Meta-analysis of shockwave therapy for plantar fasciitis

NewsBot · Jun 1, 2021

Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis: systematic review of randomized controlled trials
Haimanot Melese,Abayneh AlamerORCID Icon,Kefale Getie,Fetene Nigussie &Sileshi Ayhualem
Disability and Rehabilitation: 26 May 2021

Purpose
The aim of this review was to synthesize current evidence on the efficacy of extracorporeal shock wave therapy on pain, and foot function in subjects with plantar fasciitis.

Materials and methods
A comprehensive search of PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus were done to identify randomized controlled trials of extracorporeal shock wave therapy in subjects with plantar fasciitis. PEDro scale was used to evaluate the methodological quality of included trials. Visual Analogue Scale and Foot Function Index were the primary outcome measures of this review. Due to varying of entailed trials, meta-analysis was not carried out.

Results
Eleven randomized controlled trials with 658 patients were included. Extracorporeal shock wave therapy exhibited a moderate confirmation to better pain, and foot function of individuals with chronic plantar fasciitis.

Conclusion
Extracorporeal shock wave therapy could be a promising rehabilitation intervention and might support to improve pain, and foot function of subjects with chronic plantar fasciitis.

IMPLICATIONS FOR REHABILITATION
Extracorporeal shock wave therapy (ESWT) exerted beneficial effects on pain and functional outcomes for chronic plantar fasciitis.

ESWT could be effectively performed with no side effects.

ESWT could be an alternative to the conventional management of chronic plantar fasciitis.
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NewsBot · Oct 19, 2021

Demographic and Clinical Factors Predict Focused Shockwave Therapy Results on Patients With Plantar Fasciitis. A Multilevel Analysis.
Vertuccio, A.; Perugia, D.; Lanzetti, R. M.; Massimiani, A.; Lacopo, A.; Nusca, S. M.; Baldini, R.; Santoboni, F.; Latini, E.; Vetrano, M.; Vulpiani, M. C.
Muscles, Ligaments & Tendons Journal (MLTJ) . Jul-Sep2021, Vol. 11 Issue 3, p376-382. 7p.

Background. Plantar fasciitis (PF) is one of the most common causes of heel pain. The use of ESWT is approved in the treatment of chronic PF. The aim of this study was to conduct a retrospective analysis to create models for a pre-treatment evaluation in people with PF, and to assess whether demographic and clinical features could be used to predict medium-term outcomes six months after fESWT. Methods. 183 cases of plantar fasciitis were treated with fESWT. The outcome was NRS variation at three and six months. Age, gender, Likert scale and FAOS were the predictive factors evaluated. Results. A significant improvement in the mean values of NRS and FAOS was observed at the follow up controls. Patients with unfavorable characteristics association (age ≥ 56 years, FAOS < 66.7, Likert scale 3-4) showed higher NRS values, instead patients with favorable characteristics association (age < 56 years, FAOS ≥ 66.7, Likert scale 1-2) showed lower NRS values. Conclusions. The multilevel modeling creates clinical models for a pre-treatment evaluation of patients with PF, predicting a better or worse medium-term after fESWT. The patient presenting a combination of unfavorable characteristics could be informed about a worst therapeutic response, and modification on therapy protocol or association of different therapies could be considered.
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NewsBot · Nov 3, 2021

Pain Management Optimisation by an Ultrasound-Guided Analgesic Technique in Outpatients with Plantar Fasciitis during High-Energy Extracorporeal Shock Wave Therapy.
Chierichini, Angelo; Spinazzola, Giorgia; Conti, Carla; Saracco, Michela; Vergari, Alessandro; Continolo, Nicola; Ferrone, Giuliano; Rossi, Marco
Turkish Journal of Anesthesia & Reanimation . Oct2021, Vol. 49 Issue 5, p350-356. 7p.

Objective: Several studies have demonstrated the efficacy of high-energy extracorporeal shock wave therapy (HESWT) for the treatment of painful foot diseases. A crucial complication of HESWT is the appearance of pain with the subsequent interruption of the procedure. The aim of this study was the evaluation of ultrasound (US)-guided posterior tibial nerve block (PTNB) efficacy in outpatients who discontinued the first application of HESWT due to surge of moderate-severe pain. Methods: Twenty-one patients, scheduled for HESWT due to plantar fasciitis, who interrupted the treatment for surge of pain (numeric rating scale [NRS] ≥ 5), were enrolled. After interruption of the first treatment, the patients received US-guided PTNB for every subsequent HESWT session. The same skilled anaesthesiologist performed an US-guided PTNB all the times. Once the nerve was identified, the needle was inserted and 5ml mepivacaine 1% were injected. Intensity of pain during each procedure by NRS and evaluation of patient’s adherence to the treatment were detected. Results: The HESWT was split into only three applications giving in average about 0.25 mJ mm<sup>–2</sup>, and all patients completed the treatment sessions. US-guided PTNB showed a significant reduction of NRS (P < 0.01) between the first HEWST without anaesthesia and the three subsequent treatments under peripheral block. Conclusion: US-guided PTNB resulted a valid support for the HEWST in outpatients with plantar fasciitis because it reduced the pain during the procedure, allowing to minimise the patient discomfort and to give the therapeutic doses just in three sessions.
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NewsBot · Nov 26, 2021

Myofascial points treatment with focused extracorporeal shock waves (f-ESW) for plantar fasciitis: an open label randomized clinical trial
Lucrezia Tognolo et al
Eur J Phys Rehabil Med. 2021 Nov 17

Background: Plantar fasciitis (PF) is a common cause of heel pain. Among the several conservative treatment options, Extracorporeal Shock Wave Therapy (ESWT) is considered the standard treatment. However, recent studies suggest that PF may be sustained by a myofascial impairment proximal to the pain area with a biomechanical disequilibrium of the entire limb and pelvis.

