Extracorporeal Shockwave Therapy (ESWT) in the Treatment of Plantar Fasciitis – A Biometrical Review

Abstract

The application of extracorporeal shockwave therapy (ESWT) as a treatment for conservatively unsuccessfully treated plantar fasciitis has experienced a rapid increase over the last years. However, the efficacy of ESWT has not yet been established unequivocally, as published studies have led to inconsistent results. Furthermore, reviews on clinical trials on ESWT are either not up to date, incomplete, or methodologically inadequate. As a consequence, a systematic literature search was conducted which yielded 21 relevant articles on ESWT in the treatment of plantar fasciitis. These were rated according to biometrical criteria for the conduct of therapeutic trials based on international guidelines. None of the rated trials fulfilled all of the criteria, and it is concluded that at this point the efficacy of ESWT can be neither confirmed nor excluded. Randomised and controlled clinical trials are required to adequately estimate the value of ESWT as a treatment for plantar fasciitis.

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

“…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]…”

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

“…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.…”

“…It is now used worldwide and has been FDA-approved for the treatment of plantar fasciitis. 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).…”

Finite element modeling of acoustic wave propagation and energy deposition in bone during extracorporeal shock wave treatment

“…[1][2][3] Recently, extracorporeal shock wave treatment (ESWT) has been investigated as a novel application of shock wave (SW) therapies for treating a variety of musculoskeletal disorders, such as plantar fasciitis, bone fractures and non-unions, calcified tendonitis of the shoulder, and later epicondylitis of the elbow. [4][5][6][7][8][9] An increasing body of literature suggests that ESWT is capable of providing a nonsurgical and relatively pain free alternative treatment modality for patients who do not respond well to conservative treatments.…”