Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs

Jiale Sun, Fuqiang Gao, Yanhua Wang, Wei Sun, Baoguo Jiang, Zirong Li, Jiale Sun, Fuqiang Gao, Yanhua Wang, Wei Sun, Baoguo Jiang, Zirong Li

Abstract

Background: Plantar fasciitis (PF) is the most common reason for heel pain. The efficacy of extracorporeal shock wave therapy (ESWT) as an ideal alternative to conservative treatments and surgery is controversial, and almost all previous articles compared general ESWT with placebo without indicating the kind of shock wave. We undertook a meta-analysis to compare the efficacy of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo, to assess their effectiveness in chronic PF.

Methods: The PubMed, Medline, EmBase, Web of Science, and Cochrane library databases were searched for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included the odds ratios (ORs) of pain relief, pain reduction, and complications. Relevant data were analyzed using RevMan v5.3.

Results: Nine studies involving 935 patients were included. ESWT had higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97-3.39, P < .00001). ESWT had markedly lower standardized mean difference than placebo, with heterogeneity observed (standardized mean difference 1.01, 95% CI -0.01 to 2.03, P = .05, I = 96%, P < .00001). FSW and RSW therapies had greater therapeutic success in pain relief than the placebo group (OR 2.17, 95% CI 1.49-3.16, P < .0001; OR 4.63, 95% CI 1.30-16.46, P = .02), but significant heterogeneity was observed in RSW therapy versus placebo (I = 81%, P = .005).

Conclusion: This meta-analysis suggested that FSW therapy can relieve pain in chronic PF as an ideal alternative option; meanwhile, no firm conclusions of general ESWT and RSW effectiveness can be drawn. Due to variations in the included studies, additional trials are needed to validate these conclusions.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Risk of bias graph.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Flow chart of the study selection.
Figure 4
Figure 4
Forest plot of success rate of general ESWT in chronic plantar fasciitis. 95% CI = 95% confidence interval, ESWT = extracorporeal shock wave therapy, fixed = fixed-effects model.
Figure 5
Figure 5
Forest plot of success rate of FSW therapy in chronic plantar fasciitis. 95% CI = 95% confidence interval, FSW = focused shock wave, fixed = fixed-effects model.
Figure 6
Figure 6
Forest plot of success rate of RSW therapy in chronic plantar fasciitis. 95% CI = 95% confidence interval, random = random-effects model, RSW = radial shock wave.
Figure 7
Figure 7
Forest plot of reduction in pain scale of general ESWT. 95% CI = 95% confidence interval, ESWT = extracorporeal shock wave therapy, IV = inverse variance, random = random-effects model, SMD = standard mean difference.
Figure 8
Figure 8
Forest plot of reduction in pain scale of FSW therapy in chronic plantar fasciitis. 95% CI = 95% confidence interval, FSW = focused shock wave, IV = inverse variance, random = random-effects model, SMD = standard mean difference.