Aim of the study: By combining the concepts of Fascial Manipulation and ESWT, the purpose of this study was to evaluate the effectiveness of the ESWT on myofascial points in a sample of subjects with PF.

Study design: Open label randomized controlled clinical trial.

Setting: Outpatient clinic.

Methods and population: Patients with PF were randomly assigned to an Experimental treatment Group (EG), treated with focused ESWT on myofascial points, and a Control Group (CG), treated with the focused ESWT traditional approach on the medial calcaneal tubercle. Every patient underwent a 3-session program and follow-up after 1 and 4 months. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and the Italian Foot Functional Index (17-iFFI).

Results: Thirty patients were enrolled in the study. Four patients of the CG dropped out the study, therefore twenty-six patients were included in the final analysis. Improvement in 17-iFFI and FAOS scores was observed in both groups starting from the third treatment and confirmed at the 1-month and 4-month follow-ups, with earlier improvement in the score values observed in the EG.

Conclusions: ESWT on myofascial points could provide an interesting alternative with better outcomes in terms of time needed for recovery compared to traditional ESWT for the conservative management of PF
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NewsBot · Jan 15, 2022

The Musculoskeletal Applications of Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis
Tengku Nazim B Tengku Yusof, Dexter Seow, Khushdeep S Vig
J Am Podiatr Med Assoc. 2021 Dec 8;18-191

Background: Extracorporeal Shockwave Therapy (ESWT) was first introduced into clinical practice in 1982 and has proved to be a beneficial adjuvant in the non-invasive treatment of numerous orthopaedic pathologies. However, clinical evidence reporting the use of ESWT in treating musculoskeletal disorders of the foot and ankle remain limited and a general consensus on its efficacy has not been achieved. Therefore, we reviewed the available literature and analysed any reported evidence in order to determine the benefits of ESWT in this cohort.

Methods: PubMed, EMBASE and Cochrane Library databases were systematically reviewed for any clinical studies that reported the treatment of foot and ankle disorders with ESWT.

Results: A total of 24 clinical studies, including 12 randomised control trials and 12 case series, were identified and included into this study. Analysis of the reported evidence indicate that ESWT can be beneficial in the symptomatic management of plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. However, differences in ESWT protocols used limit the generalizability of these findings and prevented an optimum treatment protocol from being determined.

Conclusions: Evidence from the articles analysed in this review suggest a beneficial healing effect of ESWT in treating musculoskeletal disorders affecting the foot and ankle, with minimal side effects being reported. Thus, ESWT can be used safely in combination with other treatment modalities in order to achieve the best patient outcomes. Future studies should attempt to optimize the treatment protocols of ESWT to confirm these findings.
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NewsBot · Jan 26, 2022

The Musculoskeletal Applications of Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis
Tengku Nazim B. Tengku Yusof; Dexter Seow; Khushdeep S. Vig
J Am Podiatr Med Assoc 18-191.

BACKGROUND: Extracorporeal Shockwave Therapy (ESWT) was first introduced into clinical practice in 1982 and has proved to be a beneficial adjuvant in the non-invasive treatment of numerous orthopaedic pathologies. However, clinical evidence reporting the use of ESWT in treating musculoskeletal disorders of the foot and ankle remain limited and a general consensus on its efficacy has not been achieved. Therefore, we reviewed the available literature and analysed any reported evidence in order to determine the benefits of ESWT in this cohort. METHODS: PubMed, EMBASE and Cochrane Library databases were systematically reviewed for any clinical studies that reported the treatment of foot and ankle disorders with ESWT. RESULTS: A total of 24 clinical studies, including 12 randomised control trials and 12 case series, were identified and included into this study. Analysis of the reported evidence indicate that ESWT can be beneficial in the symptomatic management of plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. However, differences in ESWT protocols used limit the generalizability of these findings and prevented an optimum treatment protocol from being determined. CONCLUSIONS: Evidence from the articles analysed in this review suggest a beneficial healing effect of ESWT in treating musculoskeletal disorders affecting the foot and ankle, with minimal side effects being reported. Thus, ESWT can be used safely in combination with other treatment modalities in order to achieve the best patient outcomes. Future studies should attempt to optimize the treatment protocols of ESWT to confirm these findings.
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NewsBot · Jan 29, 2022

Evaluation of plantar fasciitis improvement after shock wave therapy in calcaneal spur patients by musculoskeletal ultrasonography
Soad Said El Molla, Ahmed M. Fahmy, Amr Mohamed Gamil, Rehab Ali Ibrahim & Mai Mohamed Kamel
Egyptian Rheumatology and Rehabilitation volume 48, Article number: 43 (2021)

Background
Plantar fasciitis due to calcaneal spur is a common cause of heel pain and functional disability, and its management presents a huge challenge for clinicians which results sometimes in unpleasant clinical outcomes. The efficacy of extracorporeal shock wave therapy (ESWT) as an alternative therapeutic option to surgical management after failure of conservative treatment has been addressed. Our aim was to evaluate the efficacy of ESWT in the treatment of plantar fasciitis in calcaneal spur patients using ultrasonography.

