Comparative Effectiveness of Conservative Therapies for Plantar Fasciitis: A Retrospective Observational Study

Background: Plantar fascitis is a common cause of heel pain in adults. Although various conservative treatments have been studied, comparative real-world effectiveness remains underreported. Objective: To retrospectively evaluate and compare the clinical effectiveness of percutaneous neuromodulation, extracorporeal shockwave therapy (ESWT), and custom foot orthoses in patients with plantar fasciitis. Methods: A retrospective observational study was conducted from January 2020 to December 2023 at a podiatric clinic. Inclusion and exclusion criteria were applied to medical records, and 120 patients were divided into three groups according to treatment, with 7 patients excluded due to non-compliance with follow-up. Pain intensity (VAS) and functional improvement (FFI) were assessed at baseline, 1 month, and 6 months post-treatment. Statistical analysis included paired t-tests, ANOVA, effect size (Cohen's d), and 95% confidence intervals. The STROBE checklist was followed. Results: All three interventions showed significant improvement in pain and function at 6 months (p < 0.05). Neuromodulation achieved the highest pain reduction (VAS mean difference -6.2, d = 1.02), followed by ESWT (d = 0.78) and orthoses (d = 0.65). Functional scores improved similarly across all groups, with no significant difference at 6 months (p = 0.12). Conclusions: Percutaneous neuromodulation demonstrated greater clinical effectiveness in pain reduction compared to ESWT and orthoses, although functional outcomes were similar. Further prospective studies are needed to confirm these findings.