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Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy
Porter MD, Shadbolt B
Clinical Journal of Sport Medicine 2005 May;15(3):119-124
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To compare the efficacy of low-energy extracorporeal shock wave therapy (ESWT) and intralesional corticosteroid injection (CSI) for the treatment of plantar fasciopathy present for at least 6 weeks. DESIGN: A prospective, randomized, controlled, observer-blinded study over a period of 12 months. SETTING: Primary care and hospital setting. PATIENTS: A total of 132 patients were enrolled in the study, and 125 completed the study. Nineteen nonrandomized patients acted as a surrogate control group. INTERVENTIONS: All patients performed a standardized Achilles tendon and plantar fascia stretching program. The patients were randomly allocated to either treatment group A or B. Group A received a single CSI, while group B were referred for a course of low-dose ESWT comprising 3 treatments over a period of 3 weeks. Group C consisted of 19 nonrandomized patients who performed the standardized stretching program only. MAIN OUTCOME MEASUREMENTS: The worst daily pain recorded on a visual analogue scale (VAS), and the tenderness at the plantar fascia insertion as determined by an algometer. These measures were recorded immediately prior to the commencement of treatment and 3 months and 12 months posttreatment. RESULTS: With regard to VAS pain scores, values for the CSI (1.48; 0 to 7) were significantly lower than both ESWT (3.69; 0 to 8), and controls (3.58; 2 to 5) at 3 months. At 12 months, VAS scores for CSI (0.84; 0 to 7) and ESWT (0.84; 0 to 4) were both significantly lower than controls (2.42; 1 to 4). The tenderness values at 3 months were significantly higher for CSI (9.42; 7 to 11) than both ESWT (6.72; 4 to 11) and controls (7.63; 6 to 9). p < 0.05 was used throughout. CONCLUSIONS: Corticosteroid injection is more efficacious and multiple times more cost-effective than ESWT in the treatment of plantar fasciopathy that has been symptomatic for more than 6 weeks.
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