Skip to main content


Log in

A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript



Troublesome heel spur is a nuisance condition that affects people of all ages. Treatment of patients with heel spur is a difficult and lengthy process requiring patience from both the patient and the therapist. Sometimes, the only and ultimate method of treatment is surgery, although spurs tend to recur. The aim of the study is a comparative analysis of the analgesic efficacy of ultrasound and shock wave therapy in patients with heel spur. The cause of pain in the course of calcaneal spur is inflammation of the attachment of the plantar fascia, which plays an important role in the process of walking and is seriously strained during different types of movement. Treatment of patients is a difficult and lengthy process.

Materials and methods

The study was conducted on a group of 47 patients of both sexes, aged 38–60 years (mean 51.3) with a plantar calcaneal spur confirmed by X-ray images. Patients were randomly assigned into two groups using a simple randomization: Group 1—ultrasound therapy group (a series of ten treatments) and Group 2—the radial shock wave group (series of four treatments). In all patients, pain intensity was assessed three times: before therapy, after the first and second weeks of treatment. A version of Laitinen’s pain assessment questionnaire and the Huskisson visual analogue scale (VAS) were used. Of the group of studied respondents, 47 patients of both sexes and aged 38–60 years (mean age 51.3) with a heel spur (confirmed on X-rays), who had pain for at least a month, were randomly included in the study. The patients were classified into: Group 1—US therapeutic group (a series of ten treatments) and Group 2—with RSWT (a series of five treatments). Pain intensity was assessed three times: before the treatment, after the first and second week of the treatment with the application of the VAS and the Leitinen Pain Questionnaire.


However, a decrease in pain sensation was reported in all test intervals, and its largest decrease occurred in both groups within 1 week of beginning treatment. More dynamic change in this period was recorded in Group 1.


The conclusion is that while ultrasound and shock wave therapy show significant analgesic efficacy in patients with heel spur, fewer shock wave therapy sessions are needed than ultrasound sessions for effective relief, suggesting that the shock wave therapy has greater analgesic efficacy. A similar analgesic effect was achieved with the administration of a smaller number of shock wave treatments and a full series of ultrasound treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others



Shock wave therapy




Visual analogue scale


Extracorporeal shock wave therapy


Energy density flux


Radial shock wave therapy


  1. Lorkowski J, Hładki W, Galicka-Latała D, Trybus M, Brongel L (2009) Estimation of underfoot pressure distribution of female patients with obesity and bilateral plantar fasciitis. Przeg Lek 66(9):513–518 (in Polish)

    Google Scholar 

  2. Thomson CE, Crawford F, Murray GD (2005) The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and metaanalysis. BMC Musculoskelet Disord 6(4):19–30

    Article  PubMed  PubMed Central  Google Scholar 

  3. Frey C, Zamora J (2007) The effects of obesity on orthopaedic foot and ankle pathology. Foot Ankle Int 28(9):996–999

    Article  PubMed  Google Scholar 

  4. Gefen A (2002) Stress analysis of the standing foot following surgical plantar fascia release. J Biomech 35(5):629–637

    Article  PubMed  Google Scholar 

  5. Toomey EP (2009) Plantar heel pain. Foot Ankle Clin 14(2):229–245

    Article  PubMed  Google Scholar 

  6. Boerner E, Toruń-Kotarska E, Kusiciel-Lewandowska J (2009) The comparison of the efficiency of ultrasounds therapy of calcanean spur depending on therapeutic dose. Acta Bio-Optica Inform Med 15(3):230–233 (in Polish)

    Google Scholar 

  7. Rompe JD (2009) Plantar fasciopathy. Sports Med Arthrosc 17(2):100–104

    Article  PubMed  Google Scholar 

  8. Roxas M (2005) Plantar fasciitis: diagnosis and therapeutic considerations. Altern Med Rev 10(2):83–93

    PubMed  Google Scholar 

  9. Jasiak-Tyrkalska B, Jaworek J, Frańczuk B (2007) Efficacy of two different physiotherapeutic procedures in comprehensive therapy of plantar calcaneal spur. Fizjoter Pol 2(4):145–154 (in Polish)

