Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 12, pp 1763–1770 | Cite as

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

  • Hui Li
  • Yuan Xiong
  • Wu Zhou
  • Yi Liu
  • Jing Liu
  • Hang Xue
  • Liangcong Hu
  • Adriana C. Panayi
  • Bobin MiEmail author
  • Guohui LiuEmail author
Arthroscopy and Sports Medicine



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.


Plantar fasciitis Shock wave Ultrasound Therapy 



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



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

Author contributions

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.


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.

Compliance with ethical standards

Conflict of interest

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


  1. 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 6:19CrossRefGoogle Scholar
  2. 2.
    Roxas M (2005) Plantar fasciitis: diagnosis and therapeutic considerations. Altern Med Rev 10:83–93PubMedGoogle Scholar
  3. 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 32:149–157CrossRefGoogle Scholar
  4. 4.
    Abbassian A, Kohls-Gatzoulis J, Solan MC (2012) Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis. Foot Ankle Int 33:14–19CrossRefGoogle Scholar
  5. 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 19:10–18CrossRefGoogle Scholar
  6. 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 85:1270–1277CrossRefGoogle Scholar
  7. 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):525–530CrossRefGoogle Scholar
  8. 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):324–330CrossRefGoogle Scholar
  9. 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):1364–1372CrossRefGoogle Scholar
  10. 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):249–254CrossRefGoogle Scholar
  11. 11.
    Kamel M, Kotob H (2000) High frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. J Rheumatol 27(9):2139–2141PubMedGoogle Scholar
  12. 12.
    Probe RA, Baca M, Adams R et al (1999) Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res 368:190–195CrossRefGoogle Scholar
  13. 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 97:701–708CrossRefGoogle Scholar
  14. 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 92:606–620CrossRefGoogle Scholar
  15. 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 4:19–32CrossRefGoogle Scholar
  16. 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):2100–2109CrossRefGoogle Scholar
  17. 17.
    Cornwall MW, McPoil TG (1999) Plantar fasciitis: etiology and treatment. J Orthop Sports Phys Ther 29(12):756–760CrossRefGoogle Scholar
  18. 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 48:847–855CrossRefGoogle Scholar
  19. 19.
    Li H, Lv H, Lin T (2018) Comparison of efficacy of eight treatments for plantar fasciitis: a network meta-analysis. J Cell Physiol 234:860–870CrossRefGoogle Scholar
  20. 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 136:1289–1296CrossRefGoogle Scholar
  21. 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 56:762–767CrossRefGoogle Scholar
  22. 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 18:2443–2452CrossRefGoogle Scholar
  23. 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–S56PubMedGoogle Scholar
  24. 24.
    Cheing G, Chang H, Lo SK (2007) A comparison of the effectiveness of extracorporeal shock wave. Shock Waves 17:195–201CrossRefGoogle Scholar
  25. 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 46:133–145CrossRefGoogle Scholar
  26. 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 125:6–9CrossRefGoogle Scholar
  27. 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 31:391–397CrossRefGoogle Scholar
  28. 28.
    Ilieva EM (2013) Radial shock wave therapy for plantar fasciitis: a one year follow-up study. Folia Med 55:42–48 (Plovdiv) CrossRefGoogle Scholar
  29. 29.
    Ogden JA, Alvarez RG, Levitt R (2001) Shockwave therapy for chronic proximal plantar fasciitis. Clin Orthop Relat Res 387:47–59CrossRefGoogle Scholar
  30. 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 80:546–552CrossRefGoogle Scholar
  31. 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):230–233Google Scholar
  32. 32.
    Straburzyn´ska-Lupa A, Kornacka A (2005) Ultrasound therapy in the treatment of calcar pedis-own experiences. Ortop Traumatol Rehabil 7(1):79–86Google Scholar
  33. 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 34:583–593CrossRefGoogle Scholar
  34. 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 130:541–546CrossRefGoogle Scholar
  35. 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 39:1423–1431CrossRefGoogle Scholar
  36. 36.
    Othman A, Ragab EM (2010) Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 130:1343–1347CrossRefGoogle Scholar
  37. 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):166–172CrossRefGoogle Scholar
  38. 38.
    Ogden JA (2004) Extracorporeal shock wave therapy for plantar fasciitis: randomized controlled multicenter trial. Br J Sports Med 38:382CrossRefGoogle Scholar
  39. 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 9:2041731418801103CrossRefGoogle Scholar
  40. 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 234:206–210CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hui Li
    • 1
  • Yuan Xiong
    • 1
  • Wu Zhou
    • 1
  • Yi Liu
    • 1
  • Jing Liu
    • 1
  • Hang Xue
    • 1
  • Liangcong Hu
    • 1
  • Adriana C. Panayi
    • 2
  • Bobin Mi
    • 1
    Email author
  • Guohui Liu
    • 1
    Email author
  1. 1.Department of OrthopedicsUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
  2. 2.The Division of Plastic SurgeryBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations