In Reply: We agree with Dr Wheelock that the
negative results of our trial do not rule out the possibility that other modes
of delivery of ESWT may or may not be efficacious for this condition. In particular,
our study does not provide any data about the efficacy of single-dose high-energy
ESWT. However, the mean total dose that the active group received was 1401.7
mJ/mm2, which is higher than the 1300 mJ/mm2 total dose
delivered to patients in the active groups of both previous trials of single-dose
high-energy ESWT.1,2 In
our trial, the device energy was increased to the highest tolerable level
of pain in the active group, aiming for a total dose of >1000 mJ/mm2, and, as we reported, our results were consistent irrespective of total
dose of ESWT received. The same procedure was simulated in the placebo group.
Buchbinder R, Forbes A, Ptasznik R. Shock Wave Therapy for Treatment of Plantar Fasciitis. JAMA. 2003;289(2):172–173. doi:10.1001/jama.289.2.172-a
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