The use of extracorporeal shockwave therapy (ESWT) for severe resistant plantar fasciitis

E. Choong, R. Brown, S. Clint

Introduction: Plantar fasciitis (PF) is typically self-limiting and the vast majority of patients are successfully treated with conservative measures. However, for a small number of patients, symptoms persist and may require alternative treatment. In 2009, NICE found ESWT to be a safe treatment option for refractory PF and recommended further clinical research. This audit aimed to investigate the effectiveness of ESWT for resistant PF.

Methods: Patient enrolment took place during an 18-month period in an outpatient department of a DGH. Patients were recruited from referring primary care providers (GPs, podiatrists, physiotherapists). Inclusion criteria included a history of at least 3 months of chronic plantar heel pain that proved resistant to at least 3 months of conservative treatment. Patients with bilateral symptoms were not excluded. Diagnosis was confirmed by clinical examination and by excluding other causes of pain with an MRI scan. A total of 32 heels (25 patients) received 3 shockwave interventions, each two weeks apart. 2000 pulses were delivered each intervention using the Swiss Dolorclast radial shockwave device without local anaesthetic. Effectiveness was measured using the Foot Function Index (FFI) pre-treatment and 3 months post-treatment. A reduction in FFI >10% was defined as a responder.

Results: There were 7 missing outcomes at 3 months, giving a total of 25 completed outcome scores. At baseline, the mean FFI score was 53.0% +/-21.0. At 3 months, the mean FFI score was 28.7% +/-26.6. The mean difference was 24.3% (95% CI: [13.88-34.84]: P< 0.0001). 14/25 heels (56%) achieved >10% reduction in FFI scores at 3 months. No side effects were observed.

Conclusion: This audit demonstrated that ESWT is a safe treatment option for the management of severe resistant PF. However, due to the small sample, it is not possible to provide robust clinical evidence of its effectiveness. Further research is warranted.