project research final ppt calcaneal spur

Calcaneal Spur

1. ةينميلا ةيروهمجلا
يملعلا ثحبلاو يلاعلا ميلعتلا هرازو
يزارلا ةعماج
ةيبطلا ةيحصلا مولعلاو بطلا ةيلك
يعيبطلا جلاعلا مسق
Yemen Republic
Ministry of Higher Education&
Scientific Research
Al-Razi University
Faculty of Medicine and Health Science
Physiotherapy department
Comparing the effectiveness of Shock wave therapy
and Ultrasound therapy in treatment of Calcaneal
Spur pain Sana'a –Yemen.

2. ةينميلا ةيروهمجلا
يملعلا ثحبلاو يلاعلا ميلعتلا هرازو
يزارلا ةعماج
ةيبطلا ةيحصلا مولعلاو بطلا ةيلك
يعيبطلا جلاعلا مسق
Yemen Republic
Ministry of Higher Education&
Scientific Research
Al-Razi University
Faculty of Medicine and Health Science
Physiotherapy department
Comparing the effectiveness of Shock wave therapy
and Ultrasound therapy in treatment of Calcaneal
Spur pain Sana'a –Yemen.
Supervisor
Dr. OsamahEzzaddin
Master in A acupuncture and moxibustion
and massage
EsraaMoammorSlaam
LamisAli AL-Qubati
ManarNabil Mufleh
ZainbSaleh AL-Hamdany
MossabSaifAL-Hamdany
Abdullah Hamid AL-Shabany
Abdullah Awadh Abo-Saad
Ahmed Abdullah AL-Qadasi
Ali Mohsen Mufleh
Mohammed Abdo Mufleh
Researchers

3. OUTLINES OF THE RESEARCH:
•Introduction
•Objectives
•Research Methodology
•Results
•Discussion
•Conclusion and Recommendation

4. INTRODUCTION

5. INTRODUCTION

6. INTRODUCTION
Background

7. INTRODUCTION
Background
Calcanealspurisoneofthemostfrequentcausesoffootpaininadults(15to20%)
(Toomey,2009).ThemainsymptomofCalcanealspurisheelpainduringweight-
bearingactivities(Rosenbaumetal.,2014).Accordingtoliteraturedata,this
diseaseoccursmorefrequentlyinwomenthanmen.Calcificationoccursmost
commonlyifthefootwearisuncomfortable,ifthepatientisobese,orduetoa
preexistingfootdeformity(Sullivanetal.,2020).

8. INTRODUCTION
Background
Calcanealspurisadiseasemanifestedbythepresenceofcalcification
onthecalcaneus.HistologicalanalysisshowsthattheCalcanealspur
consistofacoreofmaturelamellarboneanddemonstratesevidenceof
degenerationandfibrocartilaginousproliferation,alongwithoneor
moreintramembranous,chondroid,andendochondralossifications
occurringatthesurface(Kirkpatricketal.,2017).

9. Introduction
Problem Statement

10. Introduction
Problem Statement
Calcanealspur,acommonfootpathologycharacterizedbyheel
pain,posesasignificantburdenonthepopulationofYemen,yet
thereislimitedresearchonitsepidemiologyandtreatment
practiceswithinthecountry.Yemen,facingnumeroussocio-
economicchallengesandhealthcaresystemconstraints,
experiencesuniquecontextualfactorsthatmayinfluencethe
prevalence,management,andoutcomesofcalcanealspur
(RamaduraiandBhatia,2018).

11. Introduction
Justification of the study

12. Introduction
Justification of the study
Thetreatmentapproachesforcalcanealspur,withhealthcare
providersoftenutilizingarangeofinterventionswithoutclear
evidenceofcomparativeeffectiveness.Thisstudyaimsto
directlycomparetheclinicaleffectsofextracorporealshock-
wavetherapy(ESWT)andultrasoundtherapy,twocommonly
employedmodalities,toprovideclarityontheirrelativeefficacy
inmanagingcalcanealspur(Lietal.,2018).

