SLR - July 2015 - Eric Muhm
Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized, Controlled Multicenter Study
Reference: Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouche RT, Caminear DS, Fullem B, Vester JC, Horn C, Banke JJ, Burgkart R, Gerdesmeyer L. Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized, Controlled Multicenter Study. J Bone Joint Surg Am. 2015 May 6; 97(9): 701-8.
Reviewed By: Eric Muhm, DPM
Residency Program: Detroit Medical Center, Detroit, MI
Podiatric Relevance: Plantar fasciitis is one of the most common ailments seen by podiatric physicians and the most common overall cause of heel pain. The majority of cases are successfully treated non-surgically with reported success rates as high as 90 percent. Previous studies have examined the use of extracorporal shock wave therapy (ESWT) in the treatment of plantar fasciitis with mixed results. This study attempts to provide level 1 clinical evidence for the use of ESWT in the treatment of chronic plantar fasciitis.
Methods: This double-blind, randomized, placebo-controlled trial was conducted at five study centers in the United States. A total of 250 patients were enrolled over a fifty-week period and were randomly assigned to extracorporeal shock wave therapy (n = 126) or placebo intervention (n = 124). After three interventions of ESWT or a placebo therapy in weekly intervals, patients were followed for twelve weeks after the last intervention. Success of each therapy was measured by percentage change of heel pain on the visual analog scale (pain with daily activity, pain with first steps in the morning, and pain with a force meter) as well as the patients Roles and Maudsley functional improvement scores.
Results: 246/250 (98.4%) patients remained enrolled in the study through the 12 week follow-up period. The percentage difference in VAS score was measured for both the ESWT group (69.2%) and the placebo group (34.5%) which was found to be statistically significant in favor of ESWT. Roles and Maudsley functional improvement scores were also measured and ESWT was found to be superior to the placebo therapy.
Conclusion: The clinical effectiveness of ESWT for the treatment of plantar fasciitis has shown mixed results in previously published studies. This study provides supporting evidence for the use of ESWT as a non-surgical treatment of chronic plantar fasciitis with success rates between 55-65%.