The effectiveness of Extracorporeal shock wave therapy (ESWT) in the treatment of lower limb conditions- a pilot Clinical Audit.

Purpose

To investigate the use of ESWT in advanced practitioner clinics for lower limb conditions (tendinopathies).

The orthopaedic department procured an ESWT machine for use in orthopaedic clinics. This lead to a project aimed at setting up a package of care for treating lower limb conditions. It involved the utilisation of AHP's in orthopaedic clinic to manage this difficult group of patients in an orthopaedic setting.

Patella tendon (1)
100% better
Gluteal (15)
53% better
47% no better
Plantar fascia (20)
37% better
47% Lost to follow up
16% no better
Achilles (15)
64% better
29% Lost to follow up
7% no better

Approach

Patients diagnosed with; plantar fasciitis, Achilles tendinosis, patella tendinosis and Gluteal tendinopathy are referred to the service. These are direct referrals to the orthopaedic triage team. They come from a variety of sources mainly orthopaedic surgeons and physiotherapists.

Once deemed appropriate for treatment, they are booked into the ESWT clinic for 3 consecutive weeks of treatment. On initial assessment they are fully assessed to ensure they are appropriate for treatment; any contra-indications are excluded.

A short questionnaire is conducted and where appropriate outcome measures are conducted including VAS.

If they meet the criteria they then have 3 consecutive weeks of ESWT, this is conducted using present setting on the machine and delivered by either a band 8 podiatrist of band 8 Physiotherapist. They are given advice leaflets and exercises and have a telephone consultation at 12 weeks to look at their outcomes

Outcomes

The main findings demonstrate improvements across the 4 lower limb conditions.

  • Plantar fascia (20) - 37% better, 47% Lost to follow up, 16% no better.
  • Achilles (15) 64% better, 29% Lost to follow up, 7% no better.
  • Gluteal (15) 53% better, 47% no better.
  • Patella tendon (1) 100% better.
  • VAS scores varied from 1-8.  

Overall the use of ESWT seems to demonstrate a more that 50% improvement in the pain scores of the four selected lower limb pathologies. Obviously this is a small sample group and there were a large percentage lost to follow up which need to be accounted for. However overall there is a positive effect for the treatment of these lower limb conditions.

Implications

This fairly new innovation demonstrates improvements in the pain and function of patients with these specific lower limb conditions. It demonstrates that this modality seems to have a place in the management of these tendinopathic conditions. Incorporating education and exercise programs into their management may further enhance the treatment especially with Gluteal tendinopathy.

The next step would be to identify those patients who will respond best to treatment to ensure maximal benefit. Furthermore, it is important to identifying those patients that may not be suitable for this treatment.

Fund acknowledgements

None. 

Additional notes

This work was presented at Physiotherapy UK 2019