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Radial Extracorporeal Shockwave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis

Ludger Gerdesmeyer, MD, PhD; Carol Frey, MD; Johannes Vester, PhD; Markus Maier, PhD ; Lowell Weil, Jr, DPM; Lowell Weil, Sr, DPM; Martin Russlies, PhD; John Stienstra, DPM; Barry Scurran, DPM; Keith Fedder, MD; Peter Diehl, MD; Heinz Lohrer, MD; Mark Henne, MD and Hans Gollwitzer, MD

Published online before print October 1, 2008, doi:10.1177/0363546508324176Am J Sports Med November 2008vol. 36 no. 11 2100-2109

Germany

Decrease of pain by 72,1%

study-5

Radial extracorporeal shockwave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials.

Hypothesis: 

There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis. 
Study Design: Randomized, controlled trial; Level of evidence, 1.

Methods: 

Three interventions of radial extracorporeal shockwave therapy (0.16 mJ/mm2; 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks’ follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients’ and investigators’ global judgment of effectiveness 12 weeks and 12 months after extracorporeal shockwave therapy.

Results: 

Radial extracorporeal shockwave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P< .025, 1-sided). No relevant side effects were observed.

Conclusion: 

Radial extracorporeal shockwave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.

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