Plantar fasciitis (PF) is very common in the general population, often persisting for many months. As extracorporeal shockwave therapy (ESWT) has been used in the management of tendinopathies and botulinum toxin A (BoNT-A) has been used to treat pain, this study compared the effects of those two interventions for the treatment of PF.
METHODSThis open label, prospective, randomized study included patients with PF who had not responded to physiotherapy and electrotherapy. The participants were randomly assigned to receive either ESWT, focused at the area of maximum tenderness for 15 minutes per session, or 100 units of BoNT-A, with injections divided between the insertion of the plantar fascia in the calcaneus and the area of maximal tenderness. The subjects were assessed for pain in the affected foot on a 10-point visual analogue scale (VAS), when taking the first steps in the morning, during daily activity, and while performing exercises. Each patient was also assessed with the Quality of Life Health Status Questionnaire.
RESULTSData for 72 patients were included in the analysis. The median pain score when taking the first steps in the morning was significantly better in the ESWT group than in the BoNT-A group (P＝0.009). Better improvement was also noted in the ESWT group than in the BoNT-A group on the Roles and Maudsley Scale of Pain between the first and second visit, as well as in the percentage of patients who noted improvement in pain on at least one of three modalities of VAS pain scores (P＝0.006 and P＝0.029, respectively). A regression analysis revealed that ESWT and low body weight were independently associated with improvement in pain.
CONCLUSIONThis study of patients with recalcitrant plantar fasciitis found that shockwave therapy was superior to botulinum toxin A for reducing pain.