Results
The mean plantar fascia (PF) thickness was statistically significantly higher in the calcaneal spur patient group (5.66 ± 1.14 mm) than in the healthy control group (2.40 ± 0.35 mm), (P = 0.001). Significant PF thickness reduction, visual analog scale (VAS), and Roles and Maudsley score (RMS) improvement were observed (P < 0.001) after 4 sessions of ESWT.

Conclusion
PF thickness increases significantly in calcaneal spur patients and responds to treatment. ESWT decreases the thickness of the PF and improves pain and function significantly.
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NewsBot · Feb 4, 2022

Pain Management Optimisation by an Ultrasound-Guided Analgesic Technique in Outpatients with Plantar Fasciitis during High-Energy Extracorporeal Shock Wave Therapy
Angelo Chierichini et al
Turk J Anaesthesiol Reanim . 2021 Oct;49(5):350-356

Objective: Several studies have demonstrated the efficacy of high-energy extracorporeal shock wave therapy (HESWT) for the treatment of painful foot diseases. A crucial complication of HESWT is the appearance of pain with the subsequent interruption of the procedure. The aim of this study was the evaluation of ultrasound (US)-guided posterior tibial nerve block (PTNB) efficacy in outpatients who discontinued the first application of HESWT due to surge of moderate-severe pain.

Methods: Twenty-one patients, scheduled for HESWT due to plantar fasciitis, who interrupted the treatment for surge of pain (numeric rating scale [NRS] 5), were enrolled. After interruption of the first treatment, the patients received US-guided PTNB for every subsequent HESWT session. The same skilled anaesthesiologist performed an US-guided PTNB all the times. Once the nerve was identified, the needle was inserted and 5ml mepivacaine 1% were injected. Intensity of pain during each procedure by NRS and evaluation of patient's adherence to the treatment were detected.

Results: The HESWT was split into only three applications giving in average about 0.25 mJ mm-2, and all patients completed the treatment sessions. US-guided PTNB showed a significant reduction of NRS (P < 0.01) between the first HEWST without anaesthesia and the three subsequent treatments under peripheral block.

Conclusion: US-guided PTNB resulted a valid support for the HEWST in outpatients with plantar fasciitis because it reduced the pain during the procedure, allowing to minimise the patient discomfort and to give the therapeutic doses just in three sessions.
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NewsBot · Jul 3, 2022

Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to “minimal-dose” rESWT for patients with chronic plantar fasciopathy; a double-blinded randomised controlled trial
Patrick C.Wheeler et al
Foot and Ankle Surgery; 1 July 2022

Background
Investigating outcomes following radial-extra-corporeal-shockwave-therapy (rESWT) in patients with chronic plantar fasciopathy

Methods
This double-blinded RCT in a single NHS Sports medicine clinic recruited 117 patients with chronic plantar fasciopathy randomised equally to either 3 sessions of rESWT or “minimal-dose” respectively. Mean age 51.7±9.6 years, 66% female, symptom duration: 32.6±30.8 months.

Results
“Average pain” improved by 50% at 6-months, (>1/3 at interim time-points). Statistically significant within-group improvements were identified in pain, local function, and “ability” PROMs in both groups. Fewer benefits in activity levels or mood. No between-group differences were seen at the interim or final time-points.

Conclusion
3 sessions of “recommended-dose” rESWT is non-superior to “minimal-dose” rESWT in patients with chronic plantar fasciopathy. rESWT may be ineffective in the treatment of patients with chronic plantar fasciopathy, “minimal-dose” rESWT may be sufficient for a therapeutic effect, or a greater number of treatment sessions may be required for benefit.
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NewsBot · Aug 7, 2022

Comparison of Plantar Pressure Distribution, Ultrasonographic and Clinical Features Following the Application of Different Energy Levels of Extracorporeal Shock Wave Therapy in Patients with Plantar Fasciitis: A Randomized, Prospective, Double-Blind Clinical Trial
Şükran Güzel et al
J Am Podiatr Med Assoc. 2022 Aug 4

Background: The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) have been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. The objective of this study was to compare the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis through comparisons of plantar fascia thickness and pressure distribution.

Methods: Between July 2020 and September 2020, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm2 ), Group 2 (n = 25) received medium energy density (0.18 mJ/mm2), and Group 3 (n = 21) received high energy density (0.38 mJ/mm2). All groups received three sessions of ESWT with a frequency of 2,000 shocks/min at one week intervals. The patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), and plantar fascia thickness measured by ultrasonography, and plantar pressure distribution.

Results: The posttreatment VAS and FFI scores were determined to be statistically significantly lower than the pretreatment values in all three groups (p<0.001). There was no significant difference between the groups in terms of the pre and post treatment values of VAS, FFI scores, plantar fascia thickness and pressure distribution (p>0.05). No statistically significant difference was found between the groups in terms of percentage changes in all the outcome parameters (p>0.05).

