Evaluation of therapeutic effects of extracorporeal shock wave therapy,ultrasound therapy and laser therapy in plantar fasciitis

Introductıon: Plantar fasciitis (PF) is the most common cause of heel pain. It is usually a self-limiting condition. Numerous interventions have been described for the treatment. The objective of this study was to examine and compare the effect of extracorporeal shock wave therapy (ESWT), low level laser therapy (LLLT) and therapeutic ultrasound (US) on clinical, radiological and plantar pressure changes. Methods: This was a randomized, prospective, comparative clinical study. Sixty patients with a diagnosis of PF were divided randomly into three treatment groups: group 1 underwent 15 sessions LLLT (8j/cm² 830nm), group 2 underwent 15 sessions continius US (1mhz 2W/cm²) and group 3 underwent 3 sessions ESWT (2000 shocks). All patients were assessed by Visual Analog Scale (VAS), Heel Tenderness İndex (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles and Maudsley score (RMS) and SF-36 also MR imaging and pedobarographic assessment were performed before treatment and 1 month after treatment. Primary efficacy success criteria was defined as percentage decrease of heel pain larger than 60% from baseline at 1 month after treatment for at least 2 of the 3 heel pain (VAS) measurements. Results: Significant improvement measured in mean VAS, AOFAS, HTI scores and improvement in SF-36 quality of life parameters at all three groups. All groups showed significant decrease in plantar fascia thickness on MRI. The treatment success rate was 70.6% in LLLT group, 65% in ESWT group and 23.5% in US group. LLLT and ESWT proved significantly superior to US therapy by primary efficacy criteria (p=0,006, p=0,012), there was no significant difference between LLLT and ESWT (p = 0.717). The dynamic plantar pressure in patients whose treatment were successful were significantly increased on the heel medial and forefoot medial according to those who fail (p<0,05). Conclusion:Treatment of PF with LLLT, US and ESWT significantly reduces pain, providing clinical and radiological improvement. However when we evaluate the success rates LLLT or ESWT treatments resulted more successfull in pain improvment and functional outcomes compared with US therapy.