Extracorporeal shock wave therapy shows comparative results with other modalities for the management of plantar fasciitis: A systematic review and meta-analysis

Abstract

Background: Plantar fasciitis (PF) is one of the most common causes of heel pain. With its treatment being mainly conservative, a lot of controversy surrounds the choice of the best conservative management for this entity. The purpose of this meta-analysis was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) to other conservative treatment options for the management of plantar fasciitis PF. Methods: PubMed, Cochrane, and Google Scholar (Pages 1–20) were searched systematically for randomized control trials (RCTs) published after 2013 comparing ESWT to other treatment modalities. ESWT was compared against six other treatment modalities and a placebo. Results: Fifteen studies involving 1123 patients were included in the meta-analysis. ESWT was found to perform significantly better than placebo (SMD: 7.53, CI: [5.84, 9.22]; p < 0.00001) for VAS pain score, and CSI for FFI (SMD: 1.07, CI: [0.08, 2.07], p = 0.03). PRP outperformed ESWT for post-intervention VAS scores (SMD: −1.05; CI: [−1.53, −0.57]; p < 0.0001) and FFI (SMD: −0.84; CI: [−1.38, −0.30]; p = 0.002), while custom orthotics improved FFI significantly over ESWT (SMD: −0.74; CI: [−1.19, −0.28; p = 0.001]. No other significant differences were found between ESWT and other treatment modalities for the three metrics included in this study. Conclusion: ESWT has been proven to be a successful treatment for PF. However, PRP showed a statistically and clinically significant greater improvement in pain and FFI than ESWT. However, compared to ESWT, PRP is still a more technically challenging procedure. Level of Evidence: Level 1 Meta-Analysis