Is Extracorporeal Shock Wave Therapy an Underutilized Treatment for Chronic Plantar Fasciitis? Commentary on an article by Hans Gollwitzer, MD, et al.: "Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis. A Randomized, Controlled Multicenter Study".

Abstract

In their excellent article, Gollwitzer et al. provide additional Level-I evidence that, when properly performed, extracorporeal shock wave therapy can be an effective treatment for chronic plantar fasciitis, with a low major complication rate. Two hundred and fifty patients with chronic plantar fasciitis nonresponsive to at least six months of nonoperative treatment consisting of at least two pharmacological and at least two nonpharmacological treatments were randomized to three weekly sessions of 2000 impulses of focused extracorporeal shock wave therapy or placebo, with none of the patients opting for local anesthesia. Outcome measures included three visual analog scale (VAS) scores and their sum composite score, the Roles and Maudsley score, the investigator’s global judgment of treatment effectiveness, and patient satisfaction. Treatment was considered successful if the study participant had at least 60% reduction of pain in two of three VAS scores or if the participant was able to work, was satisfied with treatment outcome, and required no concomitant therapy to control heel pain. More than 98% of the participants were available for intention-to-treat analysis at twelve weeks, with significantly higher treatment success in the extracorporeal shock wave therapy group (64.8%) compared with the placebo group (46.3%), a significantly higher Roles and Maudsley score in the extracorporeal shock wave therapy group (60.8%) compared with …