Skip to main content
Features

Assessing The Evidence On Alternative Treatments For Plantar Heel Pain

Plantar fascia pathology can pose a significant challenge for many providers and patients. With this in mind, this author reviews the most recent evidence for alternative treatments such as extracorporeal shock wave therapy (ESWT), laser therapy and platelet-rich plasma (PRP).

The challenge of treating patients with plantar heel pain lies in the lack of universal agreement about the etiology of the condition.1,2 A general consensus among clinicians is that most patients with plantar heel pain have degenerative changes of the plantar fascia at the fibrocartilaginous enthesis attachment to the calcaneus.1,3

The histopathology of plantar fascia specimens taken from patients with chronic plantar heel pain show collagen degeneration with fiber disorientation, increased mucoid ground substance, angiofibroblastic hyperplasia and calcification.4-6 Accordingly, some authors proposed the term “fasciosis” or “fasciopathy” in place of “fasciitis” when describing the pathologic state of the plantar fascia causing plantar heel pain.6,7 Others argue that inflammation may precede the degenerative changes in the plantar fascia that have only been documented in surgical specimens taken from patients with long-standing heel pain.1

One should note that, besides degeneration within the plantar fascia,  imaging and histologic studies show that plantar heel pain may also be caused by thickening of the plantar fascia, calcaneal spur, periosteal edema of the calcaneus and bone marrow edema of the calcaneus.8-10 Few accepted treatments can actually target a specific pathology causing plantar heel pain because advanced diagnostic testing is necessary to identify this pathology. However, this type of imaging, due to cost and issues with payor approval, is not routinely justified in the clinical setting.

Traditional treatments of plantar heel pain focus on relieving mechanical load on the insertion of the plantar fascia at the calcaneus. These interventions include stretching, taping, insoles, custom foot orthoses, heel pads, heel lifts and plantar fascia night splints.11 Other treatments focus on reducing inflammation or pain. These modalities include corticosteroid injections, oral nonsteroidal anti-inflammatory drugs (NSAIDs), ice and physical therapy modalities.12 

Regardless of medical specialty, there is universal agreement that no specific treatment or therapeutic approach gives rapid or predictable results for relieving plantar heel pain.3,13,14  

As a result, medical practitioners continue to seek new or alternative treatments for plantar heel pain. Besides implementing measures to offload the plantar fascia, clinicians are now interested in technologies used for tendinopathy, fracture healing and ulcerations as there is increasing recognition that chronic heel pain is really a form of a non-healing wound of the tissues attached to the inferior aspect of the calcaneus. Accordingly, let us take a closer look at alternative or “non-traditional” treatment interventions for chronic plantar heel pain and recent clinical studies assessing their treatment effects.

Pertinent Considerations In Understanding The Mechanism And Impact Of Extracorporeal Shock Wave Therapy (ESWT) 

Shock waves are sound waves that create vibrations within tissue. In medical applications, one applies shock waves to a body part in order to create a controlled injury and stimulate healing. Extracorporeal shock wave therapy (ESWT) by definition uses unique sets of acoustic pressure waves produced outside the body to treat musculoskeletal conditions.15,16 The mechanism by which shock waves enhance healing is still not well understood but there is evidence that the local tissue injury causes neovascularization with increased production of tissue growth factors.15 Other proposed mechanisms revolve around analgesia created by the physical alteration of small axons as well as chemical alteration of pain receptor neurotransmission.16

Shock waves, depending upon the source, have various physical properties that affect how acoustic energy transfers to tissue. In addition, the dosage and penetration depth will ultimately determine therapeutic levels achieved inside the body at the target tissue. Focal shock waves have high tissue penetration power and impact force. Electrohydraulic, electromagnetic or piezoelectric methods produce these focal shock waves.17 Radial shock waves, which are actually radial pressure waves, have lower tissue penetration with less impact. An air compressor generates these radial shock waves ballistically. The shockwave device reaches the maximum energy of radial shock waves at the tip of the applicator on the surface of the skin. With focused shock waves, however, the device can achieve the maximum energy in a focal zone within the treated tissue.17 

Whether focused or radial, the intensity of the shock wave treatment can affect outcomes. A systematic review and meta-analysis of 11 high-quality randomized clinical trials showed that moderate- to high-intensity shock waves are more effective in treating plantar heel pain in comparison to low-intensity shock waves.18 Chang and colleagues reported a similar dose-response relationship in their systematic review and meta-analysis of 12 clinical trials.19 This study showed that medium- to high-intensity focused shock wave therapy was more effective than low intensity. Ironically, studies of radial shock wave treatment showed comparable results to medium- and high-intensity focused shock wave. To add to the dilemma of choosing one type of shock wave over another, there is evidence that applying local anesthesia will hamper results as getting biofeedback from the patient will enhance targeting of the shockwave to the proper location.20

This may explain why early studies of high-intensity, focused shock wave treatment showed no benefit in treating plantar heel pain.21,22 Both of these studies utilized a single session of focused shock wave treatment performed with the patient under local or general anesthesia.  

