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

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.