Archives of Orthopaedic and Trauma Surgery

, Volume 115, Issue 2, pp 75–79 | Cite as

Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study

  • J. D. Rompe
  • C. Hopf
  • B. Nafe
  • R. Bürger
Original Article


The aim of this prospective single-blind pilot study was to explore the pain-alleviating effect of low-energy extracorporeal shock wave therapy (ESWT) in painful heel associated with inferior calcaneal spurs. Thirty patients who suffered from persistent symptoms for more than 12 months qualified for low-energy ESWT and were assigned at random to two groups, real or simulated ESWT. Before beginning the treatment, any other therapy was stopped for a period of 6 weeks. The shock waves were applied by an experimental device allowing exact localization through an integrated fluoroscopy unit. Patients were treated three times at weekly intervals. Each time 1000 impulses of 0.06 mJ/mm2 were given around the heel spur. Follow-ups were done after 3, 6, 12 and 24 weeks. Patients of the placebo group who did not improve at the 6-week follow-up were then offered ESWT therapy and were checked at 3, 6, 12 and 24 weeks after the last treatment. Whereas we noticed no significant differences between the groups before ESWT, there was a significant alleviation of pain and improvement of function at all follow-ups in the treatment group.


Placebo Treatment Group Shock Wave Pilot Study Placebo Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Barrett SL, Day SV (1991) Endoscopic plantar fasciotomy for chronic plantar fasciitis/heel spur syndrome: surgical technique — early clinical results. J Foot Surg 30:568–570Google Scholar
  2. 2.
    Baxter DE, Thigpen CM (1984) Heel pain: operative results. Foot Ankle 5:16–22Google Scholar
  3. 3.
    Bergmann JN (1990) History and mechanical control of heel spur pain. Clin Podiatr Med Surg 7:243–259Google Scholar
  4. 4.
    Bordelon RL (1983) Subcalcaneal pain, a method of evaluation and plan for treatment. Clin Orthop 177:49–59Google Scholar
  5. 5.
    Campbell JW, Inman VT (1974) Treatment of plantar fasciitis and calcaneal spurs with the UC-BL shoe insert. Clin Orthop 103:57–62Google Scholar
  6. 6.
    Chandler TJ, Kiblerm WB (1993) A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. Sports Med 15:344–352Google Scholar
  7. 7.
    Chard MD, Hazleman BL (1989) Tennis elbow — a reappraisal. Br J Rheumatol 28:186–192Google Scholar
  8. 8.
    Conti RJ, Shinder M (1991) Soft tissue calcifications induced by local corticosteroid injection. J Foot Surg 30:34–37Google Scholar
  9. 9.
    Dahmen GP, Meiss L, Nam VC, Skruodies B (1991) Extrakorporale Stoßwellentherapie (ESWT) im knochennahen Weichteilbereich an der Schulter. Extracta Orthop 15:25–28Google Scholar
  10. 10.
    Daly PJ, Kitaoka HB, Chao EY (1992) Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. Foot Ankle 13:188–195Google Scholar
  11. 11.
    Du Vries JL (1957) Heel spur (calcaneal spur). Arch Surg 74:536–543Google Scholar
  12. 12.
    Furey JG (1975) Plantar fasciitis: the painful heel syndrome. J Bone Joint Surg [Am] 57:672–680Google Scholar
  13. 13.
    Graham CE (1983) Painful heel syndrome: rationale and treatment. Foot Ankle 3:261–268Google Scholar
  14. 14.
    Greer Richardson E (1992) Painful heel. In: Crenshaw AH (ed) Campbell's operative orthopaedics, vol 4. Mosby, St. Louis, pp 2787–2792Google Scholar
  15. 15.
    Griffith JD (1910) Osteophytes of the os calcis. Am J Orthop Surg 8:501–510Google Scholar