Since that time, researchers began testing the efficacy of moderate- to low-intensity shock wave, which one can administer without anesthesia, in order to obtain biofeedback from the patient to target the affected tissue.20 When researchers performed ESWT without anesthesia in multiple sessions, regardless of intensity levels, ESWT showed favorable outcomes in many prospective clinical trials evaluating the treatment of plantar heel pain.23-28 Systematic reviews and meta analyses of randomized controlled trials studying ESWT verify that the treatment is safe and effective in relieving plantar heel pain for up to 12 months.18,19,29-31 

The studies selected for review and meta-analysis covered a wide range of treatment protocols. The shock wave treatments averaged one to three sessions per patient with a rest period of three days to two weeks between sessions.31 The number of impulses per session ranged from a minimum of 1,500 to a maximum of 4,000 with an energy range between 0.08 mJ/mm2 (low intensity) to 0.64 mJ/mm2 (high intensity) per impulse.31 Adverse effects included pain during treatment, edema, skin redness, temporary paresthesia and one case of syncope due to pain.18,19

Comparing ESWT To Corticosteroid Injection: Which Is Superior?

Four studies demonstrate a superiority of ESWT over corticosteroid injection to relieve plantar heel pain and improve function measured over time.32-35 Two of these studies used focused shock wave while the other two used radial shockwave.32-35 Clinicians did not use anesthesia in any of these studies and ESWT produced better pain relief than corticosteroid injection at both three-month and six-month follow-ups.

In summary, studies of treatment of plantar heel pain with ESWT show favorable results with minor risks of temporary adverse reactions. However, there is no consensus regarding what type of shock wave technology or what dosage of treatment will provide the best long-term results. Meta-analysis of randomized controlled trials evaluating ESWT, using both focused and radial shock wave technologies, reveal a wide range of impulses and energy dosage. This poses a dilemma for the practitioner in deciding which technology and protocol will work best in his or her hands when treating plantar heel pain. 

Furthermore, as several different anatomic structures and pathologies may cause plantar heel pain, modifying the type of shock wave, dosage and frequency could optimize treatment outcomes if the practitioner was certain of the etiology. Further research is required to provide insight into these issues as this could improve the efficacy of ESWT therapy for plantar heel pain.

What Does The Literature Tell Us About Laser Therapy?

Multiple authors have reported applying visible or invisible laser light to the surface of the body to treat a variety of musculoskeletal conditions.36-38 Most of these studies of laser treatment of musculoskeletal conditions employed low-level laser light (LLLT) using either a gas laser (He-Ne), which produces visible red light of wavelength between 594 and 632 nm, or semiconductor lasers (GaAs or GaAlAs) that have a wavelength between 780 and 905 nm. 

The primary effects of laser therapy are on the photoreceptors present in the mitochondria and on cell membranes. This process, known as photobiostimulation, reportedly enhances cellular functions and cell proliferation rates.39,40 There is also evidence that low-level laser light therapy can dilate capillaries and activate angiogenesis.41 Finally, low-level laser light therapy exerts an anti-inflammatory effect by decreasing the level of proinflammatory cytokines, such as interleukin-1 alpha and interleukin-1 beta, and increasing the level of other cytokines and anti-inflammatory growth factors.42 

Bashford and coworkers were the first to study the use of low-level laser light therapy for the treatment of plantar heel pain in 1998.43 In this study, 28 patients received 12 sessions of irradiation from a 830 nm gallium aluminum arsenide (GaAlAs) laser with a dosage of one joule (J) to the plantar heel area and two J to the medial side of the calcaneus. A control group received sham or placebo treatment. There was no significant difference in pain when comparing the two groups after treatment so the investigators concluded that low-level laser light therapy was ineffective for the treatment of plantar fasciitis.

After the study by Bashford and coworkers, the World Association for Laser Therapy recommended a treatment dose of a minimum of eight J for low-level laser light therapy for plantar fasciitis.44 Using these guidelines, Kiristi and associates used the same gallium aluminum arsenide laser with an infrared wavelength of 904 nm, output of 240 mW and applied 8.4 J to the plantar and medial calcanei of 30 patients with plantar heel pain.45 This was a double-blind, randomized, placebo-controlled trial in which patients received low-level laser light therapy or sham treatment three times a week for six weeks. At the end of the six-week treatment, the pain decreased by 59 percent in the irradiated group and by 26 percent in the placebo-treated group. Interestingly, ultrasound showed decreased thickness of the plantar fascia at the end of six weeks for both the treatment group and the sham group.

