title: Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis.
abstract: OBJECTIVE
  Utilizing meta-analysis, the authors have reviewed the available literature to assess the biologic and therapeutic effects of shockwaves on patients with chronic plantar fasciitis and the credibility of these published studies.
  
  
  METHODS
  Meta-analysis is a systematic method for statistical analysis that combines data from various independent studies, allowing the assessment of potential benefits of various treatments when conclusions based on individual studies may be difficult to evaluate. We hypothesized that extracorporeal shockwave therapy provided a reasonable nonoperative therapeutic alternative to surgical intervention in the treatment of chronic proximal plantar fasciitis.
  
  
  RESULTS
  Eight of 20 published studies fulfilled our type A to C criteria for acceptable studies of sufficient duration (one year or more after treatment). These eight studies involved 840 patients, with success rates of as much as 88%. The other 12 studies had methodological variables or lack of appropriate follow-up data that would limit their validity, although the success rates were comparable to the A to C studies.
  
  
  CONCLUSIONS
  This meta-analysis shows that the directed application of shockwaves to the enthesis of the plantar fascia at the inferior calcaneus is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome that has been refractory to other commonly used nonoperative therapies. The results suggest that this therapeutic procedure should be considered before any surgical intervention, and may be preferable prior to cortisone injection, which has a recognized risk of rupture of the plantar fascia and a frequent recurrence of symptoms.
authors: Skeletal Educational Association Atlanta, GA 30305, USA. orthozap@aol.com
authors: John A
authors: JA
authors: Ogden
authors: Richard G
authors: RG
authors: Alvarez
authors: Marie
authors: M
authors: Marlow
mesh_terms: D005208:Fasciitis / Q000150:complications / Q000628:therapy*; D005534:Foot Diseases / Q000150:complications / Q000628:therapy*; D019220:High-Energy Shock Waves / Q000627:therapeutic use; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D012107:Research Design; D055502:Secondary Prevention; D016896:Treatment Outcome