13. Objectives

14. Objectives
General Objective

15. Objectives
General Objective
TocomparetheeffectivenessofShockwavetherapyand
UltrasoundtherapyintreatmentofCalcanealSpurpainusingvisual
analogscaleatPhysicaltherapyclinicatAl-RaziUniversityin
Sana'aYemen.

16. Objectives
Specific Objectives

17. Objectives
Specific Objectives
1.To determinethesociodemographic
characteristicsofpatientswithcalcanealspur.
2.Toidentifytheprevalenceofcalcanealspurrisk
factorsinpatients.
3.Toassesstheimpactofcalcanealspurpainon
qualityoflifeusingFAOSquestionnairebefore
treatment.

18. Objectives
Specific Objectives
4.To assess the effectiveness of treatment using
ultrasound therapy and shock wave therapy using
FAOS questionnaire.

19. RESEARCH
METHODOLOGY

20. RESEARCH METHODOLOGY

21. RESEARCH METHODOLOGY
study setting

22. RESEARCH METHODOLOGY
study setting
ThestudywasconductedatPhysicaltherapy
clinicatAl-RaziUniversityinSana'acity.

23. RESEARCH METHODOLOGY
Study Design

24. RESEARCH METHODOLOGY
Study Design
This study is a randomized pre and post treatment
study between two groups with Calcaneal Spur.

25. RESEARCH METHODOLOGY
Study Population

26. RESEARCH METHODOLOGY
Study Population
PatientswithCalcanealSpuratPhysicaltherapy
clinicatAl-RaziUniversityinSana'acity.

27. RESEARCH METHODOLOGY
Inclusion
and
Exclusion Criteria

28. RESEARCH METHODOLOGY
InclusionandExclusionCriteria
1.Subjects with age of 18 years and older.
2-Bothmaleandfemalesubjects.
3-PatientswithCalcanealSpur.
InclusionCriteria

29. RESEARCH METHODOLOGY
InclusionandExclusionCriteria
1-Unwillingnesstoparticipateinthisstudy.
2-Previoushistoryoffootandanklesurgery.
3-Contraindicationstoultrasoundtherapyand
shockwavetherapy.
4-Inabilitytocomplywithstudyprocedures
ExclusionCriteria

30. RESEARCH METHODOLOGY
Sample Size

31. RESEARCH METHODOLOGY
Atotalsamplesizewas52patientswho
agreetoparticipateinthestudy,whichdone
from19/2/2024to30/3/2024.
SampleSize

32. RESEARCH METHODOLOGY
SamplingMethod

33. RESEARCH METHODOLOGY
SamplingMethod
Patientsaredividedrandomlyintotwogroups26
patientsforeachgroup.GroupAreceivedshock
wavetherapywith2000impulses,10frequency,
twiceaweek,for8sessions.GroupBreceived
continuousultrasoundtherapywithfrequency
1MHz,intensity0.8w/cm2,for8minutes,3
timesaweek,for10sessions.

34. RESEARCH METHODOLOGY
Data Collection
Technique and
Tool

35. RESEARCH METHODOLOGY
Data Collection Technique and Tool
Datawerecollectedbyrecording
sociodemographicdataofpatient,clinical
presentationandriskfactors.
Severityofdiseaseandeffectivenessoftreatment
weremeasuredusingVASscoreandFAOS
subscorethatmeasurediseasesymptomsand
impactonlife.

36. RESEARCH METHODOLOGY
Dataanalysis

37. RESEARCH METHODOLOGY
DatawereanalyzedusingSPSSversion27
software.Variousstaticallymethodwereusedto
analyzethedescriptivedataandcomparingpre
andposttreatmenteffect.
Dataanalysis

