SLR - December 2018 - Maya C. Trueman

Extracorporeal Shockwave Therapy Versus Kinesiology Taping in the Management of Plantar Fasciitis: A Randomized Clinical Trial

Reference: Ordahan B, Türkoglu G, Karahan AY, Akkurt HE. Extracorporeal Shockwave Therapy Versus Kinesiology Taping in the Management of Plantar Fasciitis: A Randomized Clinical Trial. Arch Rheumatol. 2017 Sept;32(3):227–233.

Scientific Literature Review

Reviewed By: Maya C. Trueman, DPM
Residency Program: Hoboken University Medical Center, Hoboken, NJ

Podiatric Relevance: It is of the utmost importance for a foot and ankle surgeon to be able to successfully evaluate and treat plantar fasciitis, as it is one of the most commonly encountered diagnoses in podiatric medicine. Treatment options are variable and can range from stretching exercises and night splints to cortisone injections and surgical fasciotomies. This study compares the effectiveness of kinesiology taping (KT) versus extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis. KT is a successful musculoskeletal treatment option as it promotes circulation and decreases inflammation. Similarly, ESWT acts by increasing angiogenesis at the targeted site. The authors hypothesized that the efficacies of these two treatments would have a measurable impact on patient-reported pain, functionality and quality of life levels.

Methods: This five-week long randomized clinical trial performed at the Konya Training and Research Hospital in Turkey consisted of 80 patients diagnosed with plantar fasciitis between November 2015 and February 2016. Patients were diagnosed clinically by the presence of pain to the plantar medial calcaneal tubercle as well as heel pain starting with the first steps in the morning. Patients were randomized into two treatment groups, with one to receive ESWT once weekly and the other group to receive KT every five days. Patient outcome measures were reported at the start and end of the five-week treatment period. Outcomes measures included pain measured on the visual analog scale (VAS), patient functionality measured by foot and ankle outcome scores (FAOS) and heel tenderness index (HTI).

Results: Both the ESWT and KT groups experienced significant improvement in VAS, HTI and FAOS scores. In regard to patient-reported pain levels, the ESWT group decreased from a mean score of 6.9 pre treatment to 3.8 following completion of treatment, while the KT group decreased from a mean of 7.4 pre treatment to 3.6 following treatment conclusion. No statistically significant differences were noted between groups in regard to VAS, HTI or FAOS scores.

Conclusions:
The study effectively demonstrates two reliable and simple treatment methods in the management of plantar fasciitis. While the study does not find either method superior, it provides physicians with a larger selection of treatment approaches, specifically two that allow the patient to fully weightbear and allow them an immediate return to activities of daily living as well as work. One limitation of this study is the absence of a control group. Additionally, it is important to recognize the limited time length of the study and follow-up periods, as symptoms may have recurred in these patients after study completion. Furthermore, the study population was not assessed for severity of plantar fasciitis, such as thickness of the plantar fascia via ultrasonography. Additional long-term studies are warranted, and a further breakdown of the level of severity and inflammation may be helpful in determining which treatment approach to use.

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