Plantar fasciitis is a common and painful condition affecting millions worldwide. If you've been struggling with heel pain and conventional treatments like stretching, orthotics, and anti-inflammatory medications haven't provided relief, you may be considering shockwave therapy. But does it work? Let's explore the evidence behind shockwave therapy for plantar fasciitis and whether it could be the right treatment for you.
What Is Shockwave Therapy?
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that uses high-energy sound waves to stimulate healing in damaged tissues.
There are two types of shockwave therapy:
- Focused shockwave therapy (FSWT): Generates a shock wave with a focal point that can go through several centimeters of tissue to the affected area. Focused shockwaves can be generated through four mechanisms: electrohydraulic, piezoelectric, electromagnetic, and electroacoustic.
- Radial shockwave therapy (RSWT): Delivers pressure waves emitted through a pneumatic mechanism. The depth of the impact can be adjusted, although the depth is less than a focused shockwave.
Both types work by promoting blood flow, reducing inflammation, and stimulating the repair of damaged tissue.
Scientific Evidence Supporting Shockwave Therapy for Plantar Fasciitis
Several clinical studies and meta-analyses have examined the effectiveness of shockwave therapy for plantar fasciitis. Here’s a breakdown of the key findings:
1. Meta-Analyses and Systematic Reviews
- A meta-analysis by Aqil et al. in Clinical Orthopaedics and Related Research found that shockwave therapy significantly improved pain (VAS scores) and function (Roles and Maudsley scores) in patients with plantar fasciiits. The analysis included seven RCTs and found that ESWT provided better pain relief and functional improvement compared to placebo [Aqil et al, 2013].
- Another systematic review and meta-analysis by Cortés-Pérez et al. in Clinical Rehabilitation compared ESWT to corticosteroid injections and found that ESWT was more effective in reducing pain, decreasing plantar fascia thickness, and improving foot function at both three and six months post-treatment [Cortes-Perez et al, 2024].
- A meta-analysis of Randomized controlled trials (RCTs) by Lippi et al. in the European Journal of Physical and Rehabilitation Medicine highlighted the efficacy and tolerability of ESWT. Tolerability of ESWT was measured by treatment adherence, dropouts, and safety. Secondary outcomes analyzed were pain intensity and functional outcomes, and shock wave showed significant pain reduction and functional improvement in patients with plantar fasciopathy. The study also noted that specific ESWT parameters, such as frequency and energy flux density, influenced treatment outcomes [Lippi et al, 2024].
2. Randomized Controlled Trials (RCTs)
- A prospective, multicenter, double-blind, randomized, and placebo-controlled study by Gollwitzer et al. and published in the The Journal of Bone and Joint Surgery demonstrated that focused ESWT
significantly reduced heel pain and improved functional outcomes
compared to placebo. This study involved 250 subjects and showed a
significant reduction in the visual analog scale (VAS) composite score
and the Roles and Maudsley score at 12 weeks post-treatment [Gollwitzer et al, 2015]. - In a prospective randomized-controlled trial by Kesikburun et al. published in the Journal of Foot and Ankle Surgery 29 patients were treated with either extracorporeal shockwave therapy (ESWT) or dextrose prolotherapy for the treatment of chronic plantar fasciitis. Both treatment groups showed significant improvements in overall pain (measured by the Visual Analog Scale, VAS), morning pain, Foot Function Index (FFI), and Roles and Maudsley Scale (RMS) scores at 6 and 12 weeks post-treatment compared to baseline (p < .001) with no significant difference between groups. The findings indicate that ESWT and dextrose prolotherapy have similar effectiveness in treating chronic plantar fasciitis, suggesting that either treatment can be considered based on patient preference, availability, and other clinical factors [Kesikburun et al, 2022].
- In a double-blind, sham-controlled study, 45 patients with chronic plantar fasciitis were randomized into 3 groups: Group 1: ESWT plus low-dye kinesiotape; Group 2: ESWT plus Sham-taping; and Group 3: ESWT only. In this study by Bahar-Ozdemir et al published in the International Journal of Clinical Practice a total of 45 patients
were randomized and all three groups showed significant improvements in pain and functional scores over time with no significant differences between the groups suggesting that kinesiotape may enhance functional outcomes when used as an adjunct
to ESWT in the treatment of plantar fasciitis, although it does not
significantly impact pain relief or heel tenderness compared to ESWT
alone [Bahar-Ozdemir et al, 2021].
- In a randomized prospective trial Lai et al. compared the efficacy of extracorporeal shock wave therapy (ESWT) and corticosteroid injections (CSI) in treating chronic plantar fasciitis in the Journal of Musculoskeletal and Neuronal Interactions. A total of 97 patients were enrolled and the VAS pain scores were significantly lower in the ESWT group compared to the CSI group at both 4 weeks (p = 0.001) and 12 weeks (p < 0.001) and the ESWT group had significantly better pain relief and functional outcomes at 12 weeks compared to the CSI group (p < 0.001). The findings suggest that extracorporeal
shock wave therapy (ESWT) was more effective than corticosteroid
injections (CSI) in reducing pain and improving clinical outcomes for
chronic plantar fasciitis at 12 weeks post-treatment [Lai et al, 2018].
