden PH waarde ndash basisch

bull Lokale fysiologische ontstekingsreactie door oa VEGFVEGF 2 factoren

bull Fibroblasten stimuleren door mechanotransuctie (naaldrotatie)

bull Vrijkomen van PPAR-Y na 10-14 dagen (pro-inflammatoire cytokines naar

beneden brengen)

bull MMPrsquos en TIMPrsquos in balans krijgen

Werking regeneratieve prikkel + pijndemping

Prospective Randomized Trial of Electrolysis for

Chronic Plantar Heel Pain

Foot Ankle Int 2018 May 1

Fernaacutendez-Rodriacuteguez T12 Fernaacutendez-Rolle Aacute1 Truyols-Domiacutenguez

S1 Beniacutetez-Martiacutenez JC3 Casantildea-Granell J3

BACKGROUND

Chronic plantar heel pain (CPHP) is a common condition with high prevalence rates and a projected cost of treatment of US$192 to US$376 million There are several

therapeutic approaches and there is increased interest in treatments aimed at the regeneration of tissues with poor healing potential Our purpose was to investigate the

effectiveness of ultrasound-guided percutaneous needle electrolysis in chronic plantar heel pain

METHODS

A total of 73 patients with a clinical and ultrasonographic diagnosis of plantar heel pain unrelated to systemic inflammatory disease who had not received any other treatment in

the previous 6 months on the affected foot were randomly allocated to receive either ultrasound-guided percutaneous needle electrolysis of the fascia (experimental group n

= 39) or placebo puncture (control group n = 34) The primary outcome was pain scored with an 11-point numeric pain rating scale (0 = no pain 10 = maximum pain)

Secondary outcomes were function and disability measured by the 21-item activities of daily living subscale of the Foot and Ankle Ability Measure questionnaire and fascia

thickness measured by ultrasound Outcomes were measured at 1 12 and 24 weeks

RESULTS

The mixed-model analysis of covariance observed significant group x time interactions from all variables pain in numeric pain rating scale ( P lt 001) FAAM Activities of Daily

Living Subscale scale ( P lt 002) and ultrasonographic measures of the plantar heel ( P lt 002) Patients in the experimental group had better results posttreatment at 12 and

24 weeks compared with the control group

CONCLUSION

With chronic plantar heel pain ultrasound-guided percutaneous needle electrolysis

improved pain and function This treatment may also decrease fascia thickness

14-6-2019

3

Aandoening Consensus Aandoening Consensus

Tendinopathieeumln 3 Morton-Neuroom 2 gt 3

Synovitis 3 Haglund deformiteit 2

Tendovaginitis 3 Lig deltoideum 1 gt 2

Dislocatie peroneii 3 Lig Calcaneonaviculare (spring lig) 1 gt 2

Calcificerende tendinitis 3 Benige avulsies 2

Retrocalcaneare bursitis 3 Loose bodies 1 gt 2

Distensie gewrichtskapsel 3 Enkelgewricht instabiliteit 2

Lig Tibiofibulaire anterior 3 Plantaire plaat 2

Lig calcaneofibulaire 3 Kraakbeenschade 0 gt 1

Fasciitis plantaris 3 Lig Tibiofibulaire posterior 0

Ganglia (cysten) 3 Intra-articulaire aandoeningen 0

Consensus ESSR tav indicatie voor MSU 0 = niet geindiceerd 1= Geindiceerd mits er geen andere beeldvormende techniek geschikt is 2= MSU is gelijk aan andere beeldvormende technieken 3 = MSU is de eerste keuze voor onderzoek

Het begint met een diagnose Echografie enkelvoet

Sconfienza et al Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal

Radiology (ESSR) consensus Eur Radiol (2018)

Rood = verandering consensus of nieuwkomer op de lijst tov consensus 2012

Electrolyse

Therapie - regeneratieve therapievormen

14-6-2019

4

Therapie - oefeningen

Therapie - Belasting opbouwen

14-6-2019

5

bull Werking

bull Evidentie

Shockwave

Shock Wave Behandeling

Micro-damaging disorganisatie verlaagde cell-viability

Toegenomen cel-metabolisme (calcium resorptie)

Proliferatie en Remodulatie = Regeneratie

Pijnvermindering en functieverbetering = Herstel

Werking ndash regeneratieve prikkel + pijndemping

14-6-2019

6

Evidentie

- Veel onderzoeken

van varieumlrende

kwaliteit

- 2018 systematic

review in BR J

Sports Med

bull Werking

bull Evidentie

Percutane electrolyse

14-6-2019

7

bull Chemische reactie agv de elektrolyse door alkalische reactie bij kathode

bull Beiumlnvloeden PH waarde ndash basisch

bull Lokale fysiologische ontstekingsreactie door oa VEGFVEGF 2 factoren

bull Fibroblasten stimuleren door mechanotransuctie (naaldrotatie)

bull Vrijkomen van PPAR-Y na 10-14 dagen (pro-inflammatoire cytokines naar

beneden brengen)

bull MMPrsquos en TIMPrsquos in balans krijgen

Werking regeneratieve prikkel + pijndemping

Prospective Randomized Trial of Electrolysis for

Chronic Plantar Heel Pain

Foot Ankle Int 2018 May 1

Fernaacutendez-Rodriacuteguez T12 Fernaacutendez-Rolle Aacute1 Truyols-Domiacutenguez

