Rompe, J. D., Decking, J., Schoellner, C., & Nafe, B. (2003). Shock wave application for chronic plantar fasciitis in running athletes: a prospective, randomized, placebo-controlled trial. Am J Sports Med, 31(2), 268-275.

BACKGROUND

Plantar fasciitis is a problem that results from cumulative tensile stress loads on the insertion of the plantar fascia into the calcaneus. It is a common condition among both athletes and individuals engaged in a wide variety of activities. However, the etiology of the condition is not well understood. As its name would indicate, there is often an inflammatory component to this condition. Other factors have also been observed, including thickening of the proximal fascia, decreased vascularity, loss of elasticity, alteration of pain sensations, irritation of the periosteal insertion of the fascia into the bone, and development of bone spurs.

This condition is most commonly treated with conservative measures such as rest, ice applications, nonsteroidal anti-inflammatory drugs (NSAIDS), orthotics, topical application of steroidal medications, stretching, and soft tissue mobilization. Some other methods have been used, but their effectiveness is questionable. For example, heel lifts to take tension off the plantar fascia may be used, but evidence is mixed on their effectiveness. Steroid injections into the plantar fascia have also been used in treatment, but concerns about fat pad atrophy and subsequent rupture of the plantar fascia have led to decreased use of this procedure.

If conservative treatments are not successful, surgical treatment may be performed. However, there are substantial risks in surgical treatment, such as weakening of the plantar fascia and prolonged healing time. Consequently, other treatment methods have been sought for addressing this problem. One of the procedures that has been used in the last several years is the application of extracorporeal shock waves. The actual physiology of shock wave application is still being studied, but there are some early promising results. The shock wave application to the plantar fascia is similar to the shock waves applied to kidney stones in order to break them up. There are mixed results in the research literature regarding the effectiveness of this approach. The present study was engaged to further evaluate the effectiveness of this treatment method.

RESULTS AND DISCUSSION

In this study, 45 patients with confirmed cases of plantar fasciitis that had not responded to conservative treatment were divided into two groups. One group was administered the shock wave therapy, and the other group was administered a “sham” shock wave therapy. The same physician administered both the true and sham treatments. The treatments were done at one-week intervals for three weeks.
Following the course of treatment, a different physician evaluated each participant and logged information about the degree of improvement, if any, in his or her condition. Evaluations were performed at 6 and 12 months post treatment. The primary criterion for improvement was the subject’s self-assessment of pain, especially walking on the feet first thing in the morning.

Upon analysis of the results at the six-month period, 60% of the patients in the treatment group versus 27% of the patients in the sham group reported at least a 50% reduction in pain complaints. At the 12-month evaluation, 72% of the treatment group, versus 35% of the sham group, reported positive results. The authors have concluded that extracorporeal shock wave treatment can produce beneficial results with plantar fasciitis that has not responded to conservative treatment.

The authors mention several other factors to consider with this treatment. There are no known significant side effects with extracorporeal shock wave therapy, as there often are with surgical treatment or steroid injections. However, some researchers have suggested there is a possibility of periosteal detachment and small fractures that may result from this treatment. This makes shock wave therapy a considerable option for those who have not had success with conservative treatments. However, all participants did state that administration of this treatment was unpleasant, though not as bad as the injections some of them had had. All in all, shock wave therapy appears to be a beneficial option for those who have not had success with conservative treatment and would like to avoid the detrimental effects of surgery or injection therapy.

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