Comparison of Ultrasound-Guided Prolotherapy Versus Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized Clinical Trial

This study aimed to compare the effectiveness of extracorporeal shockwave therapy (ESWT) versus dextrose prolotherapy on pain and foot functions in patients with chronic plantar fasciitis with a prospective randomized-controlled trial. A total of 29 patients in whom conservative care failed were enrolled for the study after the clinical and ultrasonographic assessment. The patients were randomly assigned to receive ESWT (ESWT group, n = 15) or dextrose prolotherapy (dextrose prolotherapy group, n = 14). ESWT group received 1800 to 2000 focused shock waves (session of 0.20-0.30 mJ/mm² with a frequency of 4-6 Hz) followed by soft tissue 3000 to 3500 radial pulses (session of 1.8-3.0 bar with a frequency of 15-21 Hz). Dextrose prolotherapy group underwent an injection of 5 ml 15% dextrose solution with 2% lidocaine. ESWT and dextrose prolotherapy were repeated 3 times by 2 weeks apart. A 100-mm Visual Analog Scale (VAS) for overall and morning pain, Foot Function Index (FFI) and the Roles and Maudsley Scale score (RMS) were assessed at baseline, 6 weeks, and 12 weeks after the last intervention. Overall VAS, Morning VAS, RMS and FFI scores improved significantly in both treatment groups at 6 weeks and 12 weeks compared to baseline (p < .001). Comparison of changes in overall VAS, Morning VAS, RMS and FFI scores did not show a significant difference between the groups at each time point (p > .05) In our study dextrose prolotherapy and ESWT had similar effectiveness in patients with chronic plantar fasciitis who have not respond to conservative care. The results showed ESWT and dextrose prolotherapy were not superior to each other     

Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy

Introduction The aim of this study was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the ultrasonographic appearance of chronically painful, proximal plantar fasciitis.Materials and methods Twenty-two patients with a unilateral proximal plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment lasting 6 months. The contralateral plantar fascia was used as the control. ESWT (3×3000 shock waves/session of 0.2 mJ/mm²) was performed at weekly intervals. The thickness of the plantar fascia was measured ultrasonographically about 2 cm distal of the medial calcaneal tuberosity. Pain estimation on a visual analogue scale (VAS) and the comfortable walking time were recorded. No local anaesthesia was applied. Follow-up was done at 6, 12 and 24 weeks.Results Before ESWT, the plantar fasciitis side was ultrasonographically significantly thicker than the control side (p<0.05), whereas 6 months after ESWT, the thickness of the fascia was no longer significantly different. The decrease in thickness of the plantar fasciitis side was significant (p<0.05). Pain during activities of daily living decreased by 79% according to the VAS, and the comfortable walking time increased, both significantly (p<0.01). In patients with little pain (VAS<30), the thickness of the plantar fasciitis side was significantly less (p<0.01) compared with patients who still suffered more pain (VAS>30).Conclusion After ESWT, the thickness of the plantar fascia in patients with plantar fasciitis decreased, pain and walking time improved (all significantly).     

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy,Ultrasound Therapy,and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm²; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm²); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles–Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes.     

Comparison of Effectiveness of Density and Number of Sessions of Extracorporeal Shock Wave Therapy in Plantar Fasciitis Patients: A Double-Blind,Randomized-Controlled Study

This study aimed to investigate the effect of density and number of sessions extracorporeal shock wave therapy (ESWT) on pain, fatigue, disability, physical function, and quality of life in patients with plantar fasciitis (PF). Between September 2019 and December 2019, a total of 94 patients with the diagnosis of PF were included in the study. All patients were randomly divided into 3 groups. Group 1 (n = 33) received a total of 7 sessions of high-energy flux density (H-ESWT) (0.26 mJ/mm² ) , group 2 (n = 31) received a total of 3 sessions of H-ESWT (0.26 mJ/mm²), group 3 (n = 30) received total of 7 sessions of low-energy flux density (<0.08 mJ/mm²) with 3 days interval. At baseline and 1 month after the treatment, the Visual Analog Scale (VAS), Short Form-36, Foot Function Index (FFI), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, and Six-Minute Walking Test (6MWT) scores were compared among the groups. Of the patients, 69 were females and 25 were males with a mean age of 45.0 ± 8.43 (range, 25-67) years. There were no statistically significant differences in the age, sex, demographic characteristics, and baseline VAS, FFI, 6MWT, and FACIT scores between the groups (p > .05). However, there was a statistically significant decrease in the VAS, FACIT, and FFI scores in all groups after treatment compared to baseline, although only the 6MWT, and Short Form-36 subscale scores were statistically significantly higher (p < .05). There was also a statistically significant difference in the scale scores in Group 1 versus Group 2 and in Group 2 versus Group 3. Our study results suggest that H-ESWT for high number of sessions is more effective than LESWT for low number of sessions on pain, quality of life, physical function, fatigue, and disability in patients with PF.     

