Skip to main content

Shock-wave therapy improved outcome with plantar fasciitis: a meta-analysis of randomized controlled trials



Shock-wave therapy (SWT) has been widely applied and proven to be an effective treatment in ameliorating symptoms of plantar fasciitis (PF). Ultrasound therapy (UT) is another common treatment of PF, and several researches have documented its advantages when compared to corticosteroid injection. Despite this, few studies have focused on comparing the use of SWT and UT in the treatment of PF. The purpose of our meta-analysis is to evaluate whether SWT is better than UT in managing PF, both in terms of ameliorating pain and improving functionality.


A systematic search of the literature was conducted to identify relevant articles that were published in Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical and OVID from the databases’ inception to October 2018. All studies comparing the efficacy of SWT and UT in terms of pain levels and functionality improvement were included. Data on the two primary outcomes were collected and analyzed using the Review Manager 5.3.


Five studies were included in the current meta-analysis. A significant difference in VAS score (MD = − 13.14, Cl − 14.07 to − 12.75 P < 0.00001, I2 = 100%) was noted between the SWT group and the UT group. No significant difference was seen in the AOFAS (MD = 3.19, Cl − 1.72 to 8.10 P = 0.20, I2 = 100%); FFI or PFPS score was not found significant difference either (SMD = − 1.17, Cl − 4.45 to 2.10 P = 0.48, I2 = 96%).


The results from this meta-analysis highlight the effectiveness of both SWT and UT in the treatment of PF. Although inter-group differences were not significant, the VAS score was better improved in the SWT group, suggesting that SWT may be a superior alternative for the treatment of PF.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Data availability

Please contact author for data requests.



Shock-wave therapy


Ultrasound therapy


Plantar fasciitis


Visual analog scale


Heel tenderness index


Foot function index


Laitinen questionnaire


Plantar fasciitis pain and disability scale


American orthopaedic foot and ankle society


Roles-maudsley score


Randomized controlled trial


  1. Thomson CE, Crawford F, Murray GD (2005) The effectiveness of extracorporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 6:19

    Article  Google Scholar 

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

    PubMed  Google Scholar 

  3. Gross MT, Byers JM, Krafft JL, Lackey EJ et al (2002) The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. J Orthop Sports Phys Ther 32:149–157

    Article  Google Scholar 

  4. Abbassian A, Kohls-Gatzoulis J, Solan MC (2012) Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis. Foot Ankle Int 33:14–19

    Article  Google Scholar 

  5. Powell M, Post WR, Keener J, Wearden S (1998) Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int 19:10–18

    Article  CAS  Google Scholar 

  6. DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA et al (2003) Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 85:1270–1277

    Article  Google Scholar 

  7. Landorf KB, Radford JA, Keenan AM et al (2005) Effectiveness of low-dye taping for the short-term management of plantar fasciitis. J Am Podiatr Med Assoc 95(6):525–530

    Article  Google Scholar 

  8. Böddeker R, Schäfer H, Haake M (2001) Extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis–a biometrical review. Clin Rheumatol 20(5):324–330

    Article  Google Scholar 

  9. Buchbinder R, Ptasznik R, Gordon J et al (2002) Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA 288(11):1364–1372

    Article  Google Scholar 

  10. Basford JR, Malanga GA, Krause DA et al (1998) A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis. Arch Phys Med Rehabil 79(3):249–254

    Article  CAS  Google Scholar 

  11. Kamel M, Kotob H (2000) High frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. J Rheumatol 27(9):2139–2141

    PubMed  CAS  Google Scholar 

  12. Probe RA, Baca M, Adams R et al (1999) Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res 368:190–195

    Article  Google Scholar 

  13. Gollwitzer H, Saxena A, DiDomenico LA et al (2015) Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Jt Surg Am 97:701–708

    Article  Google Scholar 

  14. Dizon JN, Gonzalez-Suarez C, Zamora MT et al (2013) Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil 92:606–620

    Article  Google Scholar 

  15. Sweeting D, Parish B, Hooper L et al (2011) The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review. J Foot Ankle Res 4:19–32

    Article  Google Scholar 

  16. Gerdesmeyer L, Frey C, Vester J et al (2008) Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis results of a confirmatory randomized placebocontrolled multicenter study. Am J Sports Med 36(11):2100–2109

    Article  Google Scholar 

  17. Cornwall MW, McPoil TG (1999) Plantar fasciitis: etiology and treatment. J Orthop Sports Phys Ther 29(12):756–760

    Article  CAS  Google Scholar 

  18. Katzap Y, Haidukov M, Berland OM et al (2018) Additive effect of therapeutic ultrasound in the treatment of plantar fasciitis: a randomized controlled trial. J Orthop Sports Phys Ther 48:847–855

    Article  Google Scholar 

  19. Li H, Lv H, Lin T (2018) Comparison of efficacy of eight treatments for plantar fasciitis: a network meta-analysis. J Cell Physiol 234:860–870

    Article  CAS  Google Scholar 

  20. Krukowska J, Wrona J, Sienkiewicz M et al (2016) 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

    Article  Google Scholar 

  21. Ulusoy A, Cerrahoglu L, Orguc S (2017) Magnetic resonance imaging and clinical outcomes of laser therapy, ultrasound therapy, and extracorporeal shock wave therapy for treatment of plantar fasciitis: a randomized controlled trial. J Foot Ankle Surg 56:762–767

