Efficacy of Extracorporeal Shockwave Therapy on Plantar Fasciitis in Patients With Peripheral Neuropathy

Plantar fasciitis is the most common cause of heel pain in clinical practice, accounting for approximately 80% of patients presenting with heel pain. Common clinical presentations include unilateral or bilateral foot pain, particularly upon weight-bearing after a period of rest, such as the first steps in the morning. Some patients may also report associated paresthesia, tingling, or a burning sensation. Notably, a considerable number of patients with peripheral neuropathy (PN) also present with coexisting plantar fasciitis. The proposed pathophysiological mechanisms underlying neuropathy-associated plantar fasciitis include progressive degeneration of the plantar fascia due to chronic somatosensory deficits, thickening of the plantar fascia secondary to metabolic syndromes such as diabetic neuropathy, and the loss of foot intrinsic muscle support due to motor nerve involvement. Conventional treatments for plantar fasciitis include nonsteroidal anti-inflammatory drugs (NSAIDs), local corticosteroid injections, and custom orthotics; however, these interventions exhibit significant limitations. While NSAIDs may provide temporary analgesia, their long-term utility is limited by systemic risks, particularly gastrointestinal complications. Local corticosteroid injections effectively reduce inflammation and provide acute symptom relief; however, they carry a risk of plantar fascia rupture, rendering repeated administration clinically unfavorable. Orthotic insoles redistribute biomechanical loading across the foot to reduce mechanical stress; however, they are primarily compensatory and do not facilitate tissue regeneration or fundamental repair of the chronic lesion. Given these limitations in conventional treatments, this study aims to evaluate the efficacy of extracorporeal shockwave therapy (ESWT) in reducing pain and improving functional outcomes for patients with neuropathy-associated plantar fasciitis. The investigators will assess the effects of ESWT on the pathophysiological mechanism of the neuropathic foot to alleviate the symptoms of plantar fasciitis in participants with peripheral neuropathy. Findings of the investigation aim to validate the clinical application of non-invasive ESWT for this population, thereby enhancing their functional independence and health-related quality of life.