Efficacy of Different Energy Levels Used in Focused and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Meta-Analysis of Randomized Placebo-Controlled Trials

Abstract

The objective of this study was to assess the efficacy of different energy levels used in extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis using a systematic review and meta-analysis. We searched PubMed, Embase, and Cochrane library, from inception to March 2019 for randomized controlled trials that compared ESWT with placebo in patients with plantar fasciitis. The risk of bias for selected articles was assessed based on the Cochrane Handbook Systematic Review of Interventions. The pooled data were estimated by the mean difference or odds ratio. The meta-analysis showed that the high-energy ESWT group had a better success rate than the control group only at a three-month follow-up, but no significant difference between groups was observed for the other follow-up visits (1 and 12 months). In addition, no significant differences in visual analog scale (VAS) scores between groups were observed for all the follow-up visits (one-month and three-month). On the contrary, the medium-energy ESWT group had significantly better success rates than the control group for all the follow-up visits (3, 6, and 12 months). In addition, the medium-energy ESWT group had significant improvement in VAS scores compared with the control group for all the follow-up visits (1, 3, 6, and 12 months) after removing the extreme values. The low-energy ESWT group had significant improvement in VAS scores compared with the control group for all the follow-up visits (3 and 12 months). Otherwise, focused ESWT seems to be more effective than radial ESWT when compared with the control group. Use of local anesthesia can reduce the efficacy of low- and high-energy ESWTs. Our meta-analysis suggested that medium-energy ESWT in the treatment of plantar fasciitis was more effective than the control group. A limited number of trials related to low- and high-energy ESWTs were included in our meta-analysis. More research is required to confirm the efficacy of low- and high-energy ESWTs in future studies.

Demographic and Clinical Factors Predict Focused Shockwave Therapy Results on Patients With Plantar Fasciitis. A Multilevel Analysis

“…Every patient received 3 sessions of focused ESWT, once a week. At each session, patient received 2400 shocks, at frequency 4 Hz, at energy flux density (EFD) between 0.14 and 0.20 mJ/mm 2 , according to literature data (19) and based on patient's pain tolerance. No local anesthesia was practiced.…”

Retrospective comparison of focused shockwave therapy and radial wave therapy for men with erectile dysfunction

“…rWT has garnered increasing use and attention in nonurological fields. The orthopedic field has extensively used rWT for treatment of conditions such as biceps tendinopathy (31), knee tendinopathy (15), and plantar fasciitis (15,31,32). A meta-analysis of fSWT and rWT in soft-tissue musculoskeletal injuries showed that the treatment modalities are equally safe, with varying efficacy for different injuries, although no direct head-to-head comparisons have been done (13).…”

High-energy Flux Density Extracorporeal Shock-wave Therapy Versus Therapeutic Steroid Injection in Costochondritis: A Single-Blind, Randomised Controlled Study

“…This finding indicates that the delivery of ESWT with a maximum tolerable energy density is more effective than a fixed energy density. In a meta-analysis of randomized, placebo-controlled trials, the efficacy of different energy levels of ESWT was examined in patients with plantar fasciitis and focused ESWT was found to be more effective than radial ESWT and H-ESWT/medium energy-ESWT were more effective than L-ESWT in the long-term follow-up [29]. In addition, anesthetic premedi- cation was shown to reduce the effectiveness of treatment.…”