Is Radial Extracorporeal Shock Wave Therapy an Effective Treatment for Chronic Plantar Fasciitis in Adults?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not radial extracorporeal shock wave therapy (ESWT) is an effective treatment in adults with chronic plantar fasciitis. STUDY DESIGN: Review of three English language primary studies published between 2008 and 2010. DATA SOURCES: Two randomized control trials and one cohort study analyzing the effects of radial extracorporeal shock wave therapy on chronic plantar fasciitis were found using the OVID, Medline and Cochrane Databases. OUTCOMES MEASURED: Each of the three studies measured improvement in pain from baseline after patients were treated with ESWT. Pain levels were quantified using a Visual Analog Scale (VAS). The VAS score assigned by each patient was a subjective pain severity score ranging from 0 (no pain) to 10 (worst possible pain). RESULTS: The dichotomous data from the Gerdesmeyer et al. study and the Ibrahim et al. study showed statistically significant treatment success rates with the use of extracorporeal shock wave therapy to treat plantar fasciitis pain when compared to the control group, as determined by improvement in Visual Analog Scale scores. The continuous data provided by the Hofling et al. study showed a statistically significant improvement in overall pain, maximum pain, and pain with daily activities after participants received ESWT as compared to their pain levels prior to treatment. The Hofling et al. study did not find the reduction of night pain after ESWT to be statistically significant. CONCLUSIONS: Gerdesmeyer et al., Ibrahim et al., and Hofling et al. all provided data which showed statistically significant pain improvement following extracorporeal shock wave therapy in adult patients with chronic plantar fasciitis. This improvement was present in all three studies despite varying numbers of extracorporeal shock wave therapy treatment sessions and variable time frames between treatments. In order to maximize the efficacy of ESWT, continued research is needed to determine the optimal number of ESWT treatment sessions and the optimal time frame between treatment sessions