The effect of extracorporeal shock wave therapy for the treatment of plantar fasciitis in regard to middle-aged patients’ activity level and pain localization
In this retrospective cohort study, we compared the efficacy of extracorporeal shock wave therapy (ESWT) for plantar fasciitis in patients with different activity levels and different pain locations. In total, 92 patients (99 feet) who were over 40 years old with chronic plantar fasciitis were treated with ESWT after being categorized as participating in recreational sports(group R) or only activities of daily living (group D). On the other hand, patients were categorized as having pain in the plantar fascia enthesis (group E) or the entire plantar fascia (group W). Pain during activity and general tenderness were evaluated by using the visual analog scale (VAS) before and after ESWT. Although the VAS for pain score during activity significantly improved in both groups R and D after ESWT (\(P<0.001\) in both groups), the degree of improvement in the VAS for pain score in group R was not significantly different from that in group D (\(P=0.061\)). The VAS for tenderness score also significantly improved in both groups R and D (\(P<0.001\) in both groups), but there was also no significant difference between the degree of improvement in the VAS for tenderness in group R and that in group D (\(P=0.41\)). However, the degree of improvement in the VAS for pain and VAS for tenderness scores was significantly greater in group E than that in group W (\(P<0.001, =0.042\), respectively). We concluded that ESWT was effective for treating plantar fasciitis in middle-aged patients and ESWT was effective in patients not only playing recreational sports but also having activities of daily living. ESWT was more effective in patients with pain in the plantar fascia enthesis than in patients with pain in the entire plantar fascia.
KeywordsPlantar fasciitis Extracorporeal shock wave therapy Visual analog scale
The authors are deeply grateful to Yoshimitsu Sasaki and Kojiro Matsuura, physical therapists, for their technical support.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 1.Goff, J.D., Crawford, R.: Diagnosis and treatment of plantar fasciitis. Am. Fam. Physician 84, 676–682 (2011)Google Scholar
- 4.Urovitz, E.P., Urovitz, A.B., Urovitz, E.B.: Endoscopic plantar fasciotomy in the treatment of chronic heel pain. Can. J. Surg. 51, 281–283 (2008)Google Scholar
- 5.Valchanou, V.D., Michailov, P.: High energy shock waves in the treatment of delayed and nonunion of fractures. Int. Orthop. 15, 181–184 (1991). https://doi.org/10.1007/BF00192289
- 6.Galasso, O., Amelio, E., Riccelli, D.A., Gasparini, G.: Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial. BMC Musculoskelet. Disord. 13, 86 (2012). https://doi.org/10.1186/1471-2474-13-86 CrossRefGoogle Scholar
- 7.Ioppolo, F., Tattoli, M., Di Sante, L., Attanasi, C., Venditto, T., Servidio, M., Cacchio, A., Santilli, V.: Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels. Phys. Ther. 92, 1376–1385 (2012). https://doi.org/10.2522/ptj.20110252
- 8.Rompe, J.D., Hopf, C., Küllmer, K., Heine, J., Bürger, R., Nafe, B.: Low-energy extracorporal shock wave therapy for persistent tennis elbow. Int. Orthop. 20, 23–27 (1996). https://doi.org/10.1007/s002640050021
- 10.Vulpiani, M.C., Trischitta, D., Trovato, P., Vetrano, M., Ferretti, A.: Extracorporeal shockwave therapy (ESWT) in Achilles tendinopathy. A long-term follow-up observational study. J. Sports Med. Phys. Fit. 49, 171–176 (2009)Google Scholar
- 12.Saxena, A., Fournier, M., Gerdesmeyer, L., Gollwitzer, H.: Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete. Muscles Ligaments Tendons J. 2, 312–316 (2013)Google Scholar
- 13.Gollwitzer, H., Diehl, P., von Korff, A., Rahlfs, V.W., 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. 46, 348–357 (2007). https://doi.org/10.1053/j.jfas.2007.05.011 CrossRefGoogle Scholar
- 14.Gollwitzer, H., Saxena, A., DiDomenico, L.A., Galli, L., Bouché, R.T., Caminear, D.S., Fullem, B., Vester, J.C., Horn, C., Banke, I.J., Burgkart, R., Gerdesmeyer, L.: Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized, controlled multicenter study. J. Bone Joint Surg. Am. 97, 701–708 (2015). https://doi.org/10.2106/JBJS.M.01331 CrossRefGoogle Scholar
- 15.Lou, J., Wang, S., Liu, S., Xing, G.: Effectiveness of extracorporeal shock wave therapy without local anesthesia in patients with recalcitrant plantar fasciitis: A meta-analysis of randomized controlled trials. Am. J. Phys. Med. Rehabil. 96, 529–534 (2017). https://doi.org/10.1097/PHM.0000000000000666 CrossRefGoogle Scholar
- 16.Lee, S.J., Kang, J.H., Kim, J.Y., Kim, J.H., Yoon, S.R., Jung, K.I.: Dose-related effect of extracorporeal shock wave therapy for plantar fasciitis. Ann. Rehabil. Med. 37, 379–388 (2013). https://doi.org/10.5535/arm.2013.37.3.379
- 17.Kumai, T., Benjamin, M.: Heel spur formation and the subcalcaneal enthesis of the plantar fascia. J. Rheumatol. 29, 1957–1964 (2002)Google Scholar
- 20.Aqil, A., Siddiqui, M.R., Solan, M., Redfern, D.J., Gulati, V., Cobb, J.P.: 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 CrossRefGoogle Scholar
- 23.Yin, M.C., Ye, J., Yao, M., Cui, X.J., Xia, Y., Shen, Q.X., Tong, Z.Y., Wu, X.Q., Ma, J.M., Mo, W.: Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Arch. Phys. Med. Rehabil. 95, 1585–1593 (2014). https://doi.org/10.1016/j.apmr.2014.01.033 CrossRefGoogle Scholar