- In the Journal of Foot and Ankle Surgery a randomized controlled trial by Malay et al compared the efficacy of extracorporeal shock wave therapy (ESWT) with placebo in treating chronic proximal plantar fasciitis. Participants were randomized in a 2:1 ratio to receive either ESWT (n=115) or placebo (n=57). Extracorporeal
shock wave therapy (ESWT) was found to be both efficacious and safe for
the treatment of chronic proximal plantar fasciitis, providing significant pain relief compared to placebo [Malay et al, 2006].
- In a randomized controlled trial by Rompe et al the authors compared
the efficacy of radial shock wave therapy (RSWT) alone versus RSWT
combined with a plantar fascia-specific stretching program in patients
with chronic plantar heel pain. 152 patients with chronic plantar fasciopathy Rrceived repetitive low-energy RSWT administered weekly for three weeks. The authors found radial
shock wave therapy combined with tissue-specific plantar
fascia-stretching is more efficient than radial shock wave therapy alone for the treatment of chronic plantar heel pain, particularly in the short to medium term [Rompe et al, 2015].
- The study by Speed et al. published in the Journal of Orthopaedic Research investigated the efficacy of moderate dose extracorporeal shock wave therapy (ESWT) in treating plantar fasciitis. Participants were randomized to receive either active ESWT (0.12 mJ/mm²) or sham therapy, administered monthly for 3 months. Both groups showed significant improvement over the course of the study, but there was no statistically significant difference between the ESWT and sham groups in any of the outcome measures over the 6-month period. [Speed et al, 2003].
- The randomized controlled trial by Takla & Rezk compared the clinical effectiveness of combining multi-wavelength photobiomodulation therapy (PBMT) with extracorporeal shock wave therapy (ESWT) versus ESWT alone in treating plantar fasciitis. 120 patients were randomly assigned to one of four groups and the combination of multi-wavelength photobiomodulation therapy and extracorporeal shock wave therapy is more effective than extracorporeal shock wave therapy alone in treating chronic plantar fasciitis [Takla & Rezk, 2019].
- The study by Tognolo et al published in the European Journal of Physical and Rehabilitation Medicine investigated the effectiveness of focused extracorporeal shock wave therapy (f-ESWT) on myofascial points in patients with plantar fasciitis. Patients were randomly assigned to an experimental group (EG) treated with f-ESWT on myofascial points, or a control group (CG) treated with the traditional f-ESWT approach on the medial calcaneal tubercle. The experimental group (EG) demonstrated earlier improvement in score values compared to the control group (CG) suggesting treatment of myofascial points in patients with plantar fasciitis could be an effective treatment option when compared to traditional f-ESWT approach. This supports the
hypothesis that addressing global biomechanical re-equilibrium may be
necessary for complete resolution of the pathology [Tognolo et al, 2022].
- Uğurlar et al compared the therapeutic effects of four treatment modalities for chronic plantar fasciitis: extracorporeal shock wave therapy (ESWT), platelet-rich plasma (PRP) injection, local corticosteroid injection, and prolotherapy in this randomized, controlled, prospective study. The corticosteroid injection providing the most immediate relief, but lost its effectiveness over time. The other treatments, ESWT, prolotherapy, and PRP, showed more sustained benefits [Uğurlar et al, 2018].
- The randomized controlled trial by Ulusoy et al. compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) in treating chronic plantar fasciitis. All three groups showed significant improvements in pain and functional scores, and the thickness of the plantar fascia decreased significantly on MRI in all groups. The low-level laser therapy (LLLT) and extracorporeal shock wave therapy (ESWT) were more effective than ultrasound therapy [Ulusoy et al, 2017].
- The study by Wheeler et al published in Foot and Ankle
Surgery investigated the efficacy of standard-dose rESWT compared to minimal-dose rESWT in patients with chronic plantar fasciopathy. Patients were randomized equally to receive either three sessions of standard-dose rESWT or minimal-dose rESWT. Both groups showed a significant improvement in pain and function at 6 months, with average pain improving by 50%.There were no significant differences between the standard-dose and minimal-dose rESWT groups at any time point. [Wheeler et al, 2022].
3. Comparisons to Other Treatments
Studies comparing ESWT to traditional therapies, such as physical therapy, orthotics, and NSAIDs, suggest that shockwave therapy is more effective for patients with persistent symptoms lasting more than six months. However, it may not be as beneficial for acute cases of plantar fasciitis.
Benefits of Shockwave Therapy for Plantar Fasciitis
- Non-invasive: No surgery or injections required.
- Minimal downtime: Patients can usually resume normal activities soon after treatment.
- Long-lasting relief: Many studies indicate sustained pain relief for up to a year or more.
- Few side effects: Some patients may experience mild discomfort, redness, or swelling, but serious complications are rare.
Potential Drawbacks and Limitations
- May not work for everyone: Some patients see minimal improvement.
- Multiple sessions required: Typically, 3-5 sessions are needed for optimal results.
- Cost: Insurance coverage varies, and out-of-pocket expenses can be high.
Is Shockwave Therapy Right for You?
If you’ve tried conservative treatments without success and your plantar fasciitis has persisted for more than six months, shockwave therapy could be a viable option.
Conclusion
Shockwave therapy has strong clinical backing for treating chronic plantar fasciitis, with multiple studies demonstrating its effectiveness. While it’s not a guaranteed cure, it offers a promising alternative to invasive procedures and long-term medication use. If you're considering shockwave therapy contact us at:
(781) 591-7855
info@BSBortho.com
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Wellesley MA 02481