Conclusions: The results of the study suggest that neither low, medium, or high levels of ESWT were superior to one another in terms of pain, foot functions, fascia thickness and pressure distribution in the treatment of plantar fasciitis.
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NewsBot · Dec 11, 2022

Long Term Effectiveness of ESWT in Plantar Fasciitis in Amateur Runners
Joanna Kapusta, Marcin Domżalski
J Clin Med. 2022 Nov 24;11(23):6926

Background: Shock wave therapy is one of the modern methods of treatment used to treat diseases of muscles, tendons, and entheses in orthopedics, as well as in sports medicine. The therapy is increasingly used in the treatment of plantar fasciitis-a disease that is very difficult and burdensome to treat. Where basic conservative treatment for heel spurs fails, the only alternative consists of excision of the bone outgrowth, and shock wave therapy: a modern, minimally invasive, and relatively safe method. The aim of the study was to determine the long-term effectiveness of extracorporeal shock wave therapy in the treatment of painful ailments occurring in the course of plantar fasciitis in amateur runners.

Materials and methods: The study includes a group of 39 men and women, aged 34-64 (mean age 54.05 ± 8.16), suffering from chronic pain in one or both feet, occurring in the course of plantar fasciitis. The patients had to meet five criteria to qualify for the study. The group was divided into two subgroups: those who had not undergone other physiotherapeutic procedures prior to the extracorporeal shock wave therapy (ESWT-alone; 23 people), and those who had received other procedures (ESWT-plus; 16 people). The therapy was performed using extracorporeal shock wave (ESWT). No local anesthesia was used. The effectiveness of the extracorporeal shock wave therapy was evaluated using the visual analogue scale of pain (VAS), Modified Laitinen Pain Index Questionnaire, the AOFAS scale (American Orthopedic Foot and Ankle Society), and a survey questionnaire consisting of 10 questions concerning metrics and subjective assessment of the effects of therapy. The interview was conducted before ESWT, and again five years later.

Results: The use of extracorporeal shock wave therapy reduced the intensity and frequency of pain, and improved daily and recreational activity. Moreover, a reduction in the level of pain sensation on the VAS scale and pain symptoms during walking was demonstrated. More favorable results were obtained in the ESWT-plus group; however, the first effects were observed later than in the ESWT-alone group.

Conclusions: Extracorporeal shock wave therapy is an effective form of therapy for amateur runners. It reduces pain associated with plantar fasciitis that amateur runners may experience at rest, while walking, and during daily and recreational activity.
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NewsBot · Jan 18, 2023

Efficacies of extracorporeal shockwave therapy and low-level laser therapy in patients with plantar fasciitis
GökhanKozaAyhanKamanlibNedimKabancHalilHarmand
Foot and Ankle Surgery; 18 January 2023

Background
Various conservative treatment methods can be administered in the early stages of plantar fasciitis (PF). The aim of the treatment is to enable the patient to return to the physical activity as soon as possible.

Aim
In this study it was aimed to compare efficacies of Extracorporeal Shockwave Therapy (ESWT) and Low-Level Laser Therapy (LLLT) on patients with PF.

Design
A local prospective cross-sectional study

Setting
Department of Physical Medicine and Rehabilitation Outpatient Clinic of Sakarya University, Faculty of Medicine

Population
Patients aged 18-70 years, having ongoing heel pain for at least 3 months, and not using oral and/or parenteral corticosteroids in the last 6 months.

Methods
A total of 40 patients with PF included in the current study. Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), American Orthopedic Foot and Ankle Association Score (AOFAS) and Foot Function Index (FFI) questionnaire were performed for all patients. ESWT and LLLT groups comprised of 22 (55%) and 18 (45%) patients, respectively.

Results
We found significant improvements in scores based on the VAS, RMS, AOFAS, FFI in patients with PF and it was sustained for 3 months (p = 0.001, for all scores). While decrease in scores based on the VAS and FFI in LLLT group was statistically more significant compared to ESWT group (p = 0.014, p = 0.013), there was statistically less significant decrease in scores on the AOFAS in LLLT group than that of ESWT group (p = 0.032).

Conclusions
The results of this study indicated significant improvements in terms of pain, functional status and daily life activities following the administration of either of the treatments. Furthermore, LLLT was found to be significantly more effective for alleviating pain than ESWT in the treatment of PF.
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NewsBot · Jan 30, 2023

Effect of Extracorporeal Shock Wave Therapy on Pain in Plantar Fasciitis: A Review Study
Krutika Gangani et al
Chettinad Health City Medical Journal (E-2278-2044 & P-2277-8845)

Background: The most frequent cause of discomfort in the inferior heel is plantar fasciitis, and Extracorporeal Shock Wave Therapy (ESWT) is one of the most effective therapy for plantar fasciitis. It was aimed to determine how extracorporeal shock wave therapy would affect plantar fasciitis.
Method: Studies were searched on Google Scholar and PubMed over the last 10 years. Randomised Control Trials (RCT), meta-analysis, cohort, and observational studies which used extracorporeal shock wave therapy for the treatment of plantar fasciitis were included and the primary outcome of this study is variation in pain relief.
Results: Patients with persistent plantar fasciitis who had extracorporeal shock wave therapy showed a moderately positive correlation with reduced pain and improved foot function of individuals.
Conclusion: Extracorporeal shock wave therapy is effective in decreasing pain in patients with plantar fasciitis
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NewsBot · Feb 23, 2023

