Extracorporeal Shockwave Therapy Versus Ultrasound Therapy for Plantar Fasciitis: A Systematic Review and Meta-Analysis

Abstract

The objective of this study was to compare the outcomes of extracorporeal shockwave therapy (ESWT) versus ultrasound therapy (UST) in plantar fasciitis. A systematic review and meta-analysis were performed. An electronic search identifying studies comparing ESWT and UST for plantar fasciitis was conducted. Primary outcomes were morning and activity pain, functional impairment, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. Secondary outcomes included the fascial thickness, primary efficacy success rate, activity limitations, pain intensity, and satisfaction. Seven studies enrolling 369 patients were identified. No significant difference was found between ESWT and UST for functional impairment (mean difference [MD] = -2.90, P = 0.22), AOFAS scale score (MD = 35, P = 0.20), and pain in the first steps in the morning (MD = -4.72, P = 0.39). However, there was a significant improvement in pain during activity for the ESWT group (MD = -1.36, P = 0.005). For secondary outcomes, ESWT had improved results in terms of primary efficacy success rate, activity limitations, and patient satisfaction. The reduction of plantar fascia thickness showed no significant difference. Pain intensity after treatment had varied results amongst included studies. In conclusion, ESWT is superior to UST for plantar fasciitis as it improves pain activity and intensity, primary efficacy success rate, and activity limitations.

Keywords: extracorporeal shockwave therapy; functional impairment; heel pain; plantar fasciitis; ultrasound therapy.

Figure 1. PRISMA flow diagram.

The PRISMA diagram details the search and selection processes applied during the overview. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2. Forest plot of ESWT vs. UST – morning pain.

Quantitative analysis showing the mean difference in pain in the morning reported by Konjen et al. (2015) [23], Ulusoy et al. (2017) [24], and Akınoğlu and Köse (2018) [26]. ESWT, extracorporeal shockwave therapy; UST, ultrasound therapy.

Figure 3. Forest plot of ESWT vs. UST – activity pain.

Quantitative analysis showing the mean difference in pain during activity reported by Ulusoy et al. (2017) [24] and Akınoğlu and Köse (2018) [26]. ESWT, extracorporeal shockwave therapy; UST, ultrasound therapy.

Figure 4. Forest plot of ESWT vs. UST – functional impairment.

Quantitative analysis showing the standard mean difference in functional impairment reported by Konjen et al. (2015) [23], Akınoğlu et al. (2017) [25], and Dedes et al. (2019) [27]. ESWT, extracorporeal shockwave therapy; UST, ultrasound therapy.

Figure 5. Forest plot of ESWT vs. UST – AOFAS scale score.

Quantitative analysis showing the standard mean difference in UST reported by Ulusoy et al. (2017) [24] and Akınoğlu et al. (2017) [25]. ESWT, extracorporeal shockwave therapy; UST, ultrasound therapy.