Comparison of High-Dose Extracorporeal Shockwave Therapy and Intralesional Corticosteroid Injection in the Treatment of Plantar Fasciitis

Abstract

Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results.

Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial

“…Their findings clearly indicated that although ESWT was nearly as effective as CSI in treating plantar fasciitis at 12 months of follow-up, CSI was more efficacious and much more cost effective than ESWT (31). In another similar study, Yucel et al (33) compared the effects of high-dose ESWT and CSI in patients with chronic plantar fasciitis lasting >6 months using the VAS score. The response to treatment was considered to be a 50% reduction in pain using the VAS or the heel tenderness index.…”

“…The response to treatment was 82% (27 of 33 patients) in the ESWT group and 85% (23 of 27 patients) in the CSI group. They concluded that first-line treatment for their patients was CSI because of its cost effectiveness (33). In another recent study, the 2 methods of treatment of chronic plantar fasciitis, CSI (2 mL of betamethasone and 2 mL of lidocaine) and ESWT (2 sessions of therapy using 0.28 mJ/mm 2 energy flux density with 1000 to 1500 pulses), were compared using the plantar fascia thickness (determined by ultrasonography) and the subjective Mayo Clinic scoring system.…”

“…Recently, ESWT has been recommended for the treatment of plantar fasciitis in several studies owing to its effectiveness in reducing morning pain in 61% and a reduction in VAS scores in 72% of the patients (32,33). Chang et al (16), in a systemic review of 12 studies (11,431 patients total) comparing different types of ESWT, reported that ESWT with the highest and medium energy density tolerable by the patients was the superior method.…”

Plantar fasciitis – to jab or to support? A systematic review of the current best evidence

“…Seven pseudo-randomized trials were identified from the literature but due to an inadequate randomization process or the absence of randomization description, were excluded from this review 8,11,17,19,33–35. A summation of both the included and excluded studies can be found in Table 1.…”

Plantar fasciitis

“…32 However, because cortisone has greater side effects than modalities such as extracorporeal shock wave therapy, it can equally be argued that the cheaper (cortisone injection) or less invasive treatment (shock wave) should be used initially. 33 One comparison study suggested that if ultrasonography revealed perifascial oedema then cortisone injections gave superior results, but if not then shock wave therapy gave superior results. 34 Cortisone iontophoresis has also been used, for those who wish to avoid the pain of an injection.…”