Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain.
BACKGROUND
Whether shock wave therapy or shock wave therapy combined with plantar fascia-specific stretching is more efficient in treating chronic plantar heel pain remains unclear. The aim of the study was to test the null hypothesis of no difference of these two forms of management for patients who had unilateral plantar fasciopathy for a minimum duration of twelve months and which had failed at least three other forms of treatment.


METHODS
One hundred and fifty-two patients with chronic plantar fasciopathy were assigned to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group 1, n = 73) or to receive the identical shock wave treatment and to perform an eight-week plantar fascia-specific stretching program (Group 2, n = 79). All patients completed the nine-item pain subscale of the validated Foot Function Index and a subject-relevant outcome questionnaire. Patients were evaluated at baseline, and at two, four, and twenty-four months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first steps of walking in the morning) on this Index, and satisfaction with treatment.


RESULTS
No difference in mean age, sex, weight or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with shock-wave therapy plus plantar fascia-specific stretching than those managed with shock-wave therapy alone (p < 0.001), as well as individually for item 2 (p < 0.001). Twenty-four patients in Group 1 (32%) versus forty-seven patients in Group 2 (59%) were satisfied with the treatment (p < 0.001). Significant differences persisted at four months, but not at twenty-four months.


CONCLUSIONS
A program of manual stretching exercises specific to the plantar fascia in combination with repetitive low-energy radial shock-wave therapy is more efficient than repetitive low-energy radial shock-wave therapy alone for the treatment of chronic symptoms of proximal plantar fasciopathy.
OrthoTrauma Evaluation Institute, Oppenheimer Str. 70, 55130 Mainz, Germany. Electronic address: profrompe@web.de.
Jan D
JD
Rompe
SUN Orthopedics and Sports Medicine, Division of Evangelical Community Hospital, 900 Buffalo Road, Lewisburg, PA 17837, USA. Electronic address: jfuria@ptd.net.
John
J
Furia
Dept. of Life, Health and Environmental Sciences, School of Medicine, University of L'Aquila, Viale San Salvatore, Delta 6 Medicina, 67100 L'Aquila, Italy. Electronic address: angelo.cacchio@univaq.it.
Angelo
A
Cacchio
Department of Anatomy II, Ludwig-Maximilians-University, Pettenkoferstr. 11, 80336 Munich, Germany. Electronic address: christoph_schmitz@med.uni-muenchen.de.
Christoph
C
Schmitz
Queen Mary University of London, Centre for Sports and Exercise Medicine, Mile End Hospital, Mann Ward, 275 Bancroft Road, London E1 4DG, England. Electronic address: n.maffulli@qmul.ac.uk.
Nicola
N
Maffulli
D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D003131:Combined Modality Therapy; D036981:Fasciitis, Plantar / Q000628:therapy*; D005260:Female; D006365:Heel; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D010147:Pain Measurement; D011446:Prospective Studies; D016138:Walking
ESWT; Plantar fasciitis; Plantar fasciopathy; Shock wave treatment; Stretching