S1 Beniacutetez-Martiacutenez JC3 Casantildea-Granell J3

BACKGROUND

Chronic plantar heel pain (CPHP) is a common condition with high prevalence rates and a projected cost of treatment of US$192 to US$376 million There are several

therapeutic approaches and there is increased interest in treatments aimed at the regeneration of tissues with poor healing potential Our purpose was to investigate the

effectiveness of ultrasound-guided percutaneous needle electrolysis in chronic plantar heel pain

METHODS

A total of 73 patients with a clinical and ultrasonographic diagnosis of plantar heel pain unrelated to systemic inflammatory disease who had not received any other treatment in

the previous 6 months on the affected foot were randomly allocated to receive either ultrasound-guided percutaneous needle electrolysis of the fascia (experimental group n

= 39) or placebo puncture (control group n = 34) The primary outcome was pain scored with an 11-point numeric pain rating scale (0 = no pain 10 = maximum pain)

Secondary outcomes were function and disability measured by the 21-item activities of daily living subscale of the Foot and Ankle Ability Measure questionnaire and fascia

thickness measured by ultrasound Outcomes were measured at 1 12 and 24 weeks

RESULTS

The mixed-model analysis of covariance observed significant group x time interactions from all variables pain in numeric pain rating scale ( P lt 001) FAAM Activities of Daily

Living Subscale scale ( P lt 002) and ultrasonographic measures of the plantar heel ( P lt 002) Patients in the experimental group had better results posttreatment at 12 and

24 weeks compared with the control group

CONCLUSION

With chronic plantar heel pain ultrasound-guided percutaneous needle electrolysis

improved pain and function This treatment may also decrease fascia thickness

14-6-2019

4

Therapie - oefeningen

Therapie - Belasting opbouwen

14-6-2019

5

bull Werking

bull Evidentie

Shockwave

Shock Wave Behandeling

Micro-damaging disorganisatie verlaagde cell-viability

Toegenomen cel-metabolisme (calcium resorptie)

Proliferatie en Remodulatie = Regeneratie

Pijnvermindering en functieverbetering = Herstel

Werking ndash regeneratieve prikkel + pijndemping

14-6-2019

6

Evidentie

- Veel onderzoeken

van varieumlrende

kwaliteit

- 2018 systematic

review in BR J

Sports Med

bull Werking

bull Evidentie

Percutane electrolyse

14-6-2019

7

bull Chemische reactie agv de elektrolyse door alkalische reactie bij kathode

bull Beiumlnvloeden PH waarde ndash basisch

bull Lokale fysiologische ontstekingsreactie door oa VEGFVEGF 2 factoren

bull Fibroblasten stimuleren door mechanotransuctie (naaldrotatie)

bull Vrijkomen van PPAR-Y na 10-14 dagen (pro-inflammatoire cytokines naar

beneden brengen)

bull MMPrsquos en TIMPrsquos in balans krijgen

Werking regeneratieve prikkel + pijndemping

Prospective Randomized Trial of Electrolysis for

Chronic Plantar Heel Pain

Foot Ankle Int 2018 May 1

Fernaacutendez-Rodriacuteguez T12 Fernaacutendez-Rolle Aacute1 Truyols-Domiacutenguez

S1 Beniacutetez-Martiacutenez JC3 Casantildea-Granell J3

BACKGROUND

Chronic plantar heel pain (CPHP) is a common condition with high prevalence rates and a projected cost of treatment of US$192 to US$376 million There are several

therapeutic approaches and there is increased interest in treatments aimed at the regeneration of tissues with poor healing potential Our purpose was to investigate the

effectiveness of ultrasound-guided percutaneous needle electrolysis in chronic plantar heel pain

METHODS

A total of 73 patients with a clinical and ultrasonographic diagnosis of plantar heel pain unrelated to systemic inflammatory disease who had not received any other treatment in

the previous 6 months on the affected foot were randomly allocated to receive either ultrasound-guided percutaneous needle electrolysis of the fascia (experimental group n

= 39) or placebo puncture (control group n = 34) The primary outcome was pain scored with an 11-point numeric pain rating scale (0 = no pain 10 = maximum pain)

