Extracorporeal Shockwave Therapy Versus Ultrasound Therapy for Plantar Fasciitis: A Systematic Review and Meta-Analysis.

Zeyana Al-Siyabi,Mohammad Alazemi,Ahmed A Aldubaikhi,Mohammad Karam,Ethar Al-Hajri,Abdulmalik Alsaif

doi:10.7759/cureus.20871

Abstract

The objective of this study was to compare the outcomes of extracorporeal shockwave therapy (ESWT) versus ultrasound therapy (UST) in plantar fasciitis. A systematic review and meta-analysis were performed. An electronic search identifying studies comparing ESWT and UST for plantar fasciitis was conducted. Primary outcomes were morning and activity pain, functional impairment, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. Secondary outcomes included the fascial thickness, primary efficacy success rate, activity limitations, pain intensity, and satisfaction. Seven studies enrolling 369 patients were identified. No significant difference was found between ESWT and UST for functional impairment (mean difference [MD] = −2.90, P = 0.22), AOFAS scale score (MD = 35, P = 0.20), and pain in the first steps in the morning (MD = −4.72, P = 0.39). However, there was a significant improvement in pain during activity for the ESWT group (MD = −1.36, P = 0.005). For secondary outcomes, ESWT had improved results in terms of primary efficacy success rate, activity limitations, and patient satisfaction. The reduction of plantar fascia thickness showed no significant difference. Pain intensity after treatment had varied results amongst included studies. In conclusion, ESWT is superior to UST for plantar fasciitis as it improves pain activity and intensity, primary efficacy success rate, and activity limitations.

Highlights

BackgroundPlantar fasciopathy or plantar fasciitis is one of the most common foot disorders and occurs in approximately 10% of the population throughout their life [1]
extracorporeal shockwave therapy (ESWT) showed a superior effect when compared with ultrasound therapy (UST) in terms of functional impairment, AOFAS scale score, and morning pain shown by the results of the analyses
The evidence is limited with only seven studies with a total of 369 patients comparing the use of ESWT and UST, the results of this meta-analysis suggest that ESWT is a superior option in the treatment of patients with plantar fasciitis

Summary

Introduction

Plantar fasciopathy or plantar fasciitis is one of the most common foot disorders and occurs in approximately 10% of the population throughout their life [1]. It was defined as an inflammatory syndrome, recent studies have emphasised that plantar fasciopathy is more likely to be a degenerative process associated with multifactorial aetiology [2,3]. Pain may last for months or years [3]. Conservative treatments, such as activity modification, oral analgesics, ice massage, stretching exercises, orthotics, and corticosteroid injections, can help with disabling pain. Patients with chronic plantar fasciitis can consider other treatment options, including extracorporeal shockwave therapy (ESWT), ultrasound therapy (UST), low-level laser therapy (LLLT), or surgical plantar fasciotomy [10,11]

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