Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial.
BACKGROUND
Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited.


OBJECTIVE
To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar fasciitis.


METHODS
Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJ/mm(2)) or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start-up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy.


RESULTS
Eighty-eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37% of the subjects in the ESWT group and 24% in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31% in the ESWT and sham groups, respectively. Positive responses in start-up pain occurred in 37% and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period.


CONCLUSIONS
There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints.
Speed
C A
CA
Department of Medicine, Rheumatology, Sports and Exercise Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, UK. cas50@medschl.cam.ac.uk
Nichols
D
D
Wies
J
J
Humphreys
H
H
Richards
C
C
Burnet
S
S
Hazleman
B L
BL
D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D004307:Dose-Response Relationship, Radiation; D004311:Double-Blind Method; D036981:Fasciitis, Plantar / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D010166:Palliative Care / Q000379:methods; D017211:Treatment Failure