Efficacies of extracorporeal shockwave therapy and low-level laser therapy in patients with plantar fasciitis

BackgroundVarious conservative treatment methods can be administered in the early stages of plantar fasciitis (PF). The aim of the treatment is to enable the patient to return to the physical activity as soon as possible.AimIn this study it was aimed to compare efficacies of Extracorporeal Shockwave Therapy (ESWT) and Low-Level Laser Therapy (LLLT) on patients with PF.DesignA local prospective cross-sectional studySettingDepartment of Physical Medicine and Rehabilitation Outpatient Clinic of Sakarya University, Faculty of MedicinePopulationPatients aged 18–70 years, having ongoing heel pain for at least 3 months, and not using oral and/or parenteral corticosteroids in the last 6 months.MethodsA total of 40 patients with PF included in the current study. Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), American Orthopedic Foot and Ankle Association Score (AOFAS) and Foot Function Index (FFI) questionnaire were performed for all patients. ESWT and LLLT groups comprised of 22 (55%) and 18 (45%) patients, respectively.ResultsWe found significant improvements in scores based on the VAS, RMS, AOFAS, FFI in patients with PF and it was sustained for 3 months (p = 0.001, for all scores). While decrease in scores based on the VAS and FFI in LLLT group was statistically more significant compared to ESWT group (p = 0.014, p = 0.013), there was statistically less significant decrease in scores on the AOFAS in LLLT group than that of ESWT group (p = 0.032).ConclusionsThe results of this study indicated significant improvements in terms of pain, functional status and daily life activities following the administration of either of the treatments. Furthermore, LLLT was found to be significantly more effective for alleviating pain than ESWT in the treatment of PF.     

Extracorporeal Shockwave Therapy Plus Rehabilitation for Patients With Chronic Plantar Fasciitis Might Reduce Pain and Improve Function but Still Not Lead to Increased Activity: A Case-Series Study With Multiple Outcome Measures

Plantar fasciitis is a common cause of plantar-aspect heel pain. Although many patients will improve, a proportion will have ongoing and sometimes debilitating symptoms. Evidence from randomized controlled trials has shown that extracorporeal shockwave therapy (ESWT) results in benefits in treating pain. However, uncertainties remain whether these benefits translate to improvements in overall function. The present prospective case series examined the results from 35 patients with chronic plantar fasciitis who had undergone a course of ESWT in addition to a graded rehabilitation program. Of the 35 subjects, 34% were male, and the median age was 50.9 years. The duration of symptoms before ESWT was 24 months. The results of the present case series demonstrated statistically significant improvements in measures of self-reported “average pain” from a median of 7.0 of 10 at baseline to 5.0 of 10 at 3 months (p < .001) and of “worst pain” from 9.0 of 10 at baseline to 7.0 of 10 at 3 months (p < .001). In addition, significant improvements were found in several validated patient-rated outcome measures of local foot/ankle function but not in overall markers of health, anxiety/depression scores, or activity levels, despite the improvements in pain. No statistically significant correlations were found between gender, age, or chronicity of symptoms and the improvements seen. No significant side effects occurred in the present study. The results of our series support the use of ESWT for patients with chronic plantar fasciitis for local pain symptoms; however, uncertainties remain regarding global benefits to health.     

