SLR - April 2011 - Quinn Taylor Charbonneau
Reference: Rompe JD, Cacchio A, Weil L, Furia JP, Haist J, ReinersV, Schmitz C and Maffulli N (2010). Plantar Fascia-Specific Stretching Versus Radial Shock-Wave Therapy as Initial Treatment of Plantar Fasciopathy. J Bone Joint Surg Am. 92A(15): 2514-22.
Scientific Literature Review
Reviewed by: Quinn Taylor Charbonneau, DPM
Residency Program: Massachusetts General Hospital, Boston, MA
Podiatric Relevance:
Randomized controlled trials have described the clinical effect of both plantar fascia-specific stretching and shock-wave therapy on plantar fasciopathy. The purpose of this study was to compare these two non-surgical modalities for a common podiatric condition. The authors tested these two forms of treatment on patients with unilateral plantar fasciopathy, symptomatic for a maximum of six weeks and previously untreated.
Methods:
One hundred and two (102) adult patients with acute plantar fasciopathy participated in this study. Fifty four (54) patients were randomly assigned to perform an eight week plantar fascia-specific stretching program (Group I) and 48 to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II). A seven item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire was completed by each patient at baseline, and also at two, four, and fifteen months after baseline. Patient satisfaction, mean change in the Foot Function Index sum score at two months after baseline, and a mean change in pain on initial ambulation each morning were used as the primary outcome measures in this study.
Results:
Groups I and II were found to be equivocal in mean age, sex, weight and duration of symptoms at baseline. Significantly greater changes in Foot Function Index sum score at two months after baseline was observed in patients who participated in the stretching program compared to those who received shock-wave therapy (p < 0.001). The stretching program was also observed to be significantly more effective than shock-wave therapy at decreasing pain with morning ambulation (p = 0.002). While the stretching program group yielded thirty-five patients (65%) who were satisfied with the treatment, the shock-wave therapy group yielded only fourteen patients (29%) that were satisfied. These findings were also observed at four months, but no significant difference between the groups was measured at fifteen months after baseline.
Conclusions:
For adult patients with proximal plantar fasciopathy, a program of manual stretching exercises targeting the plantar fascia was found to be superior to repetitive low-energy radial shock-wave therapy for at least the first four months after initiating treatment. Comparison of these modalities at fifteen months after beginning treatment showed no significant difference, suggesting that plantar fasciopathy may resolve over time regardless of which modality is chosen.