Short and Long-Term Efficacy of Radial Extracorporeal Shock Wave Therapy (rESWT) in the Treatment of Chronic Plantar Fasciitis.

Abstract

Background Plantar fasciitis (PF) is a common musculoskeletal disorder. It is the primary cause of heel pain, with global prevalence. The condition often results from repetitive microtrauma to the plantar fascia, with Chronic PF generally characterised by persistent, localised pain, alongside impaired foot function. Conventional conservative treatments include non-steroidal anti-inflammatory drugs (NSAIDs), orthotic devices, and physiotherapy. These treatments are commonly used; however, their long-term effectiveness is inconsistent. Surgical interventions, although required in some more severe cases, also come with inherent risks and variable clinical outcomes. In contrast, radial extracorporeal shock wave therapy (rESWT) is a non-invasive therapeutic approach, which has generated growing interest due to its potential to promote tissue regeneration and modulate pain. However, despite evidence indicating that it is a potentially effective intervention, the lack of standardised treatment protocols and limited long-term outcome data have limited more widespread clinical application. Objectives The main objective of this systematic review is to assess the short- and long-term efficacy of rESWT in alleviating pain and enhancing foot function in adults with chronic PF. The secondary objective is to compare rESWT outcomes with other therapeutic interventions to understand its relative effectiveness. In the process, the review generates insights that can inform clinical decision-making, as well as identifying gaps in the current literature which future research can address. Study Design A comprehensive systematic literature search was undertaken per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases (PEDro, PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library) were searched for randomised controlled trials (RCTs) published between 2014 and 2024. Studies were included if they met the predefined inclusion criteria: Namely, adult participants (≥18 years) diagnosed with chronic PF (symptoms ≥2 months), intervention using rESWT, and outcome measures assessing pain and/or foot function. Only English-language and full-text RCTs were included for review. The methodological quality of the studies was assessed per the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Results Six RCTs were selected for the final synthesis. The review found rESWT interventions resulted in reductions in pain intensity and improvements in foot function both short term (4–12 weeks), and in some instances over periods extending up to two years. Comparisons with alternative treatments such as corticosteroid injections, ultrasound therapy, and placebo also indicate that rESWT results in comparable, if not superior, therapeutic outcomes to these alternate approaches. That said, the overall quality of the evidence is impacted by methodological limitations, including small sample sizes, insufficient participant and/or provider blinding, and heterogeneity in treatment parameters and outcome assessments. Conclusion The synthesised evidence supports the clinical utility of rESWT as an effective, non-invasive intervention for chronic PF management, especially in patients who prove unresponsive to conventional conservative treatment strategies. rESWT has demonstrated short- and long-term benefits in pain reduction and functional improvement. However, additional high-quality, large-scale RCTs, which include standardised protocols and extended follow-up periods, are required to improve the evidence base and facilitate the development of clinical guidelines. For the translational impact of rESWT in clinical practice to be maximised, this review concludes that it is essential to address such methodological shortcomings and ensure broader population representation in future trials.