Clinical Question

Is focused extracorporeal shock wave therapy effective in relieving pain in patients with chronic plantar fasciitis?

Bottom Line

In this study, unlike others, patients with chronic plantar fasciitis treated with extra-corporeal shock wave therapy had greater pain relief than those treated with placebo. (Level of Evidence = 1b)

Synopsis

The outcomes of treating plantar fasciitis with extracorporeal shock wave therapy have been mixed, and the overall improvement has not been believed to be clinically important. These researchers, most of whom had ties to the manufacturer of the ultrasound equipment used in this study, were convinced that their approach would be better, so they randomized 250 patients with at least six months of heel pain to receive three once-weekly treatments of focused extracorporeal shock wave therapy or placebo therapy. The patients had to have already failed at least two pharmacologic treatments and at least two non-pharmacologic treatments, and had to rate their pain as at least a 5 on a 10-point visual analog scale. Patients used the scale to assess three different pain dimensions: taking their first steps in the morning, heel pain while doing daily activities, and heel pain while applying a standardized local pressure. The authors defined treatment success as a 60% reduction in two of these three dimensions. After 12 weeks, they had data on more than 98% of the patients. At the end of the study, the median reduction in pain was 69% in the extracorporeal shock wave therapy group and 34.5% in the placebo group. Slightly more than one-half the patients treated with extracorporeal shock wave therapy had at least a 60% reduction in pain compared with just more than one-third of those treated with placebo (number needed to treat = 6). However, the use of concomitant analgesic medication was similar in each group.

Study design: Randomized controlled trial (double-blinded)

Funding source: Industry

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: GollwitzerHSaxenaADiDomenicoLAet alClinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am2015; 97( 9): 701– 708.