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Shock wave therapy yields good, excellent results in 82% of plantar fasciitis patients
Long-term results are better than conservative treatment, for both pain and functional scores.
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The first long-term study on extracorporeal shock wave treatment for plantar fasciitis found results superior to those of conservative treatment.
Ching-Jen Wang, MD, and his colleagues in Taiwan found 82.7% good-to-excellent results and a 12% recurrence rate in plantar fasciitis patients at an average 5 years to 6 years after extracorporeal shock wave treatment. They compared these results to those of patients treated conservatively: 55% good-to-excellent results and a 55% recurrence rate.
Short-term studies on shock wave treatment for plantar fasciitis have shown 91% satisfactory results and a 6% recurrence rate, Wang said at the American Academy of Orthopaedic Surgeons 74th Annual Meeting.
“Despite the change in efficacy and the recurrence rate [at long-term follow-up] the overall findings in this study demonstrated that shock wave treatment is more effective and has a lower recurrence rate than conservative treatment for patients with plantar fasciitis.”
Randomizing patients
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Wang and his colleagues enrolled 149 patients with 168 affected heels in the study between 1999 and 2000. They randomly divided the patients into two groups: 79 patients with 85 affected heels were in the shock wave group and 70 patients with 83 heels were in the control group.
Demographics, including age, gender and symptom duration, were comparable between the two groups. Among both groups, 19 patients had bilateral plantar fasciitis and 25% were recreation athletes, most being distant runners, Wang said.
Surgeons administered 1,500 impulses of shock waves at 16 kV, the equivalent to 0.32 mmJ/mm2 minimum energy flux density, Wang said.
Over the course of treatment, 58 patients with 60 affected heels underwent shock wave therapy once; 16 patients with 19 affected heels underwent therapy twice; and five patients with six affected heels underwent the therapy three times, Wang said.
“In the control group, most patients were treated with a single modality, and later, most had received multi-modal modalities, including medications, orthotics, exercise, therapy and occasionally a cortisone injection,” Wang said.
Results between two groups
Investigators evaluated the shock wave therapy patients at 60 months to 72 months and evaluated the conservatively treated patients at 34 months to 64 months.
“The difference in pain intensity between the shock wave group and the control group was not statistically significant prior to the treatment,” Wang said. “However, the difference between the two groups in terms of pain intensity became highly significant after the treatment, favoring the shock wave group.”
The same held true for the pain and functional scores, he added.
Overall outcome scores were 69% excellent, 13.6% good, 6% fair and 11% poor in the shock wave group. In the control group, overall outcome scores were 55% good, 36% fair and 9% poor.
No patient in the control group had excellent results.
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Image: Wang CJ |
For more information:References:
- Ching-Jen Wang, MD, can be reached at Chang Gung Memorial Hospital, 123, Tai Pei Road, Niao Sung Hsiang, Kaohsiung 833, Taiwan; +1-866-7-731-7123; e-mail: w281211@adm.cgmh.org.tw. He and his colleagues received research or institutional support.
- Wang CJ, Wang FS, Yang KD, et al. Long-term results of extracorporeal shock wave treatment for plantar fasciitis. #177. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.
- Wang CJ, Wang FS, Yang KD, et al. Long-term results of extracorporeal shock wave treatment for plantar fasciitis. Am J Sports Med. 2006;34(4):592-596.