Comparison of Extracorporeal Shockwave and High-Intensity Laser in Treating Chronic Plantar Fasciitis

Abstract

Background: Plantar fasciitis (PF), an inflammation of the plantar fascia. This study compared the effects of the extracorporeal shockwave and high-intensity laser in reducing pain and enhancing function in chronic plantar fasciitis patients, who have failed to achieve results by the conservative treatment. Aim: To explore the best non-invasive treatment option for chronic PF within the scope of physical therapy. Method: After registry of trial the data collection was started.A total of45 chronic PF patientswere divided, randomly into three groups. Group 1 received BTL-6000 Shockwave therapy (ESWT) , group 2 received Diowave 60W Class IV hot Laser (HILT) and group 3 (the control group) was not given any electrotherapy treatment. All groups were given some exercises for the home plan. The groups were assessed with the Visual Analogue scale (VAS) and foot functional index (FFI) at baseline, post-treatment, and follow-up of 2 months. Result: The mean age of participants was 39.66±10.05,38.06 ±12.64 and 37.40±13.18 for ESWT, HILT group and control groups respectively. There was significant difference in VAS and FFI score p=<0.001 across the time. Pre-treatment and post-treatment scores were significantly different but post treatment and follow-up scores were not significantly different for both VAS and FFI score (p=1.00). Practical implication: This study will help us to find out chronic Plantar fasciitis treatment within physical therapy and electrotherapy domain. As both these modalities are non-invasive, cost effective and proved as effective treatment for reduction of pain and improvement of pain in chronic plantar fasciitis patients. Conclusion: Extracorporeal shockwave have been promising treatment for chronic plantar fasciitis but High intensity LASER therapy effectiveness was not explored a lot in previous literature. The study concluded that both ESWT and HILT are effective in reducing pain and improving function on VAS and FFI, though the ESWT group was found better than both groups in FFI score and VAS across time on the basis of the mean differences across time. Keywords: Exercise, Extra-corporeal shockwave therapy, heel pain, High-intensity Laser therapy, Plantar fasciitis

Effectiveness of high-intensity laser therapy in patients with plantar fasciitis: a systematic review with meta-analysis of randomized clinical trials

“…Initially, 16 articles were chosen, but seven were excluded due to their relevance to other foot conditions (plantar ulcer and Achilles tendinopathy), research on LLLT in PF, and an incomplete study. This left nine articles for analysis [26][27][28][29][30][31][32][33][34]. Figure 1 depicts the flowchart with the search strategy.…”

“…In the experimental group (EGs), 60 patients received only HILT [26,32,33], while 177 participants received HILT in combination with insoles [27][28][29], stretching exercises [28][29][30]34], therapeutic ultrasound (US) [31] or cryotherapy [29]. In CGs, LLLT [28,29], insole [27][28][29], US [31] and ECSWT [33,34] were used. In addition, two studies applied the HILT placebo [30,31].…”

“…HILT reduces pain at rest (VAS) when combined with interventions such as exercises, insoles, or cryotherapy, with an average decrease in pain of -0.7 cm (95% CI: -1.1, -0.3), results that, despite being statistically significant on paper, are not clinically important for VAS, where an average decrease of -0.9 to -1.3cm (95% CI: 0.6 to 1.8) is expected. [28][29][30][33][34][35][36]. Moreover, when compared to LLLT, HILT seems more effective, with an average analgesia of -2.76cm for VAS (95% CI: -3.51-2.0), although it should be noted that the number of RCTs that compared both lasers was limited (28,29), which could lead to publication bias and highlights the need for further research.…”

“…The superiority of HILT over ECSWT remains uncertain, a consideration of significance given the established evidence supporting ECSWT in cases of PF [33,34]. Analogous outcomes have emerged from comparisons between LLLT and ECSWT, revealing no statistically significant distinctions [13,14].…”

“…Similar findings in disability for FFI were obtained in two RCTs comparing HILT with ECSWT, with no significant change in favor of either treatment. However, this conclusion is not definitive due to the limited number of studies [33,34].…”