The Effectiveness of Extracorporeal Shock Wave Therapy for Heel Spur: A Systematic Review and Meta-Analysis

Objective: Conduction a systematic review of randomized controlled trials (RCTs) to assess the effectiveness of extracorporeal shock wave therapy (ESWT) on plantar heel pain. Methods: The study was designed as a meta-analysis of RCTs identified from the Cochrane Controlled trials register, MEDLINE, EMBASE and CINAHL from January 2000 till December 2016. We included such randomized trials, which evaluated ESWT used to treat plantar heel pain. The trials comparing ESWT with placebo, focused extracorporeal shock wave therapy (FESWT) or orthotics, kinesiotherapy, local cortison injection were considered for the inclusion in the review. Ten RCTs (n=1239) permitted a pooled estimate of the effectiveness based on the collected pain scores using 10 cm visual analogue scale (VAS) for the daily pain. Results: The estimated total weighted mean difference (WMD) was 0.9 (95% confidence interval 0.1 to 1.8) representing less than 1.0 cm on the VAS. There were evidences of heterogeneity, so we used a random effects model. Conclusion: A meta-analysis of data from ten RCTs included a total of 1239 patients and reported poor outcomes evaluating ESWT for plantar heel pain. This meta-analysis shows that using of ESWT for plantar heel pain is uncertain in clinical practice. Nevertheless, it suggests that further studies to establish efficacy dose of ESWT for heel pain are needed