The Efficacy of Focused Extracorporeal Shock Wave Therapy and Ultrasound Therapy in the Treatment of Calcar Calcanei: A Randomized Study
Ivana Topalović et al
20 Feb 2023

The prospective, simple randomized study assesses the effect of focused extracorporeal shock wave therapy (f-ESWT) on pain intensity and calcification size compared to the application of ultrasound physical therapy in treating patients with calcar calcanei. A total of 124 patients diagnosed with calcar calcanei were consecutively included in the study. The patients were divided into two groups: the experimental group (), which included the patients treated with f-ECWT, and the control group (), consisting of patients treated with the standard ultrasound therapy method. The experimental group’s patients received ten therapy applications spaced seven days apart. The patients in the control group had ten ultrasound treatments on ten consecutive days over two weeks. All patients in both groups were tested using the Visual Analog Scale (VAS) to measure pain intensity before the beginning and at the end of treatment. The size of the calcification was assessed in all patients. The study hypothesizes that f-ESWT reduces the pain and the size of the calcification. Pain intensity reduction was registered in all patients. The calcification size in patients in the experimental group was reduced from the initial range of 2 mm–15 mm, to a content of 0.0 mm–6.2 mm. The calcification size in the control group ranged from 1.2 to 7.5 mm, without any change. None of the patients experienced any adverse reactions to the therapy. Patients treated with standard ultrasound therapy did not have a statistically significant reduction in the calcification size. In contrast, the patients in the experimental group treated with f-ESWT showed a substantial decrease in the calcification size.
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NewsBot · May 23, 2023

Effect of radial shock wave and ultrasound
therapy combined with traditional physical
therapy exercises on foot function and
dorsiflexion range in plantar fasciitis:
a prospective randomized clinical trial
K.Z. FOUDA et al
European Review for Medical and Pharmacological Sciences

OBJECTIVE: This study aimed to
assess the effect of radial shock wave and ultrasound therapy combined with traditional physical therapy on foot function and range of motion
in chronic plantar fasciitis.
PATIENTS AND METHODS: Sixty-nine participants with chronic plantar fasciitis (25-
56 years) were allocated randomly into three
groups. Group (A) received ultrasound (US) therapy plus conventional physical therapy exercises (in the form of stretching, strengthening exercise, and deep friction massage), Group (B) received a radial shock wave (RSW) therapy plus
conventional physical therapy exercises, and
Group (C) received a combination of both RSW
and US therapy in addition to conventional physical therapy exercises, with 3 sessions per week
for US therapy and one session for RSW therapy, in addition to 45 minutes of exercises for all
groups for 4 consecutive weeks. Foot function
was assessed using the foot function index (FFI),
and ankle dorsiflexion range of motion was measured using the Baseline® bubble inclinometer at
baseline and 4 weeks following treatment.
RESULTS: ANOVA revealed significant differences (p<0.05) in the measured outcomes
among the groups after treatment. Tukey’s honest significant difference post-hoc test demonstrated a highly statistically significant (p<0.001)
improvement in the assessed outcomes of group
C in the post-intervention settings when compared to the other groups. After 4 weeks of intervention, the mean (SD) of FFI in groups A, B, and
C were (64.54±4.91, 61.93±4.17, and 45.16±4.57)
respectively, and the active range of motion
(ROM) of the ankle dorsiflexion were (35.27±3.22,
36.59±2.91, and 41.85±3.04) respectively.
CONCLUSIONS: The addition of RSW to US
with the conventional physical therapy program
improved foot function and ankle dorsiflexion
range of motion significantly for patients with
chronic plantar fasciitis.
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NewsBot · Sep 4, 2023

EFFECTIVENESS OF SHOCKWAVE THERAPY IN REDUCING PAIN AND INCREASING ACTIVITY IN PLANTAR FASCITIS
Sanel Nuspahić et al
Vol. 59 No. 4 (2023): Knowledge - Capital of the Future / Articles

Introduction: Plantar fascitis is an overstrain syndrome that manifests as pain in the lower part of the heel. In some cases, the pain can occur along the entire length of the medial longitudinal arch of the foot. The shock wave is a non-invasive method for the treatment of musculoskeletal changes. It is an acoustic wave that transmits high energy to painful sites and myoskeletal tissues with subacute, subchronic and chronic conditions.
The aim of the work: To examine the analgesic effect of shock wave therapy in patients with chronic plantar fascitis, as well as the impact of shock wave therapy on the performance of daily activities.
Methods and materials: In our research, the average age of the patients was 18 - 65 years. This prospective study examined 21 patients diagnosed with plantar fasciitis. The study was conducted over a period of 6 months. The numerical pain scale at the beginning and end of the therapy, the functional index for the lower extremities (The Lower Extremity Functional Index - LEFI) was used to conduct the research. On the LEFI questionnaire, patients evaluate difficulties in daily activities at the beginning and at the end of therapy.
Results: Based on the results of the Wilcoxon ranked test, a significant reduction in the level of pain was observed after therapy (Z=-3.462;p=0.001). After therapy, a significant improvement in daily activities was observed (p< 0.05). The total average score before therapy was 50.81±14.18, while after therapy the average score was 68.43±12.06. on the LEFI questionnaire. Significant differences were observed (t=-5.758; p< 0.001).
Conclusion: Shock wave therapy proved to be a successful method of pain treatment for the examined diagnosis, improving the functionality and quality of life of patients. Patients can improve their activities of daily living and reduce disability with this non-invasive, cost-effective and safe intervention.
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NewsBot · Sep 19, 2023

