Calcifying Tendonitis of the Ankle, Effectivenness of 5% Acetic Acid Iontophoresis and Ultrasound over Achiles Tendon: A Prospective Case Series

Marcos E Fernández-Cuadros1,2*, Olga S Pérez-Moro2, María Jesús Albaladejo-Florin2, Ruben Algarra-
López
2 and Luz Casique-Bocanegra1
1Rehabilitation Department, Santísima Trinidad’s General Foundation Hospital, Salamanca, Spain
2Rehabilitation Department, Santa Cristina’s University Hospital, Madrid, Spain
*Corresponding author: Marcos E Fernández-Cuadros, PhD, Rehabilitation Department, Santa Cristina’s University, Santísima Trinidad’s General Foundation Hospital, Salamanca, Spain, Calle Maestro Vives 2, CP 28009, Madrid, Spain

Abstract
Objective: To conduct a prospective Multicentre Quasiexperimental
before-and-after study (Non-Randomized Control Trial) to demonstrate the effectiveness of Acetic Acid Iontophoresis and Ultrasound in the treatment of Calcifying Tendonitis (CT) of the ankle.
Material and methods: Prospective, multicentre, quasiexperimental
before-after intervention study, to 10 patients who attended to both Rehabilitation Departments, at Santísima Trinidad’s General Foundation Hospital, Salamanca-Spain and at Santa Cristina’s University
Hospital, Madrid-Spain, from June-2014 to December-2018.
Outcome measures: 1) Pain: Measured by Visual Analogical Scale (VAS); 2) Calcification size: In millimetres (mm), both measured radiologically at the beginning/end of treatment.
Intervention: Iontophoresis with 5% acetic acid at 4.7 mA × 10 minutes and continuous Ultrasound 1 W/cm2 /1MHz × 5 minutes over calcification.
Results: Mean age 49.2 ± 7.28-years (n = 10). Female 50% (n = 5). Average number of sessions was 21.7 ± 7.22. Treatment showed a significant amelioration of pain measured by VAS from 7.9 ± 1.66 to 2.8 ± 2.09 points (p = 0.0002). Calcification size diminished significantly from 10 ± 5.3 to 5.3 ± 5.22 mm (p = 0.0186).
Conclusions: CT is more common in middle-aged people. In our study, CT affects similarly both male and female. Iontophoresis with 5% Acetic Acid and Ultrasound is a safe, simple and inexpensive technique. Twenty sessions of 5% acetic acid iontophoresis plus Ultrasound are capable of reducing significantly pain and size of calcification on Achilles’ tendon at the ankle.
This study shows a level of evidence II-1 and grade of recommendation B that allows us to postulate Acetic Acid iontophoresis and ultrasound as an effective treatment in CT.

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