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Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs

Abstract

Background

Plantar fasciitis is the most common cause of heel pain. It may remain symptomatic despite conservative treatment with orthoses and analgesia. There is conflicting evidence concerning the role of extracorporeal shock wave therapy (ESWT) in the management of this condition.

Questions/purposes

We investigated whether there was a significant difference in the change of (1) VAS scores and (2) Roles and Maudsley scores from baseline when treated with ESWT and placebo. Specifically we compared overall improvement from baseline composite VAS, reduction in overall VAS pain, success rate of improving overall VAS pain by 60%, success rate of improving VAS pain by 60% when taking first steps, doing daily activities, and during application of a pain pressure meter.

Methods

MEDLINE, Embase, and CINAHL databases were searched from January 1980 to January 2013 and a double extraction technique was used to obtain relevant studies. Studies had to be prospective randomized controlled trials on adults and must not have used local anesthesia as part of their treatment protocol. Studies must have specifically recruited patients who continued to be symptomatic despite a minimum of 3 months of conservative treatments. All papers were assessed regarding their methodologic quality and a meta-analysis performed. Seven prospective randomized controlled trials were included in this study. There were 369 patients included in the placebo group and 294 in the ESWT group.

Results

After ESWT, patients had better composite VAS scores (random effects model, standardized mean difference [SMD] = 0.38; 95% CI, 0.05, 0.72; z = 2.27). They also had a greater reduction in their absolute VAS scores compared with placebo (random effects model, SMD = 0.60; 95% CI, 0.34, 0.85; z = 4.64). Greater success of improving heel pain by 60% was observed after ESWT when taking first steps (random effects model, risk ratio [RR] = 1.30; 95% CI, 1.04, 1.62; z = 2.29) and during daily activities (random effects model, RR = 1.44; 95% CI, 1.13, 1.84; z = 2.96). Subjective measurement of pain using a pressure meter similarly favored ESWT (random effects model, RR = 1.37, 95% CI, 1.06, 1.78; z = 2.41). There was a significant difference in the change to “excellent - good” Roles and Maudsley scores in favor of the ESWT group.

Conclusions

ESWT is a safe and effective treatment of chronic plantar fasciitis refractory to nonoperative treatments. Improved pain scores with the use of ESWT were evident 12 weeks after treatment. The evidence suggests this improvement is maintained for up to 12 months. We recommend the use of ESWT for patients with substantial heel pain despite a minimum of 3 months of nonoperative treatment.

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References

  1. 1.

    ACFAS Clinical Practice Guideline Heel Pain Panel. The diagnosis and treatment of heel pain. J Foot Ankle Surg. 2001;40:329–340.

    Article  Google Scholar 

  2. 2.

    Atkins D, Crawford F, Edwards J, Lambert M. A systematic review of treatments for the painful heel. Rheumatology (Oxford). 1999;38:968–973.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Buchbinder R. Clinical practice: plantar fasciitis. N Engl J Med. 2004;350:2159–2166.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Chang KV, Chen SY, Chen WS, Tu YK, Chien KL. Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: a systematic review and network meta-analysis. Arch Phys Med Rehabil. 2012;93:1259–1268.

    PubMed  Article  Google Scholar 

  5. 5.

    Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;3:CD000416.

    PubMed  Google Scholar 

  6. 6.

    Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008;36:2100–2109.

    PubMed  Article  Google Scholar 

  7. 7.

    Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46:348–537.

    PubMed  Article  Google Scholar 

  8. 8.

    Ibrahim MI, Donatelli RA, Schmitz C, Hellman MA, Buxbaum F. Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int. 2010;31:391–397.

    PubMed  Article  Google Scholar 

  9. 9.

    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Malay DS, Pressman MM, Assili A, Kline JT, York S, Buren B, Heyman ER, Borowsky P, LeMay C. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg. 2006;45:196–210.

    PubMed  Article  Google Scholar 

  11. 11.

    Marks W, Jackiewicz A, Witkowski Z, Kot J, Deja W, Lasek J. Extracorporeal shock-wave therapy (ESWT) with a new-generation pneumatic device in the treatment of heel pain: a double blind randomised controlled trial. Acta Orthop Belg. 2008;74: 98–101.

    PubMed  Google Scholar 

  12. 12.

    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg. 2000;87:1448–1454.

    Article  CAS  Google Scholar 

  13. 13.

    PRISMA. Transparent Reporting of Systematic Reviews and Meta-Analyses. Available at: http://www.prisma-statement.org/statement.htm. Accessed November 23, 2012.

  14. 14.

    Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br. 1972;54:499–508.

    PubMed  CAS  Google Scholar 

  15. 15.

    Rompe JD. Plantar fasciopathy. Sports Med Arthrosc. 2009;17:100–104.

    PubMed  Article  Google Scholar 

  16. 16.

    Rompe JD, Buch M, Gerdesmeyer L, Haake M, Loew M, Maier M, Heine J. [Musculoskeletal shock wave therapy: current database of clinical research][in German]. Z Orthop Ihre Grenzgeb. 2002;140:267–274.

    PubMed  Article  Google Scholar 

  17. 17.

    Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes: a prospective, randomized, placebo-controlled trial. Am J Sports Med. 2003;31:268–275.

    PubMed  Google Scholar 

  18. 18.

    Rompe JD, Furia J, Weil L, Maffulli N. Shock wave therapy for chronic plantar fasciopathy. Br Med Bull. 2007;81–82:183–208.

    PubMed  Article  Google Scholar 

  19. 19.

    SIGN. Methodology checklist 1: systematic reviews and meta-analyses. Available at: http://www.sign.ac.uk/guidelines/fulltext/50/checklist1.html. Accessed November 23, 2012.

  20. 20.

    Speed CA, Nichols D, Wies J, Humphreys H, Richards C, Burnet S, Hazleman BL. Extracorporeal shock wave therapy for plantar fasciitis: a double blind randomised controlled trial. J Orthop Res. 2003;21:937–940.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int. 2004;25:290–297.

    PubMed  Google Scholar 

  22. 22.

    Weil LS Jr, Roukis TS, Weil LS, Borrelli AH. 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. 2002;41:166–172.

    PubMed  Article  Google Scholar 

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Correspondence to Adeel Aqil MRCS.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Imperial College London, Charing Cross Campus, London, UK.

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Cite this article

Aqil, A., Siddiqui, M.R.S., Solan, M. et al. Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs. Clin Orthop Relat Res 471, 3645–3652 (2013). https://doi.org/10.1007/s11999-013-3132-2

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Keywords

  • Local Anesthetic
  • Risk Ratio
  • Random Effect Model
  • Nonoperative Treatment
  • Extracorporeal Shock Wave Therapy