Evaluation of the efficacy of trigger points combined
with extracorporeal shock waves in the treatment of
plantar fasciitis: heel temperature and plantar
pressure
Bo Wang et al
Research Square

Background
Plantar fasciitis (PF) is the most common cause of heel pain. Among several conservative treatments,
extracorporeal shock wave therapy (ESWT) is considered an effective treatment for refractory plantar
fasciitis. Studies have shown that the trigger points (TrPs) in the triceps surae of ESWT may play an
important role in the treatment of pain in PF patients. Therefore, the purpose of this study was to evaluate
the efficacy of extracorporeal shock waves combined with TrPs in patients with PF by using heel
temperature and plantar pressure based on the concept of trigger pointsand ESWT.
Methods
According to the inclusion and exclusion criteria, 86 patients with plantar fasciitis were recruited from the
pain clinic of Huadong Hospital, Fudan University. They were randomly divided into an experimental group
(n = 43) and a control group (n = 43). The experimental group was treated with extracorporeal shock waves
to treat the medial heel pain point combined with the gastrocnemius and soleus trigger points. The control
group was only treated with extracorporeal shock waves to treat the medial heel pain point. The two groups
were treated twice, with an interval of 1 week. Primary measurements included anumerical rating scale
(NRS) (overall, first step, heel pain during daily activities), andsecondary measurements included heel
temperature, Roles and Maudsley score (RMS), and plantar pressure. All assessments were performed
before treatment (i.e., baseline) and 6 and 12 weeks after treatment.
Results
During the trial, 3 patients in the experimental group withdrew from the study, 2 patients withdrew from the
study due to the interruption of the course of treatment affected by the new coronavirus epidemic, and 1
patient withdrew from the study due to personal reasons. In the control group, 3 patients fell and were
removed due to swelling of the heel. Therefore, only 80 patients with PF were finally included. After
treatment, the two groups showed good results in NRS (overall, first step, heel pain during daily activities),
Roles and Maudsley score (RMS), and plantar temperature, especially in the experimental group. The effect
was significantly better than that in the control group.
Conclusion
ESWT of the heel combined with the triceps trigger point of the calf can more effectively improve the pain,
function and quality of life of refractory PF than ESWT of the heel alone. In addition, the ESWT of the heel
combined with the triceps trigger point of the calf can effectively reduce the skin temperature of the heel on
the symptomatic side, indicating that the heel temperature measured by infrared thermal imaging may be
used as an independent tool to evaluate the therapeutic effect of patients with chronic plantar fasciitis.
Although extracorporeal shock waves combined with TrPs treatment can cause changes in the gait structure
of patients, plantar pressure is still difficult to use as an independent tool to evaluate the therapeutic effect
of plantar fasciitis.
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NewsBot · Dec 20, 2023

The Effectiveness Of Extracorporeal Shock Wave Therapy For Plantar Fasciitis: A Systematic Review And Meta-analysis
Youjin Jung
14 December 2023

Introduction
Extracorporeal shock wave therapy (ESWT) has been used since the 1990s to treat various musculoskeletal disorders, but there is considerable controversy regarding the effectiveness of ESWT. Our aim was to conduct a systematic review of randomized controlled trials (RCT) to investigate the effectiveness of ESWT for plantar fasciitis.

Methods
A comprehensive search was conducted via electronic databases including MEDLINE, Embase, the Cochrane Controlled trials register, and 5 Korean databases from inception date to April 2022. Two review authors independently assessed studies for inclusion and risk of bias, and extracted study data. Major outcomes were pain relief, function, and quality of life.

Results
We identified a total of 48 RCTs comparing ESWT with corticosteroid injection (n=14), conventional therapies (n=19), and sham control (n=21). Most studies included participants with chronic heel pain diagnosed as plantar fasciitis. All trials were susceptible to bias. In terms of pain results, ESWT showed no significant difference when compared with the steroid injection group and the conventional therapy group, and significant pain relief was confirmed only compared to the sham control group (Mean Difference -1.71; 95% confidence interval [CI] -2.44,-0.98; I2=70%. Functional outcomes were significantly improved in the ESWT group compared to the steroid injection group (standardized mean difference 0.45; 95% CI 0.27,0.63; I2=0%) and the sham control group (SMD 0.84, 95% CI 0.23,1.45; I2=91%), but no significant difference was found when compared to the conventional therapy group.

Conclusions
Based upon the currently available low certainty evidence because of wide clinical diversity and varying treatment protocols of included trials, ESWT is associated with improved function and may be associated with pain reduction in plantar fasciitis. Further evidence is needed from well-designed studies with a standard dose and treatment protocol.
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NewsBot · May 21, 2024

Comparing two protocols of shock wave therapy for patients with plantar fasciitis: A pilot study
Fatima A L Kalbani et al
PLoS One. 2024 May 6;19(5):e0302553

Objectives: This pilot study primarily aimed to detect the adherence as well as the effect size required to estimate the actual sample size needed for a larger scale study to compare and evaluate the effectiveness of two extracorporeal shock wave therapy (ESWT) protocols along, with a physical therapy program in reducing pain and improving function among patients suffering from plantar fasciitis. The study also aimed to report the effects of the ESWT protocols used on pain and function.