Secondary outcomes were function and disability measured by the 21-item activities of daily living subscale of the Foot and Ankle Ability Measure questionnaire and fascia

thickness measured by ultrasound Outcomes were measured at 1 12 and 24 weeks

RESULTS

The mixed-model analysis of covariance observed significant group x time interactions from all variables pain in numeric pain rating scale ( P lt 001) FAAM Activities of Daily

Living Subscale scale ( P lt 002) and ultrasonographic measures of the plantar heel ( P lt 002) Patients in the experimental group had better results posttreatment at 12 and

24 weeks compared with the control group

CONCLUSION

With chronic plantar heel pain ultrasound-guided percutaneous needle electrolysis

improved pain and function This treatment may also decrease fascia thickness

14-6-2019

5

bull Werking

bull Evidentie

Shockwave

Shock Wave Behandeling

Micro-damaging disorganisatie verlaagde cell-viability

Toegenomen cel-metabolisme (calcium resorptie)

Proliferatie en Remodulatie = Regeneratie

Pijnvermindering en functieverbetering = Herstel

Werking ndash regeneratieve prikkel + pijndemping

14-6-2019

6

Evidentie

- Veel onderzoeken

van varieumlrende

kwaliteit

- 2018 systematic

review in BR J

Sports Med

bull Werking

bull Evidentie

Percutane electrolyse

14-6-2019

7

bull Chemische reactie agv de elektrolyse door alkalische reactie bij kathode

bull Beiumlnvloeden PH waarde ndash basisch

bull Lokale fysiologische ontstekingsreactie door oa VEGFVEGF 2 factoren

bull Fibroblasten stimuleren door mechanotransuctie (naaldrotatie)

bull Vrijkomen van PPAR-Y na 10-14 dagen (pro-inflammatoire cytokines naar

beneden brengen)

bull MMPrsquos en TIMPrsquos in balans krijgen

Werking regeneratieve prikkel + pijndemping

Prospective Randomized Trial of Electrolysis for

Chronic Plantar Heel Pain

Foot Ankle Int 2018 May 1

Fernaacutendez-Rodriacuteguez T12 Fernaacutendez-Rolle Aacute1 Truyols-Domiacutenguez

S1 Beniacutetez-Martiacutenez JC3 Casantildea-Granell J3

BACKGROUND

Chronic plantar heel pain (CPHP) is a common condition with high prevalence rates and a projected cost of treatment of US$192 to US$376 million There are several

therapeutic approaches and there is increased interest in treatments aimed at the regeneration of tissues with poor healing potential Our purpose was to investigate the

effectiveness of ultrasound-guided percutaneous needle electrolysis in chronic plantar heel pain

METHODS

A total of 73 patients with a clinical and ultrasonographic diagnosis of plantar heel pain unrelated to systemic inflammatory disease who had not received any other treatment in

the previous 6 months on the affected foot were randomly allocated to receive either ultrasound-guided percutaneous needle electrolysis of the fascia (experimental group n

= 39) or placebo puncture (control group n = 34) The primary outcome was pain scored with an 11-point numeric pain rating scale (0 = no pain 10 = maximum pain)

Secondary outcomes were function and disability measured by the 21-item activities of daily living subscale of the Foot and Ankle Ability Measure questionnaire and fascia

thickness measured by ultrasound Outcomes were measured at 1 12 and 24 weeks

RESULTS

The mixed-model analysis of covariance observed significant group x time interactions from all variables pain in numeric pain rating scale ( P lt 001) FAAM Activities of Daily

Living Subscale scale ( P lt 002) and ultrasonographic measures of the plantar heel ( P lt 002) Patients in the experimental group had better results posttreatment at 12 and

24 weeks compared with the control group

CONCLUSION

With chronic plantar heel pain ultrasound-guided percutaneous needle electrolysis

improved pain and function This treatment may also decrease fascia thickness

14-6-2019

6

Evidentie

- Veel onderzoeken

van varieumlrende

kwaliteit

- 2018 systematic

review in BR J

Sports Med

bull Werking

bull Evidentie

Percutane electrolyse

14-6-2019

7

bull Chemische reactie agv de elektrolyse door alkalische reactie bij kathode

bull Beiumlnvloeden PH waarde ndash basisch

bull Lokale fysiologische ontstekingsreactie door oa VEGFVEGF 2 factoren

bull Fibroblasten stimuleren door mechanotransuctie (naaldrotatie)

bull Vrijkomen van PPAR-Y na 10-14 dagen (pro-inflammatoire cytokines naar

beneden brengen)

bull MMPrsquos en TIMPrsquos in balans krijgen

Werking regeneratieve prikkel + pijndemping

Prospective Randomized Trial of Electrolysis for

Chronic Plantar Heel Pain

Foot Ankle Int 2018 May 1

Fernaacutendez-Rodriacuteguez T12 Fernaacutendez-Rolle Aacute1 Truyols-Domiacutenguez

