Pros
The most attractive aspect of shock wave treatment for plantar fasciitis is that surgical treatment of chronic plantar fasciitis is not terribly effective. Because of this, orthopedic surgeons are seeking more effective treatment for these patients who do not seem to improve with more standard treatments. The standard treatment for plantar fasciitis that does not improve with conservative measures is surgery. Many patients wish to avoid surgery if at all possible.Furthermore, one of the most concerning aspects of surgical treatment of plantar fasciitis is that there are potentially serious complications. Few complications have been reported with the use of shock wave therapy. Patients who have surgery are at risk for continued pain, wound problems, and infections. The primary problem with ESWT is that not all patients are cured of their symptoms.
Cons
Shock wave therapy is quite expensive, and whether or not it is an effective treatment is controversial. Each individual treatment can cause in excess of $1000, and insurance companies may not necessarily cover the expense. Therefore, patients who wish to have these treatments may end up paying for them out of pocket.Finally, the effectiveness of treatments is questioned. If the shock wave treatments are helpful, the difference is small. The reports in the literature are quite variable, but even in studies that show a good effect of ESWT, it probably helps only 5-40% of patients. Therefore, a significant number of patients will still have pain after shock wave treatments.
Where it Stands
The jury is still out on whether or not shock wave therapy is effective in the treatment of chronic plantar fasciitis. Current recommendations for this treatment are that it is a safe treatment for patients who have failed conservative measures and may require surgical intervention.It is important that patients try more traditional treatments for a period of at least 6 months to a year before considering shock wave therapy. It is known that conservative measures, consisting of medications, ice application, exercises and stretches, and shoe inserts are effective treatments for plantar fasciitis. Furthermore, it is also known that a period of time of 6 months to one year is required to effectively treat plantar fasciitis. More than 90% of patients with plantar fasciitis should be effectively treated by this standard treatment plan.
Patients who have no success with these traditional treatments may benefit from shock wave therapy. It is a reasonable option to consider ESWT prior to surgical intervention. Potential side-effects of ESWT are minimal. Therefore, in patients who have chronic plantar fasciitis, and who have failed a minimum six month trial of standard treatments, shock wave therapy is a safe treatment alternative to surgery.
Sources:
Rompe, JD, et al. "Low-energy extracorporeal shockwave therapy for painful heel: a prospective controlled single-blind study." Arch Orthop Trauma Surg. 1998;115:75-9.
Rompe, JD, et al. "Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis." Jour Bone Joint Surg. 2002;84:335-41.
Haake, M, et al. "Extracorporeal shock wave therapy for plantar fasciitis: randomized controlled multicentre trial." Brit Med Jour. 2003;327(7406):75.
