Extracorporeal Shockwave Therapy (ESWT) in Patients with Chronic Proximal Plantar Fasciitis

Abstract

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.

Shockwave therapy for chronic Achilles tendinopathy: A double-blind, randomized clinical trial of efficacy

“…The third trial showed no effect. Randomized studies on the effect of ESWT in the treatment of plantar heel pain (Krischek et al 1998, Hammer et al 2002 and calcifying shoulder tendonitis (Rompe et al 1997, Loew et al 1999, Haake et al 2001a, Gross et al 2002, Gerdesmeyer et al 2003, Pleiner et al 2004 have also yielded conflicting results. One randomized study (Costa et al 2005), 2 uncontrolled studies (Perlick et al 2002, Lakshmanan et al 2004, and 1 controlled (Furia 2005) trial included ESWT in the treatment of Achilles tendinopathy.…”

“…Ultrasound guidance was not used. This treatment protocol was based on the results from 3 randomized trials treating plantar fasciitis (Krischenk 1998, Haake et al 2001, Hammer et al 2002 where ESWT was applied (100-4,000 shots, 0.08-0.2 mJ/mm 2 ) 3 times with 1 or 2 weeks between each session.…”

“…The results have, however, been conflicting regarding calcifying tendinopathy in the rotator cuff, humeral epicondylitis, and plantar fasciitis (Rompe et al 1997, Boddeker et al 2001, Gross et al 2002, Hammer et al 2002, Pleineret al 2004, Chung et al 2005. A series of randomized studies on ESWT for soft tissue disorders has been reported (Rompe et al 1997, Krishek et al 1998, Loew et al 1999, Rompe et al 2001, Haake et al 2001a, b, Gross et al 2002, Hammer et al 2002, Gerdesmeyer et al 2003, Pleiner et al 2004, Chung et al 2005, Costa et al 2005, with only 4 reporting significant effect of ESWT (Rompe et al 1997, Krishek et al 1998, Loew et al 1999, Gerdesmeyer et al 2003, and there has only been one randomized study for chronic achilles tendinopathy (Costa et al 2005). ESWT was introduced for chronic Achilles tendinopathy in 2 uncontrolled (Perlick et al 2002, Lakshmanan et al 2004) and 1 controlled (Furia 2005) series.…”

Electrohydraulic High-Energy Shock-Wave Treatment for Chronic Plantar Fasciitis

“…Several musculoskeletal entities that have been treated include calcific tendinitis of the shoulder, lateral epicondylitis, delayed union and nonunion of fractures, chronic plantar fasciitis, Achilles and patellar tendinopathies, and osteonecrosis of the femoral head [1][2][3][4][5][6][7][8][9] . Basic-science studies increasingly are providing an understanding of the physiologic mechanisms of pain relief (often immediate) and the modification and repair of the target tissue, which usually requires weeks to months to occur [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] . Extracorporeal shock-wave treatments have been applied to patients with chronic plantar fasciitis who have failed to respond to multiple conservative pharmacologic and therapeutic interventions [29][30][31][32][33][34][35][36][37][38] .…”

“…Basic-science studies increasingly are providing an understanding of the physiologic mechanisms of pain relief (often immediate) and the modification and repair of the target tissue, which usually requires weeks to months to occur [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] . Extracorporeal shock-wave treatments have been applied to patients with chronic plantar fasciitis who have failed to respond to multiple conservative pharmacologic and therapeutic interventions [29][30][31][32][33][34][35][36][37][38] . Recent randomized, controlled stud- ies have been published but with varying results because of differences in study design, direction of the shock-wave delivery, energy levels, size (volume) of the focused energy ellipsoid (f 2 ) that is transcutaneously transmitted to the fascia, and method of forming the shock wave (electrohydraulic, electromagnetic, and piezoelectric) 32,[39][40][41][42][43][44][45][46][47][48][49][50]…”