Eficacia de la electrólisis percutánea aplicada en la fascia plantar y ejercicio excéntrico

Abstract

Plantar fasciitis is a common condition of the lower limb that is characterized by biomechanical and structural changes in the plantar fascia, resulting in severe pain and significant disability. 15% of the population each year receives long-term orthopedic or conservative treatments. However, in many cases these treatments have no effect and end in surgery. Additionally, in the military, training-related injuries are the leading cause of disability, long-term rehabilitation, functional impairment, and premature discharges. These findings highlight the need to improve treatment approaches. In this context, the present investigation aims to clarify the effectiveness in the treatment of plantar fasciitis with two minimally invasive techniques. Objective: To check the efficacy of the percutaneous electrolysis (PE) in plantar fascia plus an eccentric exercise program vs. the ultrasound-guided percutaneous neuromodulation (PEN) in the tibial nerve plus an eccentric exercise program on pain intensity, thickness of plantar fascia, Achilles tendon thickness, talar fat thickness, echogenic pattern of the plantar fascia, ankle flexibility and satisfaction in military subjects with plantar fasciitis. Methodology: A randomized, prospective and longitudinal clinical trial was carried out in two groups: group 1, PE (n=34), group 2, PEN (n= 33), with an intervention period of 2 times a week for 4 weeks and 1 month of follow-up, in the facilities of the “Central Military Hospital of Perú”. Results: Pain intensity decreased (p < 0.001) in both groups, and in comparison between groups, PE (p = 0.023) presented better efficacy; The thickness of the plantar fascia was reduced (p < 0.001) in both groups, and when comparing between groups, PE (p < 0.001) had a greater effect; The thickness of the Achilles tendon decreased (p < 0.001), and when compared between both groups they were similar (p < 0.05); The echogenic pattern of the plantar fascia improved (p < 0.001) in both groups, and when comparing between groups, PE was more effective for an echogenic pattern; ankle flexibility improved (p < 0.001) in both groups, and no effect in comparison of groups; And in the satisfaction variable, PE was more effective (p < 0.01) compared to PEN. With respect to the other variables, no statistically significant results were observed in terms of intake, interaction and group. From the correlational analysis of the thickness of the plantar fascia with pain, a positive relationship has been observed between the thickness of the fascia and the intensity of pain. Conclusions: The PE in plantar fascia plus an eccentric exercise program and the PEN in tibial nerve plus an eccentric exercise program have been shown to be effective in the treatment of plantar fasciitis in military subjects. When comparing the effectiveness between both techniques, it was found that PE is more effective than PEN in reducing pain intensity, decreasing the thickness of the plantar fascia, echogenic pattern in the plantar fascia and subject satisfaction.