    Article  Google Scholar 

  22. Akinoglu B, Köse N, Kirdi N et al (2017) Comparison of the acute effect of radial shock wave therapy and ultrasound therapy in the treatment of plantar fasciitis: a randomized controlled study. Pain Med 18:2443–2452

    Article  Google Scholar 

  23. Konjen N, Napnark T, Janchai S (2015) A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial. J Med Assoc Thai 98(Suppl 1):S49–S56

    PubMed  Google Scholar 

  24. Cheing G, Chang H, Lo SK (2007) A comparison of the effectiveness of extracorporeal shock wave. Shock Waves 17:195–201

    Article  Google Scholar 

  25. Roerdink RL, Dietvorst M, van der Zwaard B et al (2017) Complications of extracorporeal shockwave therapy in plantar fasciitis: systematic review. Int J Surg 46:133–145

    Article  CAS  Google Scholar 

  26. Hammer DS, Adam F, Kreutz A et al (2005) Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy. Arch Orthop Trauma Surg 125:6–9

    Article  Google Scholar 

  27. Ibrahim MI, Donatelli RA, Schmitz C et al (2010) Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int 31:391–397

    Article  Google Scholar 

  28. Ilieva EM (2013) Radial shock wave therapy for plantar fasciitis: a one year follow-up study. Folia Med 55:42–48 (Plovdiv)

    Article  Google Scholar 

  29. Ogden JA, Alvarez RG, Levitt R (2001) Shockwave therapy for chronic proximal plantar fasciitis. Clin Orthop Relat Res 387:47–59

    Article  Google Scholar 

  30. Rompe JD, Kirkpatrick CJ, Schwitalle M et al (1998) Dose-related effects of shock waves on rabbit tendon Achilles: a sonographic and histologic study. J Bone Jt Surg Br 80:546–552

    Article  CAS  Google Scholar 

  31. Boerner E, Torun´-Kotarska E, Kusiciel-Lewandowska J (2009) The comparison of the efficiency of ultrasounds therapy of calcanean spur depending on therapeutic dose. Acta Bio-Opt Inf Med 15(3):230–233

    Google Scholar 

  32. Straburzyn´ska-Lupa A, Kornacka A (2005) Ultrasound therapy in the treatment of calcar pedis-own experiences. Ortop Traumatol Rehabil 7(1):79–86

    Google Scholar 

  33. Takla MKN, Rezk SSR (2018) Clinical effectiveness of multi-wavelength photobiomodulation therapy as an adjunct to extracorporeal shock wave therapy in the management of plantar fasciitis: a randomized controlled trial. Lasers Med Sci 34:583–593

    Article  Google Scholar 

  34. Dogramaci Y, Kalaci A, Emir A et al (2010) Intracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial. Arch Orthop Trauma Surg 130:541–546

    Article  Google Scholar 

  35. Molund M, Husebye EE, Hellesnes J et al (2018) Proximal medial gastrocnemius recession and stretching versus stretching as treatment of chronic plantar heel pain. Foot Ankle Int 39:1423–1431

    Article  Google Scholar 

  36. Othman A, Ragab EM (2010) Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 130:1343–1347

    Article  Google Scholar 

  37. Weil LS, Roukis TS, Weil LS et al (2002) Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and a comparison of results to fasciotomy. J Foot Ankle Surg 41(3):166–172

    Article  Google Scholar 

  38. Ogden JA (2004) Extracorporeal shock wave therapy for plantar fasciitis: randomized controlled multicenter trial. Br J Sports Med 38:382

    Article  CAS  Google Scholar 

  39. Zhang JY, Nie DB, Rocha JL et al (2018) Characterization of the structure, cells, and cellular mechanobiological response of human plantar fascia. J Tissue Eng 9:2041731418801103

    Article  CAS  Google Scholar 

  40. Zhu F, Johnson JE, Hirose CB, Bae KT (2005) Chronic plantar fasciitis: acute changes in the heel after extracorporeal high-energy shock wave therapy-observations at MR imaging. Radiology 234:206–210

    Article  Google Scholar 

Download references


This work was accomplished with the help of the library of Huazhong University of Science and Technology.


This study was supported by grants from the National Natural Science Foundation of China (No. 81772345). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations



YX and HX participated in the design of the study; BM and YL carried out data curation; JL and QW performed the statistical analysis; LC and QW carried out investigation; BM and CY carried out project administration; YS and WZ operated software; YX carried out supervision; LH and WZ carried out validation; YX and HX conceived the study, and participated in its design and coordination and helped to draft the manuscript; GL. YX and AP participated in the sequence alignment and drafted the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Bobin Mi or Guohui Liu.

Ethics declarations

Conflict of interest

All the authors responsible for this work declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, H., Xiong, Y., Zhou, W. et al. Shock-wave therapy improved outcome with plantar fasciitis: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 139, 1763–1770 (2019).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI:


  • Plantar fasciitis
  • Shock wave
  • Ultrasound
  • Therapy