  16. 16.
    Haist J, Steeger D, Witzsch U, Bürger RA, Haist U (1992) The extracorporal shockwave therapy in the treatment of disturbed bone union. 7th Int. Conference on Biomedical Engineering, Singapore, 222–224Google Scholar
  17. 17.
    Hassab HK, El-Sherif AS (1974) Drilling of the os calcis for painful heel with calcaneal spur. Acta Orthop Scand 45:152–157Google Scholar
  18. 18.
    Kinley S, Frascone S, Calderone D, Wertheimer SJ, Squire MA, Wiseman FA (1993) Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study. J Foot Ankle Surg 32:595–603Google Scholar
  19. 19.
    Kuhns JC (1949) Changes in elastic adipose tissue. J Bone Joint Surg [Am] 31:541–548Google Scholar
  20. 20.
    Lapidus PW, Guidotti FP (1965) Painful heel: report of 323 patients with 364 painful heels. Clin Orthop 39:178–185Google Scholar
  21. 21.
    Lester DK, Buchanan JR (1984) Surgical treatment of plantar fasciitis. Clin Orthop 186:202–204Google Scholar
  22. 22.
    Loew M, Jurgowski W (1993) Extracorporale StoßwellenLithotripsie bei Tendinosis calcarea. Z Orthop 131:470–473Google Scholar
  23. 23.
    Manoli A, Harper MC, Fitzgibbons TC, McKeman DJ (1992) Calcaneal fracture after cortical bone removal. Foot Ankle 13:523–525Google Scholar
  24. 24.
    Michele AA, Kruger FJ (1951) Plantar heel pain treated by countersinking osteotomy. Milit Surg 109:26–34Google Scholar
  25. 25.
    Mitchell IR, Meyer C, Krueger WA (1991) Deep fascia of the foot. Anatomical and clinical considerations. J Am Pediatr Med Assoc 81:373–378Google Scholar
  26. 26.
    Schepsis AA, Leach RE, Gorzyca J (1991) Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. Clin Orthop 266:185–196Google Scholar
  27. 27.
    Self TC, Kunz RE, Young G (1993) Transverse plantar incision for heel spur surgery. Four-year follow-up survey of 35 patients. J Am Podiatr Med Assoc 83:259–262Google Scholar
  28. 28.
    Snider MP, Clancy WG, McBeath AA (1983) Plantar fascia release for chronic plantar fasciitis in runners. Am J Sports Med 11:215–219Google Scholar
  29. 29.
    Snook GA, Chrisman OD (1972) The management of subcalcaneal pain. Clin Orthop 82:163–171Google Scholar
  30. 30.
    Steindler A, Smith AR (1938) Spurs of the os calcis. Surg Gynecol Obstet 66:663–671Google Scholar
  31. 31.
    Sukul K, Johannes EJ, Pierik E, van Eijck G, Kristelijn M (1992) The effect of high energy shock waves focused on cortical bone: an in vitro study. J Surg Res 53:110–116Google Scholar
  32. 32.
    Tanz SS (1963) Heel pain. Clin Orthop 28:169–174Google Scholar
  33. 33.
    Valchanou VD, Michailov P (1991) High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 15:181–184Google Scholar
  34. 34.
    Wagner KL, Sharkey PF (1991) The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle 12:135–137Google Scholar
  35. 35.
    Ward WG, Clippinger FW (1987) Proximal medial longitudinal arch incision for plantar fascia release. Foot Ankle 8:152–155Google Scholar
  36. 36.
    Woolnough J (1954) Tennis heel. Med J Aust 2:857–862Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • J. D. Rompe
    • 1
  • C. Hopf
    • 1
  • B. Nafe
    • 2
  • R. Bürger
    • 3
  1. 1.Department of OrthopaedicsUniversity HospitalMainzGermany
  2. 2.Institute for Medical StatisticsJohannes-Gutenberg UniversityMainzGermany
  3. 3.Urologic University HospitalJohannes Gutenberg UniversityMainzGermany

Personalised recommendations