What is the efficacy of Extracorporeal Shock Wave Therapy (ESWT) for plantar fasciitis?

From the Guidelines

Extracorporeal Shock Wave Therapy (ESWT) is a viable treatment option for plantar fasciitis, particularly for patients who have not responded to conservative treatments, with a success rate of approximately 70-80% for chronic cases. When considering the efficacy of ESWT for plantar fasciitis, it's essential to weigh the benefits and risks, as well as the patient's overall health status and previous treatments. The treatment involves delivering acoustic pressure waves to the affected area, stimulating healing through microtrauma, increasing blood flow, and releasing growth factors 1. Key points to consider when recommending ESWT for plantar fasciitis include:

• The patient's response to initial treatment measures, such as customized orthotic devices, night splinting, and corticosteroid injections
• The presence of any contraindications, such as pregnancy or blood clotting disorders
• The potential for side effects, including redness, bruising, or soreness
• The importance of continuing supportive measures, like proper footwear and stretching exercises, during and after treatment Given the limited information available from the provided study 1, it's crucial to rely on the most recent and highest-quality evidence when making a definitive recommendation. However, based on the available data, ESWT can be considered a safe and effective treatment option for patients with chronic plantar fasciitis who have not responded to conservative treatments. It's essential to consult with a healthcare professional to determine the best course of treatment for each individual patient, taking into account their unique needs and health status. In clinical practice, ESWT is often reserved for patients who have failed to respond to initial treatments, and its efficacy is supported by the principle of stimulating healing and reducing pain in the affected area.

From the Research

Efficacy of Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis

• The efficacy of ESWT for plantar fasciitis has been studied in several research papers, with varying results 2, 3, 4, 5, 6.
• A randomized controlled trial published in 2023 found that both ESWT and platelet-rich plasma (PRP) injection were effective in improving pain and reducing plantar fascia thickness in patients with chronic plantar fasciitis, with PRP injection being more effective at a longer duration 2.
• Another study published in 2021 found that PRP injections and ESWT were both beneficial in pain amelioration in patients with chronic plantar fasciitis, with PRP injections showing better pain reduction results compared to ESWT 3.
• A study published in 2013 found that radial shock wave therapy was a safe and effective treatment for patients with chronic plantar fasciitis, with significant improvements in pain and functional capacity observed after completion of treatment and preserved throughout a one-year follow-up 4.
• A systematic review and meta-analysis published in 2024 found that ESWT performed significantly better than placebo for VAS pain score and Foot Function Index (FFI), but PRP outperformed ESWT for post-intervention VAS scores and FFI 5.
• A study published in 2023 found that both ESWT and low-level laser therapy (LLLT) were effective in improving pain, functional status, and daily life activities in patients with plantar fasciitis, with LLLT being more effective for alleviating pain than ESWT 6.

Comparison with Other Treatment Modalities

• ESWT has been compared to other treatment modalities, including PRP injection, custom orthotics, and LLLT, with varying results 2, 3, 5, 6.
• PRP injection has been found to be more effective than ESWT in some studies, while ESWT has been found to be more effective than custom orthotics in others 2, 5.
• LLLT has been found to be more effective than ESWT for alleviating pain in one study, but less effective for improving functional status 6.

Overall Efficacy

• The overall efficacy of ESWT for plantar fasciitis is supported by several studies, with significant improvements in pain and functional capacity observed in patients treated with ESWT 2, 3, 4, 5, 6.
• However, the efficacy of ESWT may vary depending on the specific treatment protocol and patient population, and further research is needed to fully understand its effects 2, 3, 4, 5, 6.