SLR - August 2023 - R Brennon Middleton DPM PGY-2
Title: Effectiveness of Low-Level Laser Therapy in Chronic Plantar Fasciitis Conservative TreatmentReference: Gökçe, Bilge, et al. "Effectiveness of Low-Level Laser Therapy in Chronic Plantar Fasciitis Conservative Treatment." (2023).
Istanbul Medical Journal
Scientific Literature Review
Reviewed by: R Brennon Middleton DPM PGY-2
Residency program: Ascension St. Vincent Indianapolis
Podiatric Relevance: Plantar fasciitis is a common ailment that podiatric physicians will encounter in their practice. Low-level laser therapy (LLLT), pioneered in1967, has become a popular treatment option for various skin and musculoskeletal pathologies. LLLT may have a role as a conservative modality in the podiatric office in treating plantar fasciitis.
Methods: This was a retrospective study in which the authors reviewed records of 60 patients diagnosed with plantar fasciitis and treated from May 2016 to October 2016. 30 patients were treated with standard exercise treatment and LLLT while the other 30 in the control group were treated with exercise alone. Exercise included stretching of achilles tendon, gastrocnemius, plantar fascia stretching exercises, roll ball or roller exercise, toe-tap, and intrinsic muscle strengthening exercises .Included were patients with chronic heel pain for at least three months and who failed first-step conservative treatment. Diagnosis was made clinically with positive pain upon palpation at medial tubercle of calcaneus. Patients excluded were those with trauma, surgery, skin lesions, malignancy, steroid injections within the preceding three months, radiculopathy, arthropathy, and pregnancy. Outcome measures used were visual analogue scale (VAS), foot pain and functioning state was evaluated by the Foot Function Index (FFI) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. These assessments were recorded before and after treatment and at 2 month follow-up.
Results: The median age of individuals was 45.4±12.3 years. The 2 groups did not vary significantly in age, BMI, or standing time. VAS was assessed at rest, first step in the morning, and with exercise. Both groups improved significantly from baseline. The LLLT group improved in all VAS assessments compared to the control group at both first and second months; this was statistically significant (P<0.05). Using FFI score there was no significant improvement in the control group but the treatment group significantly improved in both pain and function. All measurements of AOFAS scores significantly improved with the exception of alignment score. Only the function score on the AOFAS scale in the control group showed a significant improvement.
Conclusions: The authors concluded that LLLT is an effective treatment for plantar fasciitis in regards to improvement in pain, function, and quality of life. They admit that limitations of the study were the nature of a retrospective study, short-term follow-up, and lack of placebo-group. It is possible that selection-bias is reflected in the results as treatment groups were not randomized and treatment protocol was not described. LLLT may not be a great choice as primary treatment considering mean VAS score while resting after 2 months of treatment was 5.7 which is less than desirable. LLLT could be a useful adjunctive therapy for plantar fasciitis. This is another option within the myriad of treatments for a problem that almost always resolves with conservative therapy.