Evaluation of Factors Possibly Influencing the Outcome of Focused Extracorporeal Shockwave Treatment (ESWT) of Recalcitrant Plantar Fasciitis with Calcaneal Spur

Introduction: There are several trials suggesting that radial as well as focused shockwave therapies show satisfying results as treatment options of plantar fasciitis. This study was performed to examine whether there are further patient or treatment related factors influencing the outcome of focused ESWT as treatment option for plantar fasciitis enabling physicians to estimate the possible benefit and to eventually improve efficacy. Methods: 284 patients (363 feet with plantar fasciitis) received focused ESWT for plantar fasciitis and answered a questionnaire inquiring epidemiologic and anamnestic treatment data immediately before as well as 19 to 77 weeks after the first application. Results: 74 percent of patients are satisfied, 72 percent received treatment with focused ESWT only once. The individual result was independent of the energy applied, the physician applying ESWT as well as epidemiologic data assessed, but there was a negative correlation with the number of past injections with corticosteroids. Discussion: We observed treatment benefits like satisfying results with no complications and no immobilization. These results were reproducible and were achieved with in most cases with one, in some cases with up to three treatment sessions. In contrast to other authors who stated that ESWT should rather be regarded as an end stage treatment we would recommend ESWT in even earlier stages to prevent chronification because of its better results compared to many other conservative treatment options. Conclusion: Focused ESWT is a safe and feasible treatment option for plantar fasciitis, its efficacy is consistent over different physicians. Hence, ESWT can be recommended even as early treatment option for plantar fasciitis.