Preliminary experience of a single session of low-energy extracorporeal shock wave treatment for chronic plantar fasciitis

BACKGROUND: The purpose of the present study was to evaluate the effect of a single session of ultrasound- and biofeedback-assisted extracorporeal shock wave treatment (ESWT) in patients with chronic plantar fasciitis. MATERIALS AND METHODS: 20 patients (22 heels) with symptomatic plantar fasciitis that did not respond to conservative treatment for at least 6 months were studied. Patients received a single session of low-energy, ultrasound- and patient feedback-guided ESWT. Visual analog scale (VAS) was used to compare pain intensity before treatment and at followup (72 +/- 15 days after treatment). RESULTS: There was a significant decrease in overall pain (VAS 5.5 +/- 1.8 vs. 3.3 +/- 2.7, p = 0.001), maximum pain (7.7 +/- 2.1 vs. 4.0 +/- 3.9, p = 0.008) and pain at activities of daily living (5.3 +/- 2.1 vs. 2.5 +/- 2.6, p = 0.018). Night pain decreased to a lesser extent (2.4 +/- 2.5 vs. 1.3 +/- 2.1, p = 0.317). ESWT improved symptoms in 16 heels, of which six were completely symptom-free at followup 2.4 months after treatment. Six patients experienced no change. Fourteen patients with pain localized to the heel and all male patients benefited from ESWT. No difference was noted for age, body mass index, duration, and severity of symptoms or previous treatment. CONCLUSION: Low-energy ESWT proved to be an effective treatment option for the majority of patients with chronic plantar fasciitis that failed to respond to conservative treatment. Predictive parameters for successful outcome are male gender and an easily detectable pain center at the heel.     

Dextrose prolotherapy versus radial extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized,controlled clinical trial

In the recent years, prolotherapy is increasingly being used in the field of musculoskeletal medicine. However, few studies have investigated its effectiveness in plantar fasciitis (PF). The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic PF. This randomized controlled trial was conducted on 59 patients with chronic PF. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided intrafascial 2 cc dextrose 20% injection (30 patients). The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments: pain intensity by visual analog scale (VAS), daily life and exercise activities by Foot and Ankle Ability Measure (FAAM), and the plantar fascia thickness by ultrasonographic imaging. The VAS and FAAM scales showed significant improvements of pain and function in both study groups 6 weeks and 12 weeks after the treatments. A significant reduction was noted for plantar fascia thickness at these intervals (all p < .05). The inter-group comparison revealed that except for the FAAM-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures. Dextrose prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group.Level of evidenceLevel I, randomized controlled trial.     

Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs

Background

Plantar fasciitis is the most common cause of heel pain. It may remain symptomatic despite conservative treatment with orthoses and analgesia. There is conflicting evidence concerning the role of extracorporeal shock wave therapy (ESWT) in the management of this condition.

Questions/purposes

We investigated whether there was a significant difference in the change of (1) VAS scores and (2) Roles and Maudsley scores from baseline when treated with ESWT and placebo. Specifically we compared overall improvement from baseline composite VAS, reduction in overall VAS pain, success rate of improving overall VAS pain by 60%, success rate of improving VAS pain by 60% when taking first steps, doing daily activities, and during application of a pain pressure meter.

Methods

MEDLINE, Embase, and CINAHL databases were searched from January 1980 to January 2013 and a double extraction technique was used to obtain relevant studies. Studies had to be prospective randomized controlled trials on adults and must not have used local anesthesia as part of their treatment protocol. Studies must have specifically recruited patients who continued to be symptomatic despite a minimum of 3 months of conservative treatments. All papers were assessed regarding their methodologic quality and a meta-analysis performed. Seven prospective randomized controlled trials were included in this study. There were 369 patients included in the placebo group and 294 in the ESWT group.

Results

After ESWT, patients had better composite VAS scores (random effects model, standardized mean difference [SMD] = 0.38; 95% CI, 0.05, 0.72; z = 2.27). They also had a greater reduction in their absolute VAS scores compared with placebo (random effects model, SMD = 0.60; 95% CI, 0.34, 0.85; z = 4.64). Greater success of improving heel pain by 60% was observed after ESWT when taking first steps (random effects model, risk ratio [RR] = 1.30; 95% CI, 1.04, 1.62; z = 2.29) and during daily activities (random effects model, RR = 1.44; 95% CI, 1.13, 1.84; z = 2.96). Subjective measurement of pain using a pressure meter similarly favored ESWT (random effects model, RR = 1.37, 95% CI, 1.06, 1.78; z = 2.41). There was a significant difference in the change to “excellent - good” Roles and Maudsley scores in favor of the ESWT group.

