Shock Wave Therapy for Plantar Fasciitis

Plantar fasciitis is a common problem that causes pain under the heel bone and in the arch of the foot. Plantar fasciitis is an irritation to the tough, fibrous tissue that forms the arch of the foot. Patients with plantar fasciitis complain of pain under the heel with lengthy walks and prolonged standing. Most patients with plantar fasciitis are effectively treated with some simple measures. Common treatments include anti-inflammatory medications, ice applications, shoe inserts, and stretching exercises. In some situations patients do not find relief from their symptoms and require more aggressive treatment.

Surgical intervention has been the last resort for patients when other treatments of plantar fasciitis do not work. The problem is that the success rate of surgery is not excellent, and surgery has potentially complicating side-effects.

Extracorporeal shock wave therapy, or ESWT, has emerged as a possible treatment option for patients with chronic plantar fasciitis. ESWT delivers focused shock waves to the body. There is both a high-energy and low-energy form of ESWT; and both forms of shock wave therapy can be used in the treatment of plantar fasciitis.

Low-energy shock wave treatments are given as a series of three or more treatments. The low-energy shock waves are not painful, or mildly painful. On the other hand, the high-energy shock wave treatments are given at one session. High-energy shock wave treatments are quite painful, and some type of anesthesia is needed. Either a regional block or general anesthesia can be administered for the high-energy treatments.

Shock wave therapy is thought to work by inducing microtrauma to the tissue that is affected by plantar fasciitis. This microtrauma initiates a healing response by the body. This healing response causes blood vessel formation and increased delivery of nutrients to the affected area. The microtrauma is thought to stimulate a repair process and relieve the symptoms of plantar fasciitis.

First reported in 1996, several investigators have published successful results when using shock waves to treat plantar fasciitis. (1) The FDA subsequently approved the use of shock waves for the treatment of plantar fasciitis in 2000. Since that time, numerous studies have investigated the use of shock wave treatments for plantar fasciitis.

One often cited report investigated the use of low-energy ESWT and found good results in patients treated with three sessions of ESWT. (2) This study was a well-designed, randomized trial that showed good results in patients who did not improve with more traditional treatments.

However, there are also numerous reports that have not been as successful. A study in the British Medical Journal, with more than twice as many patients as the study mentioned above, also well-designed and randomized, showed no difference in the patients treated with shock wave therapy. (3)