Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs

Abstract

Background: Plantar fasciitis (PF) is the most common reason for heel pain. The efficacy of extracorporeal shock wave therapy (ESWT) as an ideal alternative to conservative treatments and surgery is controversial, and almost all previous articles compared general ESWT with placebo without indicating the kind of shock wave. We undertook a meta-analysis to compare the efficacy of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo, to assess their effectiveness in chronic PF.

Methods: The PubMed, Medline, EmBase, Web of Science, and Cochrane library databases were searched for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included the odds ratios (ORs) of pain relief, pain reduction, and complications. Relevant data were analyzed using RevMan v5.3.

Results: Nine studies involving 935 patients were included. ESWT had higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97-3.39, P < .00001). ESWT had markedly lower standardized mean difference than placebo, with heterogeneity observed (standardized mean difference 1.01, 95% CI -0.01 to 2.03, P = .05, I = 96%, P < .00001). FSW and RSW therapies had greater therapeutic success in pain relief than the placebo group (OR 2.17, 95% CI 1.49-3.16, P < .0001; OR 4.63, 95% CI 1.30-16.46, P = .02), but significant heterogeneity was observed in RSW therapy versus placebo (I = 81%, P = .005).

Conclusion: This meta-analysis suggested that FSW therapy can relieve pain in chronic PF as an ideal alternative option; meanwhile, no firm conclusions of general ESWT and RSW effectiveness can be drawn. Due to variations in the included studies, additional trials are needed to validate these conclusions.

Figure 1

Risk of bias graph.

Figure 2

Risk of bias summary.

Figure 3

Flow chart of the study selection.

Figure 4

Forest plot of success rate of general ESWT in chronic plantar fasciitis. 95% CI = 95% confidence interval, ESWT = extracorporeal shock wave therapy, fixed = fixed-effects model.

Figure 5

Forest plot of success rate of FSW therapy in chronic plantar fasciitis. 95% CI = 95% confidence interval, FSW = focused shock wave, fixed = fixed-effects model.

Figure 6

Forest plot of success rate of RSW therapy in chronic plantar fasciitis. 95% CI = 95% confidence interval, random = random-effects model, RSW = radial shock wave.

Figure 7

Forest plot of reduction in pain scale of general ESWT. 95% CI = 95% confidence interval, ESWT = extracorporeal shock wave therapy, IV = inverse variance, random = random-effects model, SMD = standard mean difference.

Figure 8

Forest plot of reduction in pain scale of FSW therapy in chronic plantar fasciitis. 95% CI = 95% confidence interval, FSW = focused shock wave, IV = inverse variance, random = random-effects model, SMD = standard mean difference.