Treatment of chronic plantar fasciopathy with extracorporeal shock waves (review)

Christoph Schmitz,Humberto Chaves,Nikolaus Bm Császár,John P Furia,Jan-Dirk Rompe

doi:10.1186/1749-799x-8-31

Abstract

There is an increasing interest by doctors and patients in extracorporeal shock wave therapy (ESWT) for chronic plantar fasciopathy (PF), particularly in second generation radial extracorporeal shock wave therapy (RSWT). The present review aims at serving this interest by providing a comprehensive overview on physical and medical definitions of shock waves and a detailed assessment of the quality and significance of the randomized clinical trials published on ESWT and RSWT as it is used to treat chronic PF. Both ESWT and RSWT are safe, effective, and technically easy treatments for chronic PF. The main advantages of RSWT over ESWT are the lack of need for any anesthesia during the treatment and the demonstrated long-term treatment success (demonstrated at both 6 and 12 months after the first treatment using RSWT, compared to follow-up intervals of no more than 12 weeks after the first treatment using ESWT). In recent years, a greater understanding of the clinical outcomes in ESWT and RSWT for chronic PF has arisen in relationship not only in the design of studies, but also in procedure, energy level, and shock wave propagation. Either procedure should be considered for patients 18 years of age or older with chronic PF prior to surgical intervention.

Highlights

Plantar fasciitis (PF), the most common cause of heel pain, accounts for approximately 11% to 15% of foot symptoms presenting to physicians
Various lines of evidence indicate that this disorder is better classified as ‘fasciosis’ or ‘fasciopathy’, as heel pain is associated with degenerative changes in the fascia and atrophy of the abductor minimi muscle [1]
Both extracorporeal shock wave therapy (ESWT) with focused shock waves and second generation radial extracorporeal shock wave therapy (RSWT) are safe, effective, and easy treatments for chronic PF not responding to conservative therapy

Summary

Introduction

Plantar fasciitis (PF), the most common cause of heel pain, accounts for approximately 11% to 15% of foot symptoms presenting to physicians. Kudo et al [27] in a trial of 114 patients with chronic PF, recalcitrant to conservative therapies for at least six months, achieved treatment success by applying focused shock waves (single sessions of 3,800 impulses with EFD = 0.34 mJ/mm2) or placebo treatment under medial calcaneal nerve block anesthesia. The results of the patients in group B of the study by Chow and Cheing [7] were consistent with the results reported by Gerdesmeyer et al [8] and Ibrahim et al [11], indicating that the energy flux density of the applied radial shock waves must exceed a certain level in order to cause a therapeutic effect. ESWT and RSWT allow patients to return to activities of daily life within 1 or 2 days, with an immediate return to most jobs and normal daily shoe wear

Conclusions

Rompe JD

14. Ueberle F

31. Blobaum P

Findings

37. Michelson J