Methods: A total of 26 participants took part in the study, including 17 females and 9 males. The average age of the participants was 34 years with a body mass index (BMI) of 23 kg/m2. Participants were divided into three equal groups; Group A received ESWT at a frequency of 15 Hz and intensity of 3, Group B received ESWT at a frequency of 10 Hz and intensity of 4, while Group C underwent the selected physical therapy program along with sham shock wave therapy as a control. Pain levels were assessed using the Visual Analog Scale (VAS) while functional improvements were evaluated using the Foot Function Index (FFI). Data was collected prior to treatment, after three sessions and at the end of six weeks (after six sessions).

Results: The three groups were well matched, and the results revealed high adherence rates (90%, 90% and 80% respectively). Results also indicated reductions in pain levels and improvements in function for both intervention groups when compared to the control group. Group A demonstrated better outcomes compared to Group B while Group C showed relatively less improvement.

Conclusion: The study concluded a high adherence rate for the three groups as well as a small effect size detected of 0.282 that would suggest a total of 123 participants to be required to replicate the study on a larger scale. With regards to the findings of this pilot, the combination of ESWT and a targeted physical therapy program revealed a possible effective therapeutic approach for plantar fasciitis, with a higher frequency potentially yielding more favourable results
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NewsBot · May 26, 2024

Dose Escalation Can Enhance the Therapeutic Potential of Radial Extracorporeal Shock-Wave Therapy in the Treatment of Plantar Fasciitis in Runners
Sebastian Szajkowski et al
Medicina (Kaunas). 2024 May 6;60(5):766

Background and Objectives: Treatment of chronic plantar fasciitis is challenging given that there are various of available treatment options with no clear gold standard. The aim of the study was to examine the dose-escalation effect of rESWT on the biomechanical parameters of the plantar fascia and pain ailments. Materials and Methods: In the experimental group (n = 30), the intensity of the shock wave was increased every two subsequent treatment sessions. In the control group (n = 32), the treatment parameters were not changed. In both groups, six treatments were performed, with two treatment sessions a week. In order to assess the biomechanical parameters of the plantar fascia, myotonometric measurements were performed. The pain intensity was assessed using the Visual Analog Scale (VAS). Results: The tension of the plantar fascia attachment in the experimental group decreased from 27.69 ± 2.06 [Hz] before treatment to 26.29 ± 1.69 [Hz] after treatment (p = 0.009) and to 26.03 ± 2.15 [Hz] 1 month after the beginning of treatment (p = 0.003). In the control group, the frequency results did not change significantly (p > 0.05). Flexibility increased in both groups. The test results before treatment and 1 month after the beginning of the treatment showed statistical significance in the experimental group (p = 0.001) vs. (p = 0.002) in the control group. The differences were not statistically significant between groups (p > 0.05). The assessment of pain intensity carried out 1 month after the end of treatment in the experimental group amounted to 3.14 ± 2.28 points, which was statistically significantly lower compared to that in the control group, where it amounted to 5.14 ± 1.92 points. (p < 0.001). Conclusions: The use of rESWT performed with an increasing intensity of impact during subsequent treatment procedures demonstrated greater effectiveness in improving the biomechanical parameters of the plantar fascia and was also more effective in reducing the pain ailments. Our results are encouraging. The dose escalation in the treatment cycle is worth considering. To prove that this method of treatment is more effective, a randomized controlled trial should be carried out on a representative sample.
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NewsBot · Jul 4, 2024

Comparison of the Short-Term Effect between Iontophoresis and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial
Manuel Pabón-Carrasco et al
Healthcare (Basel). 2024 Jun 19;12(12):1223

Conservative treatments for plantar fasciitis have different levels of effectiveness, so it is necessary to personalize the therapeutic modality that improves the patients' symptoms.

Methods: A double-blinded randomized clinical trial was designed to evaluate the short-term efficacy of a physical treatment in chronic plantar fasciitis, namely iontophoresis, compared with radial shockwave therapy. Heel pain, health status using the EuroQol-5D questionnaire, and fascia thickness measured with ultrasound were evaluated. In total, 127 patients were randomly selected for group A and treated with iontophoresis therapy (lidocaine 0.4% and dexamethasone 0.5%), or for group B, in which they were treated with radial shockwave therapy (EWST). Measurements were taken at baseline and at follow-up during the 5 weeks of the study.

Results: Statistically significant differences were observed to the shockwave therapy group in respect to the final fascia thickness, and the VAS scale (p = 0.001). The differences between groups A and B showed that the shockwave group follow-up after 3 weeks experienced complete pain remission (1.0 ± 0.9; 95%CI 0.8-1.2) and after the 6-week follow-up, complete pain remission of plantar fasciitis was observed for both therapies. Patients had a better perception of the use of EWST at the end of the treatment, although in both groups it was satisfactory (p = 0.001).

