Plantar Fasciitis

A chronic degeneration of the fascia on the underside of the foot is usually resulting in pain on the underside of the heel. It is usually caused by either an injury or more commonly due to biomechanical abnormalities. As well as pain, it is also characterised by pain worse first thing in the morning on the first few steps and then eases slightly. It may also be painful climbing stairs or standing for long periods.

Conservative treatment of the condition usually involves rest, ice, NSAIDs, manual therapy, injection therapy or orthotics.

Current evidence (from NICE guidelines) shows there can be some improvement in pain levels using shockwave therapy for plantar fasciitis, but the efficacy of the treatment is inconsistent.

A randomised controlled trial (RCT) of 293 patients treated by ESWT or sham ESWT reported that 47% and 30% of patients, respectively, had ‘successful’ outcomes at 3-month follow-up (defined as at least 50% reduction in pressure-induced pain and pain during walking, at least a 1-point reduction in pain score on a 5-point visual analogue scale [VAS] and no requirement for pain medication 10–12 weeks after treatment)

In an RCT of 272 patients treated by ESWT or sham ESWT, the mean reduction in pain score (assessed by a 5-point VAS) from baseline to 3-month follow-up was 3.4 in the ESWT group) compared with 1.8 in the sham ESWT group.

An RCT of 149 patients treated by ESWT or conservative management reported that 69% of ESWT patients and no patients treated conservatively had an ‘excellent’ result (no heel pain) and 14% and 55% of each group, respectively, had a ‘good’ result (50% or greater reduction in baseline pain) at a mean follow-up of 64 months

A systematic review of the evidence for use of shockwave for soft-tissue injuries performed by Speed (2014), concluded that shockwave therapy was effective in the treatment of plantar fasciitis.

Therefore, shockwave therapy could be used for chronic plantar fasciitis especially if all other treatment modalities have failed.

For further information check out the link to the leaflet NICE have produced about the procedure.

References

  • Ogden JA, Alvarez RG, Levitt RI et al. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. Journal of Bone and Joint Surgery. 2004;86: 2216-2228.
  • Haake M, Buch M, Schoellner C et al. Extracorporeal shock wave therapy for plantar fasciitis: a randomised controlled trial. British Medical Journal. 2003;327:75-79.
  • Wang CJ, Wang FS, Yang KD et al. Long-term results of extracorporeal shockwave treatment for plantar fasciitis. American Journal of Sport Medicine. 2006;34(4):592-596.
  • Speed C. A systematic review of shockwave therapies in soft-tissue conditions: focussing on the evidence. Brit Jour Sports Med. 2014;48(21)