COMPARATIVE EFFICACY OF FLURBIPROFEN PHONOPHORESIS VERSUS MANUAL TOPICAL GEL APPLICATION IN PATIENTS WITH PLANTAR FASCIITIS IN FAISALABAD

Abstract

Background: Plantar fasciitis is a prevalent cause of heel pain that significantly impairs mobility and quality of life. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) like flurbiprofen provide symptomatic relief but often suffer from limited dermal penetration. Phonophoresis, which utilizes therapeutic ultrasound to enhance transdermal drug delivery, may overcome this limitation by improving tissue absorption and accelerating clinical outcomes. This study aimed to evaluate the comparative effectiveness of flurbiprofen delivered via phonophoresis versus manual application in managing plantar fasciitis.

Objective: To determine whether phonophoresis with flurbiprofen gel provides superior pain reduction and functional improvement compared to manual topical application in patients with plantar fasciitis.

Methods: A single-blinded randomized controlled trial was conducted on 40 patients aged 21–60 years with unilateral plantar fasciitis. Participants were randomized equally into two groups. Group A received flurbiprofen phonophoresis using pulsed-mode ultrasound (1 MHz frequency, 1.75 W/cm² intensity, 1:1 duty cycle) for 7 minutes per session, five sessions per week for three weeks. Group B manually applied 5 mL of 5% flurbiprofen gel twice daily for three weeks. Outcomes were measured at baseline and post-intervention using the Visual Analogue Scale (VAS) for pain and the Plantar Fasciitis Pain/Disability Scale (PFPS). Data were analyzed using paired and independent t-tests, with significance set at α = 0.05.

Results: Thirty-five patients completed the trial (Group A: n = 18; Group B: n = 17). Group A showed a significant reduction in VAS score from 9.46 ± 1.17 to 5.24 ± 1.59 (mean difference = 4.22 ± 1.24, p < 0.001), while Group B improved from 9.34 ± 1.70 to 7.68 ± 1.69 (mean difference = 1.66 ± 0.64, p < 0.001). The between-group post-intervention VAS difference was 2.44 points in favor of Group A (p < 0.001). PFPS domains, including pain duration, mobility, and activity limitations, showed significantly greater improvements in Group A across all variables (all p < 0.01).

Conclusion: Phonophoresis with flurbiprofen gel yielded significantly greater reductions in pain and functional disability than manual application in patients with plantar fasciitis. These results support phonophoresis as an effective, noninvasive therapeutic option for enhancing conservative management outcomes in this condition.