Conclusions

ESWT is a safe and effective treatment of chronic plantar fasciitis refractory to nonoperative treatments. Improved pain scores with the use of ESWT were evident 12 weeks after treatment. The evidence suggests this improvement is maintained for up to 12 months. We recommend the use of ESWT for patients with substantial heel pain despite a minimum of 3 months of nonoperative treatment.     

Effectiveness of extra-corporeal shock wave therapy (ESWT) vs methylprednisolone injections in plantar fasciitis

IntroductionIn Plantar Fasciitis, the main concern of the patients is the pain that disturbs their day to day activities. Different modalities of treatments are being used for its pain management. This study seeks to investigate and compare decrease in level of pain following treatment with Methylprednisolone injections (DMP) Vs Extra-Corporeal Shock Wave Therapy (ESWT) in plantar fasciitis.MethodsThis prospective comparative non randomized study was conducted in 60 patients of any age presenting with Plantar Fasciitis at B&B Hospital, Kathmandu. Patients were divided into 2 groups (30 each) based on patients preference. Methylprednisolone injection was given to one group and another group received ESWT. Follow up of both groups were carried out at 6 weeks, 3 months and 6 months and the outcome was measured with Visual Analogue Pain Scale (VAS). Statistical analysis wasdone using SPSS software, version 13. Chi-square and Independent t-test were applied to look for significant variations in outcome.ResultsFollow-up at 6 weeks revealed 26 (86.7%) patients attaining VAS < 5 in ESWT group in comparison to 16 (53.3%) patients of DMP group (p = 0.005). At the end of 6 months, 5 patients in DPM group still had significant pain (VAS ≥ 5) compared to 2 patients in ESWT group (p = 0.02). However 11 patients of DMP group and 23 of ESWT group received single episode of treatment only and had persistent symptomatic pain relief (VAS < 5) during all follow ups at 6 weeks, 3 months and 6 months (p = 0.004).ConclusionsPlantar fasciitis was more prevalent in overweight population and females. Significant improvement in pain was observed with both ESWT and DMP Injections. However, ESWT was found to be more effective than DMP Injections for treatment of Plantar Fasciitis.     

The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis

BackgroundPlantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment.MethodsPubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration’s tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST.ResultsEighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = − 11.53 [− 16.62; − 6.43], P < 0.0001).ConclusionPatients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis.Level of clinical evidenceII.     

冲击波联合富血小板血浆治疗跖筋膜炎的临床研究

目的探讨发散式体外冲击波疗法(extracorporeal shock wave therapy,ESWT)与富血小板血浆(platelet rich plasma,PRP)联合治疗慢性跖筋膜炎的临床疗效。方法前瞻性单中心随机对照研究,选取2017年1月至2018年12月因足跟痛于重庆大学附属三峡医院就诊并诊断为慢性跖筋膜炎的患者60例,其中男性19例,女性41例;年龄20~68岁,平均(44.56±10.68)岁。依照随机数字表法分为ESWT治疗组(E组)、PRP治疗组(P组)和ESWT-PRP联合治疗组(联合组),每组20例。比较三组患者治疗前及治疗结束后4、12、24周视觉模拟评分(visual analogue scale,VAS)、改良足功能指数(revised footfunction index,FFI-R)。分别于治疗前及治疗结束后24周采用超声测量跖筋膜厚度。结果三组患者一般资料及治疗前VAS评分、FFI-R评分比较差异无统计学意义(P>0.05),治疗结束后VAS评分、FFI-R评分均较治疗前明显改善(P<0.05)。4周时联合组及E组优于P组(P<0.05),24周时联合组及P组优于E组(P<0.05)。治疗结束24周后三组患者跖筋膜厚度较治疗前均有明显改善(P<0.05),相关性分析发现VAS评分与跖筋膜厚度存在正相关性。所有患者均未出现严重不良反应。结论采用发散式ESWT与PRP联合方案治疗慢性跖筋膜炎安全、有效、起效快、并发症少、治疗效果维持时间长,值得临床研究与推广。     