S1 Beniacutetez-Martiacutenez JC3 Casantildea-Granell J3

BACKGROUND

Chronic plantar heel pain (CPHP) is a common condition with high prevalence rates and a projected cost of treatment of US$192 to US$376 million There are several

therapeutic approaches and there is increased interest in treatments aimed at the regeneration of tissues with poor healing potential Our purpose was to investigate the

effectiveness of ultrasound-guided percutaneous needle electrolysis in chronic plantar heel pain

METHODS

A total of 73 patients with a clinical and ultrasonographic diagnosis of plantar heel pain unrelated to systemic inflammatory disease who had not received any other treatment in

the previous 6 months on the affected foot were randomly allocated to receive either ultrasound-guided percutaneous needle electrolysis of the fascia (experimental group n

= 39) or placebo puncture (control group n = 34) The primary outcome was pain scored with an 11-point numeric pain rating scale (0 = no pain 10 = maximum pain)

Secondary outcomes were function and disability measured by the 21-item activities of daily living subscale of the Foot and Ankle Ability Measure questionnaire and fascia

thickness measured by ultrasound Outcomes were measured at 1 12 and 24 weeks

RESULTS

The mixed-model analysis of covariance observed significant group x time interactions from all variables pain in numeric pain rating scale ( P lt 001) FAAM Activities of Daily

Living Subscale scale ( P lt 002) and ultrasonographic measures of the plantar heel ( P lt 002) Patients in the experimental group had better results posttreatment at 12 and

24 weeks compared with the control group

CONCLUSION

With chronic plantar heel pain ultrasound-guided percutaneous needle electrolysis

improved pain and function This treatment may also decrease fascia thickness

14-6-2019

7

bull Chemische reactie agv de elektrolyse door alkalische reactie bij kathode

bull Beiumlnvloeden PH waarde ndash basisch

bull Lokale fysiologische ontstekingsreactie door oa VEGFVEGF 2 factoren

bull Fibroblasten stimuleren door mechanotransuctie (naaldrotatie)

bull Vrijkomen van PPAR-Y na 10-14 dagen (pro-inflammatoire cytokines naar

beneden brengen)

bull MMPrsquos en TIMPrsquos in balans krijgen

Werking regeneratieve prikkel + pijndemping

Prospective Randomized Trial of Electrolysis for

Chronic Plantar Heel Pain

Foot Ankle Int 2018 May 1

Fernaacutendez-Rodriacuteguez T12 Fernaacutendez-Rolle Aacute1 Truyols-Domiacutenguez

S1 Beniacutetez-Martiacutenez JC3 Casantildea-Granell J3

BACKGROUND

Chronic plantar heel pain (CPHP) is a common condition with high prevalence rates and a projected cost of treatment of US$192 to US$376 million There are several

therapeutic approaches and there is increased interest in treatments aimed at the regeneration of tissues with poor healing potential Our purpose was to investigate the

effectiveness of ultrasound-guided percutaneous needle electrolysis in chronic plantar heel pain

METHODS

A total of 73 patients with a clinical and ultrasonographic diagnosis of plantar heel pain unrelated to systemic inflammatory disease who had not received any other treatment in

the previous 6 months on the affected foot were randomly allocated to receive either ultrasound-guided percutaneous needle electrolysis of the fascia (experimental group n

= 39) or placebo puncture (control group n = 34) The primary outcome was pain scored with an 11-point numeric pain rating scale (0 = no pain 10 = maximum pain)

Secondary outcomes were function and disability measured by the 21-item activities of daily living subscale of the Foot and Ankle Ability Measure questionnaire and fascia

thickness measured by ultrasound Outcomes were measured at 1 12 and 24 weeks

RESULTS

The mixed-model analysis of covariance observed significant group x time interactions from all variables pain in numeric pain rating scale ( P lt 001) FAAM Activities of Daily

Living Subscale scale ( P lt 002) and ultrasonographic measures of the plantar heel ( P lt 002) Patients in the experimental group had better results posttreatment at 12 and

24 weeks compared with the control group

CONCLUSION

With chronic plantar heel pain ultrasound-guided percutaneous needle electrolysis

improved pain and function This treatment may also decrease fascia thickness

14-6-2019

8

Kom je een keer vrijblijvend kennismaken

bull Gratis kennismakingsbijeenkomst echografiebull 25 september 0900 ndash 1200u

bull Gratis kennismakingsbijeenkomst shockwave therapiebull 25 september 1300 ndash 1600u

bull Update tendinopathieeumln en andere spier-peesproblemenbull 1400 ndash 2030u

15

Basisopleiding echografie voor podotherapeuten en podologen

Lisette de Graauw16