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Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-Guided Extracorporeal Shock Wave Therapy for Plantar Fasciitis: A Randomized Controlled Trial. JAMA. 2002;288(11):1364–1372. doi:10.1001/jama.288.11.1364
Author Affiliations: Department of Clinical Epidemiology, Cabrini Hospital, and Cabrini Medical Centre, Malvern, Victoria, Australia (Dr Buchbinder); Department of Epidemiology and Preventive Medicine, Monash University (Drs Buchbinder and Forbes and Ms Prabaharan); Radiology Department, Latrobe University Medical Centre (Dr Ptasznik); and Mayne Health Diagnostic Imaging, Epworth Hospital (Mss Gordon and Buchanan), Melbourne, Australia.
Context Extracorporeal shock wave therapy (ESWT) is increasingly used for plantar
fasciitis, but limited evidence supports its use.
Objective To determine whether ultrasound-guided ESWT reduces pain and improves
function in patients with plantar fasciitis.
Design Double-blind, randomized, placebo-controlled trial conducted between
April 1999 and June 2001.
Setting Participants were recruited from the community-based referring physicians
(primary care physicians, rheumatologists, orthopedic surgeons, and sports
physicians) of a radiology group in Melbourne, Australia.
Participants We screened 178 patients and enrolled 166; 160 completed the 15-week
protocol. Entry criteria included age at least 18 years with plantar fasciitis,
defined as heel pain maximal over the plantar aspect of the foot of at least
6 weeks' duration, and an ultrasound-confirmed lesion, defined as thickening
of the origin of the plantar fascia of at least 4 mm, hypoechogenicity, and
alterations in the normal fibrillary pattern.
Interventions Patients were randomly assigned to receive either ultrasound-guided
ESWT given weekly for 3 weeks to a total dose of at least 1000 mJ/mm2 (n = 81), or identical placebo to a total dose of 6.0 mJ/mm2 (n = 85).
Main Outcome Measures Overall, morning, and activity pain, measured on a visual analog scale;
Maryland Foot Score; walking ability; Short-Form–36 Health Survey (SF-36)
score; and Problem Elicitation Technique score, measured at 6 and 12 weeks
after treatment completion.
Results At 6 and 12 weeks, there were significant improvements in overall pain
in both the active group and placebo group (mean [SD] improvement, 18.1 [30.6]
and 19.8 [33.7] at 6 weeks [P = .74 for between-group
difference], and 26.3 [34.8] and 25.7 [34.9] at 12 weeks [P = .99], respectively). Similar improvements in both groups were also
observed for morning and activity pain, walking ability, Maryland Foot Score,
Problem Elicitation Technique, and SF-36. There were no statistically significant
differences in the degree of improvement between treatment groups for any
Conclusion We found no evidence to support a beneficial effect on pain, function,
and quality of life of ultrasound-guided ESWT over placebo in patients with
ultrasound-proven plantar fasciitis 6 and 12 weeks following treatment.
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