Conclusions: The results of this study showed a shorter-term effectiveness of shockwave treatment compared with the use of iontophoresis. However, both techniques were effective in satisfactorily reducing pain in this short period.
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NewsBot · Jul 28, 2024

Effect of extracorporeal shockwave therapy on plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials
Mario Simental-Mendía, Luis E. Simental-Mendía, Adriana Sánchez-García, Amirhossein Sahebkar, Tannaz Jamialahmadi, Félix Vilchez-Cavazos, Víctor M. Peña-Martínez & Carlos Acosta-Olivo
Archives of Orthopaedic and Trauma Surgery 18 July 2024

Objective
Extracorporeal shockwave therapy (ESWT) has been used as a therapeutic option for plantar fasciitis. The objective was to investigate the effect of ESWT over the plantar fascia thickness.

Methods
MEDLINE, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials evaluating the effect of ESWT in patients with plantar fasciitis, comparing ESWT with another treatment. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Meta-regression and subgroup analyses were also carried out.

Results
A total of 14 studies (867 participants) were included. ESWT significantly decreased plantar fascia thickness (weighted mean difference [WMD], −0.21 mm [95% CI −0.39, −0.02]; p = 0.03). No significant improvement in pain was observed (WMD, −0.51 cm [95% CI −1.04, 0.01]; p = 0.06) compared with non-surgical interventions.

Conclusions
Our results suggest that plantar fascia thickness is significantly decreased after ESWT intervention in patients with plantar fasciitis. However, pain relief was not significantly improved compared to other non-surgical interventions.
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NewsBot · Sep 10, 2024

Investigation of The Effectiveness of Extracorporeal Shock Wave Therapy in Patients Diagnosed with Plantar Fasciitis: Comparison of Radial and Focus Applications
Özge Tezen et al
J Foot Ankle Surg. 2024 Aug 31

The aim of the study was to investigate the effectiveness of radial and focus ESWT treatment on pain, function and size of the calcaneal spur in patients with clinical and radiological diagnosis of plantar fasciitis. A total of 112 patients aged between 18 and 95 years, were divided into two groups; group 1, rESWT (2.4 bar 12 hz 2000 beats), group 2 received fESWT (0.14 bar 14 hz 1000 beats) three times a week for three weeks. All patients were evaluated using the Visual Analog Scale (VAS)-pain and Foot Function Index (FFI) before and after the treatment, at 4 week and 12 weeks. Calcaneal spur size was measured radiographically in the patients before and after the treatment at the 12 th week follow-up. According to our records, VAS scores were found to be similar between the groups before treatment and at follow-ups (all p>0.05). In both groups, a significant decrease in VAS scores was found in the follow-ups compared to before treatment (p<0.001). FFI total, pain, activity and disability scores were found to be similar between the groups before treatment and at follow-up (all p>0.05). In both groups, a significant decrease in FFI scores was found in the follow-ups compared to before treatment (p<0.001). Both of rESWT and fESWT were effective in plantar fasciitis treatment there were no significiant difference between two modalities in long term.
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NewsBot · Sep 15, 2024

Efficacy and tolerability of extracorporeal shock wave therapy in patients with plantar fasciopathy: a systematic review with meta-analysis and meta-regression
Lorenzo LIPPI et al
Source

INTRODUCTION: Plantar fasciopathy (PF) is a common musculoskeletal condition characterized by heel pain and functional impairment. Extracorporeal shock wave therapy (ESWT) has gained increasing interest in the treatment of PF, but the optimal ESWT program is still debated. Therefore, this systematic review with meta-analysis and meta-regression aimed at providing a comprehensive assessment of the efficacy and tolerability of ESWT in PF management.
EVIDENCE ACQUISITION: Randomized controlled trials (RCTs) published until February 2023 were systematically searched on PubMed/MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PEDro. Studies assessing adult patients with PF treated with ESWT were considered. The primary outcome was the tolerability of ESWT, measured by treatment adherence, dropouts, and safety. Secondary outcomes were pain intensity and functional outcomes. Meta-analysis and meta-regression were performed to examine the relationship between ESWT program characteristics and treatment outcomes. The quality of included studies was assessed using the Jadad scale and the Cochrane risk-of-bias tool.
EVIDENCE SYNTHESIS: Eleven studies met the inclusion criteria and were included in the analysis. Our findings showed that ESWT is effective in reducing pain intensity assessed by Visual Analogue Scale [focal-ESWT: -2.818 (SE 0.803, -4.393, -1.244; P< 0.0001; radial-ESWT: -3.038 (SE 0.428, -3.878, -2.199; P<0.001)]. Meta-regression analysis indicated a positive relationship between specific ESWT parameters (frequency, number of pulses, energy flux density and frequency, and number of pulses, pressure) and pain intensity (all P<0.05) and dropout (all P<0.05).
CONCLUSIONS: ESWT seems to be an effective and tolerable treatment for PF, albeit the peculiarity of parameters might affect both the efficacy in pain relief and the adherence to the treatment. Physicians should consider individual patient characteristics when selecting the ESWT parameters for PF treatment. Further high-quality studies are warranted to establish the optimal ESWT protocol to treat PF.
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Meta-analysis of shockwave therapy for plantar fasciitis

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Meta-analysis of shockwave therapy for plantar fasciitis

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Foot orthoses for plantar heel pain: a systematic review and meta-analysis

Onychomycosis: A Systematic Review and Network Meta-Analysis of Mycological Cure

Meta-analysis of plantar pressures in diabetes

Plantar Pressure Analysis of Accommodative Insole in Older People with Metatarsalgia

Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis--critical appr

Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomize

Plantar Fascia steroid injection; a group participation meta-analysis

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