Resistant Plantar Fasciopathy: Shock Wave Versus Endoscopic Plantar Fascial Release

SLR - July 2013 - Grant Swenson

Reference: Radwan YA, Mansour AM, Badawy WS. (2012). Resistant Plantar Fasciopathy: Shock Wave versus Endoscopic Plantar Fascial Release. International Orthopaedics, 36:2147-56.

   

Scientific Literature Review

Reviewed by: Grant Swenson, DPM

Residency Program: Southern Arizona VA Health Care System

Podiatric Relevance: Heel pain is one of the most common problems faced by the podiatric surgeon. Many conservative as well as surgical techniques have been described and utilized with varying degrees of success. This article assesses the effectiveness of two common interventions for patients with chronic heel pain that have not responded to conservative measures.
 

Methods: A prospective, randomized study design was utilized to assess the effectiveness of extracorporeal shock wave therapy (ESWT) versus endoscopic partial plantar fascia release (EPFR) for the treatment of chronic plantar fasciopathy. Seventy consecutive patients with unilateral recalcitrant plantar fasciopathy were enrolled. Patients were followed for 12 months post intervention. Inclusion criteria included: 1) Failure of at least three lines of conservative treatment, and 2) a self-assessment of pain after the first five minutes of walking in the morning that was more than 40 mm on the 100 mm visual analog scale.

Results: In the ESWT group, the majority of improvements were achieved and maintained between week three and week 12 post intervention, and continued to a lesser extent for up to one year. In the EPFR group, the majority of improvements were achieved between week three and month 12 post intervention. At the 12-month follow-up, a minimum of 80 percent improvement of AOFAS score was achieved in 22/34 patients in the ESWT group and 18/31 patients in the EPFR group. No statistically significant differences between the two groups were detected through the different time periods for any measured parameter. 
 
Conclusions: The authors performed a prospective randomized study to evaluate the effectiveness of extracorporeal shock wave therapy versus endoscopic plantar fascial release. In patients who had experienced failure of conventional treatment of plantar fasciopathy, shock wave therapy was demonstrated to be a comparatively helpful potential line of management. The study revealed comparable results of ESWT, when compared with EPFR at three months and one year. ESWT appears to be a useful noninvasive treatment that may represent a short term and cost effective alternative for the treatment of chronic plantar fasciopathy that reduces the necessity for surgical procedures.