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Rompe's article on ESWT for runners

Posted by elliott on 5/07/03 at 14:42 (118031)

After hemming, hawing, and stalling, I finally decided to plunk down the $5 allowing me immediate on-line access to Rompe's new article on ESWT for runners. Being an ex-runner (well, my mind isn't ex- but my body certainly is) and having a wife with jogging-induced PF made it too hard to pass up. Here is the (free) abstract:


I am not allowed to post the full article here, as per (ii) in the copyright warning as copied below (I sure hope I'm allowed to copy the copyright warning :-)):

'You may view, download, and/or print the article for your personal scholarly, research, and educational use. You may not (i) distribute a copy (electronic or otherwise) of the article without the written permission of the journal's publisher/owner (ii) post the article on an electronic bulletin board or web site, or (iii) charge for a copy (electronic or otherwise) of the article.'

Here are my thoughts about the article:

The Siemens Sonocur (low energy) was used on runners with PF who previously ran at least 30 mpw, and post-ESWT outcomes are given. Rompe is a big name and I don't doubt he did a careful study.

Even a quick read revealed a few mistakes, ranging from trivial ('followup' inexplicably is in lower case only for the last boxes in Figure 1) to the still insignificant (the text says +/- 0.9 while Table 3 says +/- 0.8) to questionable. (The abstract begins, 'Recent articles have reported success with repeated low-energy shock wave application of chronic plantar fasciitis in runners,' but Rompe's article, while meticulously citing references for just about every benign sentence, inexplicably cites no specific references of previous ESWT studies on runners; I'm guessing that there weren't any (other than, perhaps, those that may have incidentally included a few runners in the group) and that the last two words, 'in runners', in the beginning of the abstract is a misleading mistake. Perhaps I'm wrong, but not citing references specifically for runners is strange.

In any case, I'm very disappointed I plunked down the $5 for one main reason: the article says absolutely nothing about if, when and to what extent any of the runners returned to running. It just uses the same outcome criteria (morning pain scale, 4-point walking scale, etc.) that could be used for any other group. As far as whether at any point in the study they were allowed to run if they could, there's just one vague sentence at the Materials and Methods stage that says, 'Patients were instructed to use the foot but to avoid painful stress,' which, whatever that means, is not even clear in context whether that's just for the first 6 weeks after receiving shockwave or for the duration of the study.

While the treatment group did show significantly better results than the sham group, a careful study of the tables and what they mean offers no clear indication about a return to running. Table 3 shows that after treatment, the mean of the treatment group on the 4-point walking scale dropped from 4 to just about dead-on 2, not necessarily an indicator of the ability to run (and this number barely changed from the 6-month mark to the 12-month mark, going from a mean of 2.1 to 1.9). While it is comforting that the condition of runners with PF seems to be improved with ESWT, casual readers (aren't most of us?) will understand the headlines of the abstract to say ESWT is successful for runners, with the thought being, 'You're a runner with PF? No problem! Just get zapped and get right back on the road!' I heard people in my fitness center suggesting this very thing. In fact, reading the article, one gets the impression that runners are almost incidental to the article, it's chief purpose seemingly to conduct an ESWT study not suffering from the shortcomings of just about all previous ESWT studies to date as outlined in


The most interesting part of the article is the discussion on Buchbinder, et al's, JAMA article. Perhaps the docs here will find this surprising, but Rompe acknowledges that the JAMA study 'is of excellent quality.' He then goes on to list things in the study which may have affected the outcome, and his list of reservations, if you can call it that (he doesn't), interestingly includes things not exactly at the tips of the lips of those with strong reservations here.

Also interesting were Rompe's comments as to why low energy is likely superior to high energy (far less chance of side effects).

Anyway, there's a doc or two here who has gnerously helped me out in the past, and I'd like to return the favor by sending by email a copy of Rompe's article. Before I do that, though, I need to be convinced that sending a copy of the article to a doc or two is not called 'distributing' (as per (i) above), for which the punishment is no doubt death, or, at the least, high-energy ESWT without sedation. :-)


Re: Rompe's article on ESWT for runners

john h on 5/08/03 at 09:18 (118085)

Elliott: There are few of us if any brave enough to try but I sometimes wonder if we may baby our feet to much? If you are not in horrible pain as I am not I wonder if I should not just hit the road and run a mile? We treat many injuries by getting people back on their feet as soon a possible and performing activities. People with knee surgery are back into rehab almost immediately. That old saying 'use it or lose it' may come into play. This is all pure unsupported speculation on my part but just some thoughts. Taking a stress test last week I was forced to run on a steep incline for about 13 minutes. I had not run in over 5 years. I was really no worse from the run. Two years ago I hiked up a very steep mountain that was largely uneven rocks. My feet were no worse (or better) from that trek. Perhaps there is a different approach to PF? Then again this could make your feet worse?

Re: To John Rompe's article on ESWT for runners

Pauline on 5/08/03 at 16:28 (118115)

How are your feet since that last ESWT treatment? Any change or improvement that you can see yet?

Re: To John Rompe's article on ESWT for runners

john h on 5/08/03 at 21:34 (118141)

Pauline: wnen you get down in the pain level range of 1-3 it is difficult to make a good assessment. I am not a zero and I do not run. I have been a lot worse and on a couple of occasions I have been somewhat better.

Re: To John Rompe's article on ESWT for runners

Pauline on 5/09/03 at 14:52 (118192)

Have you ever thought your tissue may be damaged beyond what your body can repair no matter how many ESWT treatments are done, and that continued treatments could possibly be making it worse?

Re: To John Rompe's article on ESWT for runners

Ed Davis, DPM on 5/09/03 at 22:52 (118214)

We know of no documented cases of ESWT making PF worse. It is possible for someone to reach a plateau or a situation in which additional treatments may provide diminishing returns.