Low–Level Laser Therapy for the Treatment of Chronic Plantar Fasciitis: A Prospective Study.
Plantar fasciitis affects nearly 1 million people annually in the United States. Traditional nonoperative management is successful in about 90% of patients, usually within 10 months. Chronic plantar fasciitis develops in about 10% of patients and is a difficult clinical problem to treat. A newly emerging technology, low–level laser therapy (LLLT), has demonstrated promising results for the treatment of acute and chronic pain.
Thirty patients were administered LLLT and completed 12 months of follow-up. Patients were treated twice a week for 3 weeks for a total of 6 treatments and were evaluated at baseline, 2 weeks post procedure, and 6 and 12 months post procedure. Patients completed the Visual Analog Scale (VAS) and Foot Function Index (FFI) at study follow-up periods.
Patients demonstrated a mean improvement in heel pain VAS from 67.8 out of 100 at baseline to 6.9 out of 100 at the 12-month follow-up period. Total FFI score improved from a mean of 106.2 at baseline to 32.3 at 12 months post procedure.
Although further studies are warranted, this study shows that LLLT is a promising treatment of chronic plantar fasciitis.
LEVEL OF EVIDENCE:
Level 4, case series.
Lasers Med Sci. 2009 Oct 20. [Epub ahead of print]
Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial.
Kiritsi O, Tsitas K, Malliaropoulos N, Mikroulis G.
Prognosis, Diagnostic Center, Larnaca, Zaka 56, 56727, Thessaloniki, Greece, firstname.lastname@example.org.
The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on plantar fasciitis documented by the ultrasonographic appearance of the aponeurosis and by patients' pain scores. Thirty individuals with diagnosis of unilateral plantar fasciitis were enrolled in a randomized, double-blind, placebo-controlled trial, but 25 participants completed the therapeutic protocol. The contralateral asymptomatic fascia was used as control. After enrolment, symptomatic individuals were randomly assigned to receive LLLT, or identical placebo, for 6 weeks. Ultrasonography was performed at baseline and after completion of therapy. The subjective subcalcaneal pain was recorded at baseline and after treatment on a visual analogue scale (VAS). After LLLT, plantar fascia thickness in both groups showed significant change over the experimental period and there was a difference (before treatment and after treatment) in plantar fascia thickness between the two groups. However, plantar fascia thickness was insignificant (mean 3.627 +/- 0.977 mm) when compared with that in the placebo group (mean 4.380 +/- 1.0042 mm). Pain estimation on the visual analogue scale had improved significantly in all test situations (after night rest, daily activities) after LLLT when compared with that of the placebo group. (P = 0.006 and P = 0.01, respectively). Additionally, when the difference in pain scores was compared between the two groups, the change was statistically significant (after night rest P = 0.000; daily activities P = 0.001). In summary, while ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis, 904 nm gallium-arsenide (GaAs) infrared laser may contribute to healing and pain reduction in plantar fasciitis.
Arch Phys Med Rehabil. 1998 Mar;79(3):249-54.
A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis.
Basford JR, Malanga GA, Krause DA, Harmsen WS.
Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
OBJECTIVE: To determine whether low-intensity laser irradiation, a widespread but controversial physical therapy agent, is an effective treatment of plantar fasciitis.DESIGN: A randomized, double-blinded, placebo-controlled clinical study.
SETTING: A sports medicine clinic.
SUBJECTS: Thirty-two otherwise healthy individuals with plantar fasciitis of more than 1 month's duration.
INTERVENTION: Dummy or active irradiation with a 30 mW .83 microm GaAlAs continuous-wave infrared (IR) diode laser three times a week for 4 weeks.
MEASUREMENTS: Morning pain, pain with toe walking, tenderness to palpation, windlass test response, medication consumption, and orthotic use were evaluated immediately before the study, as well as at the midpoint and end of treatment. Subjects were also evaluated at a follow-up 1 month after their last treatment.
RESULTS: No significant differences were found between the groups in any of the outcome measures either during treatment or at the 1-month follow-up. Treatment, however, was well tolerated and side effects were minimal.
CONCLUSIONS: Low-intensity IR laser therapy appears safe but, at least within the parameters of this study, is not beneficial in the treatment of plantar fasciitis.