Plantar Fasciitis/ Plantar Fasiit
Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs
Adeel Aqil, MRCS, corresponding author Muhammad R. S. Siddiqui, MRCS Matthew Solan, FRCS David J. Redfern, FRCS Vivek Gulati, MRCS Justin P. Cobb, FRCS
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Abstract
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:
- VAS scores
- 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 the 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 was 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.
Title: The Effect of ESWT on Heel Pain and Symptoms in Plantar Fasciitis: A Retrospective Comparative Study
Authors: Serpil Tuna
Abstract: Objective: Extracorporeal shock wave therapy (ESWT) is widely used in the treatment of plantar fasciitis. In this study, we aimed to investigate the effect of ESWT on heel pain and symptoms in the short and medium term. We also compared the subcalcaneal spur length and the heel pain severity and examined the effect of the subcalcaneal spur length on the efficiency of ESWT therapy.
Methods: The efficiency of ESWT applied to 59 heels of 48 patients was compared retrospectively. We used the Visual Analog Scale (VAS) and Wolgin scale to evaluate the treatment outcomes. We measured the subcalcaneal spur length of the patients with a foot x-ray. The correlation between the VAS scores and the length of the subcalcaneal spur was also evaluated.
Results: Improvement in VAS in the first week and 3 months after ESWT treatment was statistically significant. There was no correlation between subcalcaneal spur length and the severity of pain. The number of patients in the “medium, bad” group decreased while the number of patients in the “good” group increased according to WDS after ESWT treatment.
Conclusion: As a result of this study, we concluded that ESWT is effective in the treatment of plantar fasciitis in the short and medium term.
Keywords: Heel Pain, Plantar Fasciitis, Subcalcaneal Spur Length, ESWT, Wolgin Evaluation Scale
Objective: This meta-analysis aims to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in treating chronic plantar fasciitis through a review of randomized controlled trials (RCTs).
Authors:
- Jiale Sun, MD
- Fuqiang Gao, MD
- Yanhua Wang, MD
- Wei Sun, MD
- Baoguo Jiang, MD
- Zirong Li, MD
Monitoring Editor: Leonardo Roever.
Author Information: The authors’ affiliations and contact information can be obtained from the original article.
Keywords: Extracorporeal shock wave therapy, chronic plantar fasciitis, meta-analysis, randomized controlled trials.
Abstract:
Background: Plantar fasciitis (PF) is the most common cause of heel pain. The effectiveness of extracorporeal shock wave therapy (ESWT) as an alternative to conservative treatments and surgery is debated. Prior studies often compared general ESWT with placebo without specifying the type of shock wave. This meta-analysis compares the effectiveness of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo in treating chronic PF.
Methods: A comprehensive search of PubMed, Medline, EmBase, Web of Science, and the Cochrane library databases was conducted for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included odds ratios (ORs) for pain relief, pain reduction, and complications. Data were analyzed using RevMan v5.3.
Results: Nine studies involving 935 patients were included. ESWT showed higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97–3.39, P < .00001). ESWT had significantly lower standardized mean differences than placebo, but with observed heterogeneity (standardized mean difference 1.01, 95% CI −0.01 to 2.03, P = .05, I2 = 96%, P < .00001). FSW and RSW therapies had higher success in pain relief than the placebo group (OR 2.17, 95% CI 1.49–3.16, P < .0001; OR 4.63, 95% CI 1.30–16.46, P = .02). However, significant heterogeneity was observed in RSW therapy versus placebo (I2 = 81%, P = .005).
Original Article:
Title: Treatment of chronic plantar fasciitis with extracorporeal shock wave therapy: ultrasonographic morphological aspect and functional evaluation.
Authors: Roberto Androsoni, Alfonso Apostólico Netto, Rafael Rocha Macedo, Ricardo Pozzi Fasolin, Guilherme Boni, Rodrigo Fileto Gavaldão Moreira.
Abstract: This original article investigates the treatment of chronic plantar fasciitis using extracorporeal shock wave therapy. The study includes an evaluation of ultrasonographic morphological aspects and functional outcomes.
Abstract:
Objective: This prospective study aims to analyze the treatment outcomes of patients with chronic plantar fasciitis resistant to conservative treatment who underwent extracorporeal shock wave therapy (ESWT).
Methods: The study included 30 patients (36 feet) with a mean age of 48.7 years (ranging from 33 to 78 years) who had plantar fasciitis symptoms for an average of 13.58 months (ranging from 6 to 60 months). Of the participants, 16 were male (53.3%) and 14 were female (47.7%). The condition affected the left side in 16 patients (53.3%), the right side in 14 patients (46.7%), and was bilateral in 6 patients (20%). The patients underwent weekly ESWT sessions for four consecutive weeks. Plantar fascia thickness was measured in millimeters using ultrasound. Ankle and hindfoot assessments were conducted using the American Orthopaedic Foot and Ankle Society (AOFAS) scale, and Roles & Maudsley scales were applied at various time points: before ESWT, one month, three months, and six months after ESWT. Changes in plantar fascia thickness were assessed by ultrasound (p = 0.011).
Results: Significant improvements were observed in the evaluated criteria (p < 0.001) and plantar fascia thickness measured by ultrasound (p = 0.011) at different time points studied.
Conclusion: Extracorporeal shock wave therapy (ESWT) can be considered an important tool in the primary or adjuvant treatment of chronic plantar fasciitis when combined with conventional therapies. This approach is safe, non-invasive, and facilitates early rehabilitation and return to regular activities based on the results of statistical analysis. Furthermore, it leads to a reduction in plantar fascia thickness.
