Extracorporeal shockwave for plantar fasciitis: continuing good results

H.K. Ribee, A. Bhalla, A. Patel, B. Johnson, J. Leah, A. Bailey, C. Chapman, A. Bing, S.O. Hill, P. Laing, N. Makwana, K. Thomason, C. Marquis

Introduction: Plantar Fasciitis is an extremely common and challenging problem that presents itself to foot and ankle practitioners. Many different treatment modalities are available for this condition, with little proven benefit. ECSWT was approved for use by the FDA for the treatment of chronic proximal plantar fasciitis in 2002 and NICE published guidance in 2009 recommending its use in refractory cases.

Methods: Patients who diagnosed with ultrasound scan, and for whom other treatments were unsuccessful, underwent treatment on an outpatient basis. They had three 4-5 minute sessions, once a week. A Spectrum machine was used delivering 10 Hz waves in 500 preset pulses at 2 bar pressure, followed by 2000 preset pulses at 2.5 bar pressure. Pre - and 3 month post-treatment pain levels were recorded using a 10 point Visual Analogue Scale.

Results: 210 courses of treatment have been performed on 181 feet belonging to 135 patients. 46 patients have had treatment to both feet. 121 treatments have paired pre and postoperative VAS scores. 79 had a reduced score post treatment (65.2%), 17 had an increased score (14%), and 24 had a score which remained unchanged (19.8%). 65.8% subjectively felt they had improved. Overall there was an average reduction in VAS score from 7 to 4.975, a reduction of 2.025 points (p=0.000000000151).

Discussion: The majority of patients show a benefit in terms of an overall reduction in pain score, though it is not clear how many patients would have improved spontaneously in that time. However, there is further work to do in terms of a more detailed evaluation of the effect on foot function: anecdotally the treatment may significantly improve start up pain. We would also like to see if we can establish a benefit for the therapy earlier in the disease process.