Effect of different orthotic concepts as first line treatment of plantar fasciitis

BackgroundEvaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis.MethodsProspective, randomized head-to-head trial in 30 adults (21 women, 9 men) with plantar fasciitis without any anatomic alterations. Three different prefabricated orthotics were tested (thin, non supportive orthotic (NO); soft supportive foam orthotic (FO); foam covered rigid self-supporting plastic orthotic (PO)). The follow up was 3 weeks. Main outcome measures were maximum and average pain (VAS), duration of pain per day, walking distance and subjective comfort.ResultsThere was no significant effect of NO on maximal pain and average pain. FO and PO had a significant effect on pain levels (p < 0.05) whereas PO was superior concerning pain reduction and the time until the onset of effect (p < 0.05).ConclusionsPO are superior regarding pain reduction and pain free time when compared to FO. NO did not demonstrate a significant effect in the test setup used.     

Extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized controlled trial

BackgroundThis study aimed at estimating the extent to which a combination therapy of extracorporeal shockwave therapy (ESWT) with usual care (exercise and orthotic support) improve functional ability in the patient with plantar fasciitis when compared to usual care alone.MethodsParticipants with plantar fasciitis were randomly allocated into two groups: ESWT (n = 23), and control (n = 21). All participants received home exercise program with orthotic support. In addition, ESWT group received 2000 shock waves with 0.02 mJ/mm² for three sessions. Functional outcomes were measured by function subscale of American orthopedic foot and ankle society (AOFAS-F) score and 12 minutes walking test including walking speed, cadence. The scores were recorded at baseline, third week and third month after the treatment. Analysis was performed using repeated measures ANOVA, and an intention to treat approach using multiple imputations.ResultsResults showed that there was a significant improvement in AOFAS-F total score and walking speed over three months in both groups (p < 0.001, p = 0.04 respectively); improvements in AOFAS-F were particularly in activity limitation (p = 0.001), walking distance (p = 0.02) and walking surface (p = 0.02). Groups were comparable with each other for both walking speed and AOFAS-F in any assessment time (p > 0.05). However, groups performed differently in cadence where there was an increase in cadence in ESWT group whereas a decline in control at the third month (p = 0.07).ConclusionThe results revealed that ESWT did not have an additive benefit over usual care to improve foot function and walking performance in patient with plantar fasciitis over three months post-treatment.     

Impact of plantar fasciitis on postural control and walking in young middle-aged adults

PurposeTo assess if plantar fasciitis has an impact on postural control and walking pattern from gait analysis across different experimental conditions.MethodsThirty participants (n = 15 with plantar fasciitis) performed 5 different balance tasks on a force platform, and the center of pressure (COP) was computed for postural control analysis. Participants were also asked to walk at 3 different speeds on a gait analysis system to compute the spatial-temporal parameters. Clinical foot measurements (pain, mobility) were also collected through all participants.ResultsClinical foot measurements showed no significant difference between the two groups; except for pain palpation in plantar fasciitis group. Significant differences were observed between the two groups for COP area displacement sway (p < 0.01; d = 0.08) and velocity (p = 0.022; d = 0.04), where the fasciitis group reported poorer postural control than control mainly during more challenging balance tasks (semi-tandem, unipodal). Plantar fasciitis group reported a decrease of gait velocity (p < 0.01; d = 0.12), step length (p < 0.01; d = 0.16) and step width (p < 0.01; d = 0.18) when compared to the healthy group across walking speed tests.ConclusionsIndividuals with plantar fasciitis report poor postural control and changes in walking pattern across three speeds performance.     

Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.

Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.     

Clinical Outcomes After Extracorporeal Shock Wave Therapy for Chronic Plantar Fasciitis in a Predominantly Active Duty Population

Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing relief for most patients. However, because of the common occurrence of this pathology, this leaves many patients dissatisfied. The purpose of the present study was to determine the effectiveness of extracorporeal shock wave therapy (ESWT) to treat chronic plantar fasciitis (PF) in a largely active duty population. A review of 82 patients (115 heels) who had undergone ESWT for chronic PF was performed. Outcome data were obtained by patient telephone interviews. All ESWT was conducted at 24 kV for 2000 shocks. Of the 82 patients (115 heels), 76 (93%; 111 heels) agreed to participate. Their mean age was 42?±?10 years, with 41 males (54%) and 35 females (46%). The mean follow-up period was 42?±?22 months. Of the patients, 73.6% were active duty military personnel. The mean preoperative pain score of 7.8?±?2 had improved to 2.5?±?2 at the last follow-up visit (p?<.0001). Active duty patients reported a mean improvement in pain of 4.8?±?3 compared with 6.8?±?3 in non-active duty patients (p?=?.005). Of the 76 patients, 75 (98%) underwent 1 ESWT session, and 1 (2%) requiring 2 sessions. Overall, 74% of patients rated the outcome of their procedure as either good or excellent, with 87% stating that ESWT was successful. Ten patients (18%) left the military because of continued foot pain, with 76% able to return to running. For patients with chronic PF, these results support the use of ESWT to relieve pain in >85% of patients, with a preponderance for better pain relief in patients who are not active duty military personnel.     

Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up

The aim of this study was to compare the effect of extracorporeal shock wave therapy (ESWT) in patients with chronically painful proximal plantar fasciitis with a further conventional conservative treatment. Forty-seven patients (49 feet) with a previously unsuccessful nonsurgical treatment of at least 6 months were randomized to two groups. Heel cups had to be worn throughout the study. Group 1 (25 heels) was treated immediately with three sessions of ESWT (3000 shock waves/session of 0.2 mJ/mm2) at weekly intervals. The patients of group 2 (24 heels) continued nonsurgical treatment (iontophoresis with diclofenac and an oral nonsteroidal anti-inflammatory drug) for 12 weeks. After this period they were treated using the protocol of group 1. No significant difference of pain and walking time after further nonsurgical treatment (3 months) was seen in group 2. At 12 weeks after ESWT, the pain estimation on the visual analogue scale (VAS) for activities of daily living diminished significantly by 62.9% in group 1 and by 63.0% in group 2. The comfortable walking time had increased significantly in both groups. Two years after ESWT, pain during activities of daily living decreased by 94% in group 1 and by 90% in group 2 on the VAS and the comfortable walking time had increased significantly in both groups.     

Extracorporeal shockwave therapy (ESWT) in patients with chronic proximal plantar fasciitis

The aim of this study was to compare the effect of extracorporeal shockwave therapy (ESWT) in patients with chronically painful proximal plantar fasciitis with a conventional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections and electrotherapy. Forty-seven patients (49 feet) with a previously unsuccessful conservative treatment of at least six months were randomized to two groups. Treatment of Group 1 (25 heels) started immediately with three sessions of ESWT (3000 shockwaves/session of 0.2 mJ/mm2) at weekly intervals. In the patients of Group 2 (24 heels) treatment was continued for 12 weeks. After this period they were treated using the protocol of Group 1. No significant difference of pain and walking time after further non-ESWT treatment (three months) was seen. Six months after ESWT pain decreased by 64% to 88% on the visual analog scale (VAS) and the comfortable walking time had increased significantly in both groups.     

Shock wave therapy for recalcitrant plantar fasciitis with heel spur: a prospective randomized placebo-controlled double-blind study

AIM: Efficacy of low-energy shock wave therapy for recalcitrant plantar fasciitis. METHOD: 32 patients were randomly assigned into real and placebo ESWT groups, treatment comprised 1000 impulses of 0,08 mJ/mm 2 at 14 kV (OssaTron OSA 120, HMT AG, Switzerland) in 12 cases repeated after six weeks or placebo (energy-absorbing foil). Follow-up evaluation (19, 32 and 48 wks.) included specific questionnaire, clinical-functional examination and measurement of plantar pressure while walking (Emed AT-4. pedograph, Novel GmbH, Munich). Examiner and patients were blinded. RESULTS: 88 % of the treatment group were pain free or had good results. None of the placebo group were pain free, 33.3 % had good results (Roles and Maudsley Score). The treatment group showed significantly better outcome for morning and resting pain, pressure stamp-tolerance and walking ability. Pedography did not show a clear correlation between pain relief and load pattern. CONCLUSION: The results of this study corroborate the value of ESWT for recalcitrant plantar fascitis. As a non invasive technique with low side effects, it can complement the row of conservative treatments.