Katzap Y, Haidukov M, Berland OM, et al. Additive Effect of Therapeutic Ultrasound in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2018 Nov;48(11):847-855. doi: 10.2519/jospt.2018.8110. Epub 2018 Jul 11. (Original study)

BACKGROUND: Plantar fasciitis is the chief cause of pain in the plantar surface of the heel. Therapeutic ultrasound is one of the most common conservative treatment modalities used by physical therapists worldwide, despite scarce evidence of its efficacy in treating plantar fasciitis.

OBJECTIVE: To evaluate the additive effect of therapeutic ultrasound in the treatment of plantar fasciitis in terms of pain, function, and quality of life.

METHODS: In this prospective, randomized, double-blind, placebo-controlled clinical trial, 54 patients with plantar fasciitis, aged 24 to 80 years, who met the inclusion criteria were randomized into an active intervention and a control group. Individuals in the active intervention group were treated with self-performed stretching of the plantar fascia and calf muscles and with therapeutic ultrasound. Individuals in the control group were treated with the same stretching exercises and sham ultrasound. Both groups received 8 treatments, twice weekly. Outcome measures included a numeric pain-rating scale, the computerized adaptive test for the foot and ankle, and an algometric test.

RESULTS: Both groups showed statistically significant improvement in all outcome measures (P<.001, both groups). At the completion of the study, no statistically significant differences were found between the groups in any of the outcomes.

CONCLUSION: The addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis. Therefore, the authors recommend excluding therapeutic ultrasound from the treatment of plantar fasciitis and agree with results of previous studies that stretching may be an effective treatment for healing plantar fasciitis.

LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2018;48(11):847-855. Epub 11 Jul 2018. doi:10.2519/jospt.2018.8110.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

Therapeutic ultrasound is NOT helpful in plantar fasciitis. Definitely worth knowing!

Physician rater

This article is not very relevant to me as a primary care physician, outside of the opportunity to discuss with a patient who may be seeing a physical therapist or podiatrist for treatment. Most primary care physicians would not have this modality available as a treatment option. It does, however, have relevance to the broader medical community as an ultrasound modality that does not meet the "high value cost conscious care" metric, especially important in our era of increasing availability of point of care ultrasound and medical cost savings.

Physician rater

RCT with sham control vs ultrasound therapy for fasciitis plantaris showing no difference in results.

Rehab Clinician (OT/PT) rater

The study highlights that ultrasound has no real use in the treatment of this condition and also identifies the treatments that have clear evidence to support their use. "FINDINGS: The inclusion of active ultrasound (1 MHz, 1.8 W/cm2, continuous for 8 minutes) was not superior to sham ultrasound when added to stretching exercises in the treatment of plantar fasciitis. A combination of stretching exercises and the addition of active or sham therapeutic ultrasound was effective in decreasing pain and improving the function of patients with plantar fasciitis. IMPLICATIONS: Inclusion of active ultrasound is not recommended in the standard physical therapy treatment of plantar fasciitis."

Rehab Clinician (OT/PT) rater

Not sure about the explanation for not doing an ITT analysis. Also, a small sample, so for me that brings newsworthiness down.
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