38. Results

39. Comparing category All groups
Shockwave
group
Ultrasound
group
Number N 52 26 26
Age
18-34 12 (23.1%) 7 (26.9%) 5 (19.2%)
35-50 33 (63.5%) 17 (65.4%) 16 (61.5%)
>50 7 (13.5%) 2 (7.7%) 5 (19.2%)
Sex
Male 10 (19.2%) 4 (15.4%) 6 (23.1%)
Female 42 (80.8%) 22 (84.6%) 20 (76.9%)
BMI
Underweight 1 (1.9%) 0 (0.0%) 1 (3.8%)
Normal 12 (23.1%) 7 (26.9%) 5 (19.2%)
Overweight 20 (38.5%) 12 (46.2%) 8 (30.8%)
Obese 19 (36.5%) 7 (26.9%) 12 (46.2%)
Marital
status
Single 8 (15.4%) 4 (15.4%) 4 (15.4%)
Married 44 (84.6%) 22 (84.6%) 22 (84.6%)
Education
None educated 12 (23.1%) 6 (23.1%) 6 (23.1%)
Educated 40 (76.9%) 20 (76.9%) 20 (76.9%) 5.1 Analyze the characteristics of patient in both groups
Table(1)Thecharacteristicsofpatientsinbothgroup
Results

40. Table (2) comparing patients age, BMI, and duration of pain in both groups.
Results
N Mean Std.DeviationPvalue
Age
Shockwave26 40.88 8.18
0.250
Ultrasound26 41.88 11.09
BMI
Shockwave26 27.91 4.42
0.349
Ultrasound26 28.56 5.36
Durationof
pain
Shockwave26 2.70 2.10
0.002
Ultrasound26 4.72 6.74

41. Results
4
6
16
3 3
20
0
5
10
15
20
25
Right Left Both
Shockwave group Ultrasound group
Figure(1) Pain position

42. Results
Figure(2) Risk factor distribution in both groups
10
6
24
0
10
5
1
19
7
6
22
6
15
10
4
20
0
5
10
15
20
25
30
Previous injuryFlat FootProlonged
standing
OsteoporosisPlantar fasciitisInflammatory
disease
Diabetes Overweight
Shockwave group Ultrasound group

43. 5.2 Analyze the treatment effect in both group
Table (3) comparing VAS score and FAOS sub-scores before and after treatment for shockwave group.
Results
Mean Min –Max Std. DeviationT valueP value
VAS
Beforetreatment 6.69 4 –10 1.95
17.9<0.001
Aftertreatment 2.65 1 –6 1.52
FAOS symptoms and
stiffness
Beforetreatment 53.2 3.6 –85.7 17.4
7.9 <0.001
Aftertreatment 37 0.0 –67.8 13.4
FAOS pain
Beforetreatment 52.6 22.2 –77.8 16.9
12.7<0.001
Aftertreatment 16.4 0.0 –38.9 11.5
FAOS daily living
Beforetreatment 36.8 3.1 –71.8 18.2
9.2 <0.001
Aftertreatment 11.6 0.0 –32.8 10.5
FAOS sports and
recreational activities
Beforetreatment 51.1 5.0 –95.0 22.5
7.2 <0.001
Aftertreatment 19 0.0 –60.0 14.6
FAOS quality of life
Beforetreatment 52.8 25 –87.5 17.6
7.4 <0.001
Aftertreatment 28.5 6.2 –62.5 14.1

44. Table (4) comparing VAS score and FAOS sub-scores before and after treatment for ultrasound group.
Results
Mean Min -Max Std. DeviationT value P value
VAS
Before treatment 5.69 3 –10 1.73
9.4 <0.001
After treatment 3.08 1 –5 1.09
FAOS symptoms and
stiffness
Before treatment 53.1 32.1 –75.0 10.4
6.1 <0.001
After treatment 39.3 0.0 –53.5 10.3
FAOS pain
Before treatment 51.1 11.1 –88.9 18.6
9.9 <0.001
After treatment 21.8 0.0 –47.2 13.6
FAOS daily living
Before treatment 40.9 6.2 –65.6 13.5
9.1 <0.001
After treatment 17.2 0.0 –43.7 11.4
FAOS sports and
recreational activities
Before treatment 55.3 20.0 –85.0 17.6
8.2 <0.001
After treatment 26.9 0.0 –70.0 17.2
FAOS quality of life
Before treatment 52.6 25.0 –75.0 13.1
6.2 <0.001
After treatment 30.0 0.0 –62.5 16.2

