Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trialPosted by Mark Evans on 10/21/04 at 08:14 (161880)
Objective To determine the effectiveness of extracorporeal shock wave therapy compared with placebo in the treatment of chronic plantar fasciitis.
Design Randomised, blinded, multicentre trial with parallel group design.
Setting Nine hospitals and one outpatient clinic in Germany.
Participants 272 patients with chronic plantar fasciitis recalcitrant to conservative therapy for at least six months: 135 patients were allocated extracorporeal shock wave therapy and 137 were allocated placebo.
Main outcome measures Primary end point was the success rate 12 weeks after intervention based on the Roles and Maudsley score. Secondary end points encompassed subjective pain ratings and walking ability up to a year after the last intervention.
Results The primary end point could be assessed in 94% (n=256) of patients. The success rate 12 weeks after intervention was 34% (n=43) in the extracorporeal shock wave therapy group and 30% (n=39) in the placebo group (95% confidence interval - 8.0% to 15.1%). No difference was found in the secondary end points. Few side effects were reported.
Conclusions Extracorporeal shock wave therapy is ineffective in the treatment of chronic plantar fasciitis.
The full article can be seen at:
Re: Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trialPauline on 10/21/04 at 08:33 (161881)
The first advertisements for ESWT left folks believing that ESWT was a cure all and basicly a snap treatment. Walk in with pain, return to work without it.
As you can see from the posts of those having had ESWT there are many left in extreme pain. So much so that they think they have sustained stress fractures and indeed they have reported such happenings.
In your research, besides effectiveness are you also looking into the possibility of severe injury to tissue and bone as a direct result of having had ESWT?
I think many readers that had ESWT seem to pose that question because they are in such additional pain.
Re: Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trialMark Evans on 10/21/04 at 10:32 (161886)
I agree this is an area that warrants investigation. Certainly it seems fair to conclude at this time, that ESWT is not necessarily a benign procedure and can cause significant trauma. Patients need to know about this before treatment.
Many new procedures are 'oversold'. For example, and to sidetrack a little, I do not know any Opthalmic Surgeons who have elected for laser treatment to correct vision defects on their own eyes.
My own ESWT investigation/evaluation is still at an embryonic stage. Right now I am aware there are robust scientific studies offering contradictory evidence. But, as you know from my previous posts, I am leaving New York for England, (flying out Sunday) and I am not in a position to analyse the studies in detail. However, the picture is quite mirky.
Re: Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trialDr. Z on 10/21/04 at 14:29 (161905)
The first introduction to ESWT on this site was the ossatron group. As you know that group didn't have the understanding that it was a snap procedure. They all knew, discussed and understood that that it takes time to heal. There is no question that energy levels. application can have a positive outcome or a negative outcome depending on what levels are used.
Re: Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trialEd Davis, DPM on 10/22/04 at 11:46 (161986)
Increased pain almost never occurs when low energy is used. That is why Dr. Rompe, I, the majority of Candian and European clinics perfer the low energy approach but use high energy when appropriate. 'Snapping back' would have always been a false promise because almost universally, it is understood that the time for the ESWt effect is not immediate but about 12 weeks.
Re: Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trialJared on 10/22/04 at 14:27 (161992)
Is this a new article?
Re: Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trialDonald Iain Scott on 10/29/04 at 08:27 (162400)
To Mark Evans,
The article you have used was originally printed in BMJ 12th July 2003: BMJ 2003 327-75
Posted in the Global Family Doctor 14th July 2003. Not a recent article
For up to date articles JBJS, Foot and Ankle May 2004,American Family Physician May 2004, Yahoo health 19th October 2004, Cricinf September 2004
Urology Current issue (Peyronie's Disease)
Donald Iain Scott