    Google Scholar 

  10. Thomas JL, Christensen JC, Kravitz SR et al (2001) The diagnosis and treatment of heel pain. J Foot Ankle Surg 40(5):329–340

    Article  Google Scholar 

  11. Burnfield JM, Few CD, Mohammed OS, Perry J (2004) The influence of walking speed and footwear on plantar pressures in older adult. Clin Biomech 19(1):78–84

    Article  Google Scholar 

  12. Hills AP, Hennig EM, McDonald M, Bar-Or O (2001) Plantar pressure differences between obese and non-obese adults: a biomechanical analysys. Int J Obes Relat Metab Disord 25(11):1674–1679

    Article  CAS  PubMed  Google Scholar 

  13. Laitinen J (1978) Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbalgia and ischialgia. Am J Chin Med 4(2):169–175

    Article  Google Scholar 

  14. Huskinsson EC (1974) Measurement of pain. Lancet 2(7889):1127–1131

    Article  Google Scholar 

  15. Marks W, Lasek J, Jackiewicz A, Witkowski Z, Stasiak M, Dawid S (2008) New generation low-energy extracorporeal shock waves for the treatment of calcaneal spur—a double-blind randomized study. Kwart Ortop 2:219–226 (in Polish)

    Google Scholar 

  16. Vitali M, Caforio M, DeBartolomeo O, Pozzi A, Fraschini G, Albisetti W (2009) Extracorporeal shock waves therapy in the treatment of trochanteric bursitis: a pilot study. Rehabil Med 13(4):17–21 (in Polish)

    Google Scholar 

  17. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A (2002) Ultrasound-guided extracoroporeal shock wave therapy for plantar fasciitis. A Randomized Controlled Trial. JAMA 288(11):1364–1372

    Article  Google Scholar 

  18. Król P, Franek A, Zinka W, Kubacki J, Polak A, Franek E (2009) Focused and radial shock wave in orthopedics and physiotherapy. Fizjoter Pol 1(4):1–20 (in Polish)

    Google Scholar 

  19. Sabeti-Aschraf M, Dorotka R, Goll A, Trieb K (2005) Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff. Am J Sports Med 33(9):1365–1368

    Article  PubMed  Google Scholar 

  20. Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L (2005) Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application without local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res 23:931–941

    Article  PubMed  Google Scholar 

  21. Wang ChJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS et al (2003) Shock wave therapy induces neovascularization al the tendon-bone junction. A study in rabbits. J Orthop Res 21:984–989

    Article  PubMed  Google Scholar 

  22. Wang CJ, Yang KD, Wang FS, Chen HH, Wang JW (2003) Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med 31:425–430

    PubMed  Google Scholar 

  23. Haake M, Buch M, Schoellner C (2003) Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ 327(7406):75–79

    Article  PubMed  PubMed Central  Google Scholar 

  24. Thiel M (2001) Application of shock waves in medicine. Clin Orthop Relat Res 387(2–3):18–21

    Article  PubMed  Google Scholar 

  25. Speed CA (2004) Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. J Bone Joint Surg 86-B(2):165–171

    Article  Google Scholar 

  26. Rompe JD, Schoellner C, Nafe B (2002) Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg 84(3):335–341

    Article  PubMed  Google Scholar 

  27. Straburzyńska-Lupa A, Kornacka A (2005) Ultrasound therapy in the treatment of calcar pedis—own experiences. Ortop Traumatol Rehabil 7(1):79–86 (in Polish)

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Monika Sienkiewicz.

Ethics declarations

Conflict of interest


Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krukowska, J., Wrona, J., Sienkiewicz, M. et al. A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs. Arch Orthop Trauma Surg 136, 1289–1296 (2016).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: