Radial shock wave therapy for plantar fasciitis: a one year follow-up study

The vast majority of published papers on the efficacy of extracorporeal shockwave therapy (ESWT) have come up with rather controversial results in patients with plantar fasciitis. The AIM of the present study was to investigate the effect of radial shock wave therapy in patients with chronic proximal plantar fasciitis.

Twenty-one patients were included in the study (mean age 51.29 +/- 2.02 yrs, mean duration of symptoms 10.14 +/- 1.11 mos). Radial shock wave therapy was administered in five sessions. Total number of shocks per session was 2500 at a pressure of 2.5 bars. Visual analog scale (VAS) and a modification of the clinical rating system of the American Orthopedic Foot and Ankle Society (AOFAS) were used for outcome measurement. The patients were assessed before treatment and followed up 3, 6, and 12 months after end of treatment.

Statistically significant improvement in pain and functional capacity was found after completion of treatment in comparison with baseline; the improvement was preserved throughout a one-year follow-up. VAS mean score for pain showed changes in pain while walking the first few steps in the morning from 6.28 +/- 0.4 before therapy to 2.85 +/- 0.48 after treatment and to 1.52 +/- 0.31 at 3 months, to 1.09 +/- 0.25 at 6 months, and to 0.52 +/- 0.14 at 12 months of follow up (p <0.001). Similar dynamics was observed in pain intensity during daily activities, at rest, in the evening and upon compression. The AFOAS score showed a statistically significant reduction in pain--from 11.90 +/- 2.35 at baseline to 31.90 +/- 1.48 after the end of interventions (p < 0.001), and to 39.52 +/- 0.47 at one year of follow-up (p < 0.001). The mean values of the evaluation reflecting activity limitations and support requirements increased from 3.85 +/- 0.42 to 7.85 +/- 0.46 after treatment and to 9.71 +/- 0.19 at one year of follow up (p < 0.001). Similar dynamics was seen in the maximum walking distance and walking surfaces. Gait abnormalities changed from 3.43 +/- 0.50 at baseline to 6.28 +/- 0.59 after treatment (p < 0.001).

Based on the results of this study we could conclude that radial shock wave therapy is a safe non-invasive method of treatment. Our preliminary findings indicate that it could be an effective treatment of choice for patients with chronic plantar fasciitis that is recalcitrant to other conservative treatment modalities.