45. 5.3 Compare treatment effect between both groups
Table (5) comparing VAS score and FAOS sub-scores before and after treatment for both groups.
Results
Shockwave groupUltrasound group P value
VAS
Before treatment 6.69 5..69 .057
After treatment 2.65 3.08 0.256
FAOS symptoms and stiffness
Before treatment 53.2 53.1 0.973
After treatment 37.0 39.3 0.484
FAOS pain
Before treatment 52.6 51.1 0.762
After treatment 16.4 21.8 0.127
FAOS daily living
Before treatment 36.8 40.9 0.363
After treatment 11.6 17.2 0.073
FAOS sports and recreational activities
Before treatment 51.1 55.3 0.454
After treatment 19.0 26.9 0.081
FAOS quality of life
Before treatment 52.8 52.6 0.958
After treatment 28.5 30.0 0.731

46. Table (6) comparing the effective of treatment based on VAS score improvement between both groups .
Results
Mean Min –Max Std. Deviation P
Shockwave group 4.03 2 –6 1.14
<0.001
Ultrasound group 2.61 0 -6 1.41

47. Table (7) comparing the effective of treatment based on FAOS sub-scores improvement between both
groups.
Results
Shockwave group Ultrasound group P value
FAOS symptoms and stiffness 16.22 13.74 0.415
FAOS pain 36.22 29.27 0.094
FAOS daily living 25.16 23.66 0.692
FAOS sports and recreational activities 32.11 28.46 0.517
FAOS quality of life 24.27 22.59 0.731

48. 5.4 Analyze the effect of age, BMI, and associated risk factors on VAS score after treatment.
Table (8) the relationship between age, BMI, and associated risk factors and effective of treatment based on VAS score improvement for
both groups.
Results
Factors Group P value
Age
Shockwave group 0.363
Ultrasound group 0.835
BMI
Shockwave group 0.536
Ultrasound group 0.834
Previous injury
Shockwave group 0.989
Ultrasound group 0.487
Flat foot
Shockwave group 0.728
Ultrasound group 0.673
Prolonged standing
Shockwave group 0.749
Ultrasound group 0.932
Osteoporosis
Shockwave group NA
Ultrasound group 0.277
Plantar fasciitis
Shockwave group 0.849
Ultrasound group 0.771
Inflammatory disease
Shockwave group 0.486
Ultrasound group 0.439
Diabetes
Shockwave group 0.093
Ultrasound group 0.577

49. Discussion

50. Discussion
VASandFAOSquestionnairewereusedtocomparethe
treatmenteffects.comparingVASscoreandFAOSsub-scores
beforeandaftertreatmentforbothgroups.TheResultsshowed
significantdifferencesinimprovementofFAOSsub-scoresand
VASbeforeandaftertreatmentforbothshockwavegroupand
ultrasoundgroup.Thisagreewithotherstudiesthatshowedthat
bothultrasoundtherapyandshockwavetherapyareeffective
treatmentforcalcaneusspurandareusedasbaselinetreatments.
( Castro, et al. 2021).

51. Discussion
Comparingthetreatmenteffectofbothgroups,theresults
showedthattheeffectoftreatmentofbothgroupswereequal
basedonFAOSsub-scalesbuttherewasasignificantdifference
inreductioninVASscoreaftertreatmentbetweenbothgroupsin
favortoshockwavegroup.Theresultsmeanthatshockwave
groupismoreeffectiveinreducingpainthatultrasoundgroup.
Thisagreeswithanotherstudycomparedultrasoundandshock
wavetherapyandshowedthatshockwavetherapyhasthe
advantageinbreakingupofthecalcification,andreducingpain
(Yin, et al. 2014).

52. Conclusion
and
Recommendation

53. Conclusion
BothESWTandstandardultrasoundtherapywereeffectivein
reducingpainintensity.ThestudyfoundthatESWTsignificantly
decreasedpainwhencomparedtostandardultrasoundtherapy.
Theresultsmeanthatshockwavegroupismoreeffectivein
reducingpainthanultrasoundgroup.

54. Recommendation
Basedonthefindingsofthestudywerecommendusingbothshock
wavetherapyandUltrasoundtherapyfortreatmentCalcanealSpur
pain.

55. THANK YOU