References

    1. Rompe JD. Plantar fasciopathy. Sports Med Arthrosc 2009;17:100–4.
    1. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93:234–7.
    1. Lim AT, How CH, Tan B. Management of plantar fasciitis in the outpatient setting. Singapore Med J 2016;57:168–70. quiz 171.
    1. Rompe JD, Furia J, Weil L, et al. Shock wave therapy for chronic plantar fasciopathy. Br Med Bull 2007;81-82:183–208.
    1. Theodore GH, Buch M, Amendola A, et al. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int 2004;25:290–7.
    1. Ogden JA, Alvarez R, Levitt R, et al. Shock wave therapy for chronic proximal plantar fasciitis. Clin Orthop Relat Res 2001;47–59.
    1. Hsu RW, Hsu WH, Tai CL, et al. Effect of shock-wave therapy on patellar tendinopathy in a rabbit model. J Orthop Res 2004;22:221–7.
    1. Lohrer H, Nauck T, Dorn-Lange NV, et al. Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures. Foot Ankle Int 2010;31:1–9.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62:1006–12.
    1. Eslamian F, Shakouri SK, Jahanjoo F, et al. Extra corporeal shock wave therapy versus local corticosteroid injection in the treatment of chronic plantar fasciitis: a single blinded randomized clinical trial. Pain Med 2016;17:1722–31.
    1. Hammer DS, Adam F, Kreutz A, et al. Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int 2003;24:823–8.
    1. Konjen N, Napnark T, Janchai S. A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial. J Med Assoc Thai 2015;98(suppl 1):S49–56.
    1. Mardani-Kivi M, Karimi Mobarakeh M, Hassanzadeh Z, et al. Treatment outcomes of corticosteroid injection and extracorporeal shock wave therapy as two primary therapeutic methods for acute plantar fasciitis: a prospective randomized clinical trial. J Foot Ankle Surg 2015;54:1047–52.
    1. Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med 2005;15:119–24.
    1. Radwan YA, Mansour AM, Badawy WS. Resistant plantar fasciopathy: shock wave versus endoscopic plantar fascial release. Int Orthop 2012;36:2147–56.
    1. Roca B, Mendoza MA, Roca M. Comparison of extracorporeal shock wave therapy with botulinum toxin type A in the treatment of plantar fasciitis. Disabil Rehabil 2016;38:2114–21.
    1. Rompe JD, Cacchio A, Weil L, et al. Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. J Bone Joint Surg Am 2010;92:2514–22.
    1. Rompe JD, Furia J, Cacchio A, et al. 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. Int J Surg 2015;24:135–42.
    1. Wang CJ, Wang FS, Yang KD, et al. Long-term results of extracorporeal shockwave treatment for plantar fasciitis. Am J Sports Med 2006;34:592–6.
    1. Buchbinder R, Ptasznik R, Gordon J, et al. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA 2002;288:1364–72.
    1. Chow IH, Cheing GL. Comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain. Clin Rehabil 2007;21:131–41.
    1. Lee SJ, Kang JH, Kim JY, et al. Dose-related effect of extracorporeal shock wave therapy for plantar fasciitis. Ann Rehabil Med 2013;37:379–88.
    1. Liang HW, Wang TG, Chen WS, et al. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy. Clin Orthop Relat Res 2007;460:219–25.
    1. Park JW, Yoon K, Chun KS, et al. Long-term outcome of low-energy extracorporeal shock wave therapy for plantar fasciitis: comparative analysis according to ultrasonographic findings. Ann Rehabil Med 2014;38:534–40.
    1. Rompe JD, Schoellner C, Nafe B. Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg Am 2002;84-A:335–41.
    1. Vahdatpour B, Sajadieh S, Bateni V, et al. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments. J Res Med Sci 2012;17:834–8.
    1. Yan W, Sun S, Li X. Therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014;39:1326–30.
    1. Dorotka R, Sabeti M, Jimenez-Boj E, et al. Location modalities for focused extracorporeal shock wave application in the treatment of chronic plantar fasciitis. Foot Ankle Int 2006;27:943–7.
    1. Moghtaderi A, Khosrawi S, Dehghan F. Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: a randomized, placebo-controlled trial. Adv Biomed Res 2014;3:99.
    1. Rompe JD, Meurer A, Nafe B, et al. Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res 2005;23:931–41.
    1. Tornese D, Mattei E, Lucchesi G, et al. Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study. Clin Rehabil 2008;22:780–7.
    1. Haake M, Buch M, Schoellner C, et al. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ 2003;327:75.
    1. Kudo P, Dainty K, Clarfield M, et al. Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study. J Orthop Res 2006;24:115–23.
    1. Ogden JA, Alvarez RG, Levitt RL, et al. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg Am 2004;86-A:2216–28.
    1. Rompe JD, Hopf C, Nafe B, et al. Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study. Arch Orthop Trauma Surg 1996;115:75–9.
    1. Gollwitzer H, Diehl P, von Korff A, et al. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg 2007;46:348–57.
    1. Gollwitzer H, Saxena A, DiDomenico LA, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am 2015;97:701–8.
    1. Marks W, Jackiewicz A, Witkowski Z, et al. Extracorporeal shock-wave therapy (ESWT) with a new-generation pneumatic device in the treatment of heel pain. A double blind randomised controlled trial. Acta Orthop Belg 2008;74:98–101.
    1. Rompe JD, Decking J, Schoellner C, et al. Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med 2003;31:268–75.
    1. Speed CA, Nichols D, Wies J, et al. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res 2003;21:937–40.
    1. Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med 2008;36:2100–9.
    1. Ibrahim MI, Donatelli RA, Schmitz C, et al. Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int 2010;31:391–7.
    1. Malay DS, Pressman MM, Assili A, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg 2006;45:196–210.
    1. Maier M, Milz S, Wirtz DC, et al. Basic research of applying extracorporeal shockwaves on the musculoskeletal system. An assessment of current status. Orthopade 2002;31:667–77.
    1. Maier M, Tischer T, Milz S, et al. Dose-related effects of extracorporeal shock waves on rabbit quadriceps tendon integrity. Arch Orthop Trauma Surg 2002;122:436–41.
    1. Wang CJ, Huang HY, Pai CH. Shock wave-enhanced neovascularization at the tendon-bone junction: an experiment in dogs. J Foot Ankle Surg 2002;41:16–22.
    1. Magosch P, Lichtenberg S, Habermeyer P. Radial shock wave therapy in calcifying tendinitis of the rotator cuff--a prospective study. Z Orthop Ihre Grenzgeb 2003;141:629–36.
    1. Labek G, Auersperg V, Ziernhold M, et al. Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis. Z Orthop Ihre Grenzgeb 2005;143:240–6.
    1. Yin MC, Ye J, Yao M, et al. Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Arch Phys Med Rehabil 2014;95:1585–93.
    1. Dizon JN, Gonzalez-Suarez C, Zamora MT, et al. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil 2013;92:606–20.
    1. Zhiyun L, Tao J, Zengwu S. Meta-analysis of high-energy extracorporeal shock wave therapy in recalcitrant plantar fasciitis. Swiss Med Wkly 2013;143:w13825.
    1. Aqil A, Siddiqui MR, Solan M, et al. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res 2013;471:3645–52.

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