Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial.
BACKGROUND
Extracorporeal shock wave therapy (ESWT) is increasingly used for plantar fasciitis, but limited evidence supports its use.


OBJECTIVE
To determine whether ultrasound-guided ESWT reduces pain and improves function in patients with plantar fasciitis.


METHODS
Double-blind, randomized, placebo-controlled trial conducted between April 1999 and June 2001.


METHODS
Participants were recruited from the community-based referring physicians (primary care physicians, rheumatologists, orthopedic surgeons, and sports physicians) of a radiology group in Melbourne, Australia.


METHODS
We screened 178 patients and enrolled 166; 160 completed the 15-week protocol. Entry criteria included age at least 18 years with plantar fasciitis, defined as heel pain maximal over the plantar aspect of the foot of at least 6 weeks' duration, and an ultrasound-confirmed lesion, defined as thickening of the origin of the plantar fascia of at least 4 mm, hypoechogenicity, and alterations in the normal fibrillary pattern.


METHODS
Patients were randomly assigned to receive either ultrasound-guided ESWT given weekly for 3 weeks to a total dose of at least 1000 mJ/mm(2) (n = 81), or identical placebo to a total dose of 6.0 mJ/mm(2) (n = 85).


METHODS
Overall, morning, and activity pain, measured on a visual analog scale; Maryland Foot Score; walking ability; Short-Form-36 Health Survey (SF-36) score; and Problem Elicitation Technique score, measured at 6 and 12 weeks after treatment completion.


RESULTS
At 6 and 12 weeks, there were significant improvements in overall pain in both the active group and placebo group (mean [SD] improvement, 18.1 [30.6] and 19.8 [33.7] at 6 weeks [P =.74 for between-group difference], and 26.3 [34.8] and 25.7 [34.9] at 12 weeks [P =.99], respectively). Similar improvements in both groups were also observed for morning and activity pain, walking ability, Maryland Foot Score, Problem Elicitation Technique, and SF-36. There were no statistically significant differences in the degree of improvement between treatment groups for any measured outcomes.


CONCLUSIONS
We found no evidence to support a beneficial effect on pain, function, and quality of life of ultrasound-guided ESWT over placebo in patients with ultrasound-proven plantar fasciitis 6 and 12 weeks following treatment.
Buchbinder
Rachelle
R
Department of Clinical Epidemiology, Cabrini Hospital and Cabrini Medical Centre, Malvern, Victoria, Australia 3144. rachelle.buchbinder@med.monash.edu.au
Ptasznik
Ronnie
R
Gordon
Jeanine
J
Buchanan
Joylene
J
Prabaharan
Vasuki
V
Forbes
Andrew
A
D004311:Double-Blind Method; D005208:Fasciitis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005534:Foot Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006365:Heel; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D014463:Ultrasonography