BACKGROUND: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization (IASTM) methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. Our goal is to compare the effectiveness of ESWT versus IASTM using Graston Technique R (GT R) instruments in addition to stretching exercises (SEs) in CPHP. METHODS: Sixty-nine patients were randomly assigned to 3 groups as ESWT plus SEs (Gr I), GT R plus SEs (Gr II) and SEs (CG) (ratio 1:1:1). SEs program twice/day, for 8-week was standard for all. Gr I received low intensity ESWT while in Gr II, GT R was the selected method. Visual Analog Scale (VAS) (for initial step and activity pain); foot function index (FFI); short form-12 (SF-12), and Tampa Scale were used at pretreatment, posttreatment and follow-ups (8-week and 6-month). RESULTS: VAS and FFI scores improved in the posttreatment and follow-ups in all (p < 0.00) While effect sizes in Gr I and Gr II were greater than CG in initial step pain at posttreatment and 8-week-follow-up, Gr II had highest effect size at 6-month-follow-up. The mean SF-12 scores in Gr I and Gr II showed improvement on the posttreatment assessment. Furthermore, Gr II showed significant improvements in FFI scores compared to other groups in 6-month-follow-up (F = 6.33, p = 0.003). CONCLUSIONS: Even though ESWT plus SEs and GT R plus SEs interventions seem to have similar effects on initial step pain at posttreatment and 8-week-follow-up; GT R plus SEs was found most effective for improving functional status at 6-month in the management of CPHP.

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