Efficacy of Different Energy Levels Used in Focused and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Meta-Analysis of Randomized Placebo-Controlled Trials.

Cheng Cheng,Chen Chen,Wang Wang,Shih Shih,Huang Huang

doi:10.3390/jcm8091497

Abstract

The objective of this study was to assess the efficacy of different energy levels used in extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis using a systematic review and meta-analysis. We searched PubMed, Embase, and Cochrane library, from inception to March 2019 for randomized controlled trials that compared ESWT with placebo in patients with plantar fasciitis. The risk of bias for selected articles was assessed based on the Cochrane Handbook Systematic Review of Interventions. The pooled data were estimated by the mean difference or odds ratio. The meta-analysis showed that the high-energy ESWT group had a better success rate than the control group only at a three-month follow-up, but no significant difference between groups was observed for the other follow-up visits (1 and 12 months). In addition, no significant differences in visual analog scale (VAS) scores between groups were observed for all the follow-up visits (one-month and three-month). On the contrary, the medium-energy ESWT group had significantly better success rates than the control group for all the follow-up visits (3, 6, and 12 months). In addition, the medium-energy ESWT group had significant improvement in VAS scores compared with the control group for all the follow-up visits (1, 3, 6, and 12 months) after removing the extreme values. The low-energy ESWT group had significant improvement in VAS scores compared with the control group for all the follow-up visits (3 and 12 months). Otherwise, focused ESWT seems to be more effective than radial ESWT when compared with the control group. Use of local anesthesia can reduce the efficacy of low- and high-energy ESWTs. Our meta-analysis suggested that medium-energy ESWT in the treatment of plantar fasciitis was more effective than the control group. A limited number of trials related to low- and high-energy ESWTs were included in our meta-analysis. More research is required to confirm the efficacy of low- and high-energy ESWTs in future studies.

Highlights

Plantar fasciitis is a common foot disease and it causes inferior heel pain [1]
We investigated the efficacy of extracorporeal shockwave therapy (ESWT) with different energy levels in the treatment of plantar fasciitis at different follow-ups
The results show that medium-energy ESWT regardless of the types of shockwave generators was more effective for up to 12 months compared with the control group

Summary

Introduction

Plantar fasciitis is a common foot disease and it causes inferior heel pain [1]. About 10% to 20% of patients would develop chronic pain [1]. The most serious heel pain usually occurs after a rest period or the first steps taken in the morning [1]. Several risk factors could lead to plantar fasciitis, such as obesity, ankle dorsiflexion, and heel spurs [2]. 50% of patients diagnosed with plantar fasciitis were observed to have heel spurs [4]. Plantar fasciitis pain has a negative impact on health-related quality of life in patients [5,6]. Females have a worse quality of life with regard to footwear, foot function, foot pain, and general foot health than males [5]. Describe the rationale for the review in the context of what is already known.

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