This 2018 systematic review concludes that high-intensity Extracorporeal Shock Wave Therapy (ESWT) may be superior to corticosteroid injections for the treatment of persistent plantar heel pain (PHP).1

Another 2018 systematic review based on 13 RCTs concludes the ESWT was superior to other therapies with less complications.2

One RCT showed that ESWT and ultrasound had similar benefits on PHP.3

The Cochrane review concludes that local steroid injections may slightly reduce heel pain up to one month but not subsequently.4

Platelet-rich plasma (PRP) injections have not been shown to be superior to cortisone injections for PHP. 5

Irrespective of treatments, PHP symptoms typically improve within a year of onset however, approximately 40% of patients continue to have symptoms after 2 years.6

For symptoms to last for 2 years, we must perhaps look at non-mechanical factors such as fear!

  1. Li S et al Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018 Dec;97(50)
  2. Sun K et al Extracorporeal shock wave therapy versus other therapeutic methods for chronic plantar fasciitis. Foot Ankle Surg. 2018 Nov 13.
  3. Akinoglu Bet al Comparison of the Acute Effect of Radial Shock Wave Therapy and Ultrasound Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Study. Pain Med. 2017 Dec 1;18(12):2443-2452.
  4. David JA et al Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 2017 Jun 11;6:CD009348.
  5. Yang W et al Platelet-rich plasma as a treatment for plantar fasciitis: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Nov;96(44)
  6. Digiovanni Bet al Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006 Aug; 88(8):1775-81.
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