Houston Methodist. Leading Medicine

Foot FAQ

Question:

I am a physiatrist interested in treating plantar fasciitis with shock wave therapy. What's the latest thinking about this modality? Does it work? Is there evidence for a best way to apply the energy?

Answer:

As you already know, treatment is usually with conservative (nonoperative) care. This could include stretching, wearing a splint at night, the use of antiinflammatory medications, and/or a special arch support to help reduce the pressure on the fascia. Shock wave therapy is a newer form of nonsurgical treatment used when other forms of conservative care fail to produce the desired results (primarily pain relief). Shock wave therapy uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. Studies have shown that this form of treatment can help ease pain, while improving range of motion and function. But there have not been large randomized controlled studies to compare different ways to use the shock therapy. Most recently, a group of researchers from Taiwan conducted a systematic review and meta-analysis comparing the effectiveness of two major types of shock wave therapy (focused shock wave (FSW) therapy and radial shock wave (RSW) therapy). The results may be of interest to you. Focused shock wave (FSW) therapy is just as it sounds: the energy wave is directed at a specific area. FSW concentrates the wave field whereas radial shock wave (RSW) disperses the energy over a wider range. With RSW, it is not necessary to find the painful spots before applying the energy wave. A particular area of interest in this study was to see the value in using different intensity levels, which represent energy flow through the tissue. Turning the intensity up may provide more pain relief but could also temporarily increase pain, local swelling, and tenderness. High intensity FSW also required the use of local anesthesia, which can have its own negative side effects. Focus shock wave therapy can be delivered in three intensities: low, medium, and high. Patients receiving FSW were divided into three groups based on the intensity of wave delivery. Patients receiving RSW made up the fourth group. Results were measured based on pain reduction and overall success of the treatment. The goal was to see if one type of shock therapy was superior to the others in treating plantar fasciitis. What did they find? Well, first of all, any type of shock wave therapy yielded better results than a "sham" or placebo (pretend) treatment. The best results were gained using radial shock wave (RSW) therapy. Focused shock wave (FSW) gave the best results when used at the highest energy density tolerated by the patient in the medium intensity range. For those who use this modality to treat plantar fasciitis, the authors say don't go out and purchase a radial shock wave machine if you already have a focused shock wave device. Anyone like you who is just considering purchasing this equipment is advised to select radial shock wave therapy. It costs less and gives better results with fewer potential side effects. Ke-Vin Chang, MD, et al. Comparative Effectiveness of Focused Shock Wave Therapy of Different Intensity Levels and Radial Shock Wave Therapy for Treating Plantar Fasciitis: A Systematic Review and Network Meta-Analysis. In The American Journal of Sports Medicine. July 2012. Vol. 93. No. 7. Pp. 1259-1268.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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