Two other studies report on an eight-week follow up as well as a 12-month follow up of treatment of patients with chronic heel pain using low-level laser light therapy from a He-Ne red light (635 nm) laser generating 17 mW output and giving a total dose of 1.476 J/cm2.46,47 At an eight-week follow up, the treatment group participants demonstrated a mean improvement of 30 points on a 100-point visual analog scale (VAS) in comparison to a mean improvement of five points with the placebo group.46  Patients receiving low-level laser light therapy showed continued improvement with reduction of pain at six months and 12 months.47

Macias and coworkers also reported a small (0.4 mm) but statistically significant reduced thickness of the plantar fascia, as measured by Doppler ultrasonography, in the treatment group.46 In the study by Jastifer and colleagues, the treatment group also showed significant improvement in the pain, disability and activity limitations subscales of the Foot Function Index with the greatest improvement occurring in the first six months after treatment.47

Two other studies comparing low-level laser light to placebo or traditional treatment showed significant reduction of visual analog scale pain scores attributed to the laser treatment.48,49 At a three-month follow up, pain scores were significantly lower for the low-level laser light treatment group in comparison to the control group. Researchers also found that functional outcomes, as measured by the function subscale of the American Orthopaedic Foot and Ankle Society Score (AOFAS-F) and the Foot Function Index, were significantly better for the group of patients receiving low-level laser light treatment.

High-Intensity Laser Therapy Versus Low-Intensity Laser Treatment: Which Is More Effective?

Recently, the implementation of high-intensity laser technology (HILT) has emerged for the treatment of osteoarthritis of the knee, low back pain, facial paralysis and epicondylitis.50-53 High-intensity laser therapy uses a pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to deliver a significantly greater amount of energy than low-level laser light therapy. 

Ordahan and colleagues tested the effectiveness of high-intensity laser therapy in comparison to low-intensity laser therapy for the treatment of plantar fasciitis.54 In this randomized study, seven patients received high-intensity laser therapy and seven patients had low-intensity laser therapy for plantar fasciitis, which had been present for over six weeks.

After three weeks of treatment, both groups showed significant improvement in all parameters of the VAS, heel tenderness index and Foot And Ankle Outcome Scores.54 The high-intensity laser group demonstrated better improvement in all parameters than the low-intensity laser group. This study, like others testing ESWT for treating plantar heel pain, reveals that high-energy treatment seems more efficacious than low-energy therapy. However, the small patient pool of this single study warrants further investigation comparing intensity levels of laser therapy to treat plantar heel pain.

Comparing ESWT To Laser Therapy: What Do The Studies Reveal?

Two randomized, prospective comparative studies compare the efficacy of low-level laser light therapy and ESWT to treat patients with plantar heel pain of more than six months duration.55,56 Both studies showed that ESWT and low-level laser light therapy had similar positive effects on reducing plantar heel pain and plantar fascia thickness at a one-month follow-up, but neither modality showed superiority over the other as both treatments were equally effective.  

In conclusion, laser therapy treatment of plantar heel pain has shown positive effects without any adverse reactions. The number and quality of studies of laser treatment of plantar heel pain does not approach that of ESWT. However, the evidence thus far suggests that laser therapy has gained credibility and may warrant consideration as an alternative treatment when conventional interventions fail. 

Assessing The Potential Benefits With Platelet-Rich Plasma (PRP) Treatment 

The production of platelet-rich plasma (PRP) takes place from a sample of autologous whole blood that is centrifuged to produce platelet concentrations above baseline values. Depending upon the preparation protocol, PRP contains varying levels of platelets as well as other blood components including leukocytes and red blood cells.57

Due to wide variation among studies of PRP treatments in terms of preparation and administration protocols, one must be cautious in drawing conclusions.58 As a result, several authors propose classifications of various techniques available to prepare and administer PRP depending upon centrifuge speed, use of anticoagulants and content of platelets as well as the application method.59,60

Platelets possess biologically active growth factors and 70 percent of these growth factors are released upon activation of the platelets.61 These growth factors include insulin-like growth factor, fibroblast growth factor, vascular endothelial growth factor, transforming growth factor (TGF-β) and  platelet-derived growth factor (PDGF).62 

Platelet-rich plasma also reduces the transactivation of NF-kB, which is the critical regulator of the inflammatory process.63 In addition, PRP reduces other pro-inflammatory enzymes such as COX-2 and COX-4 as researchers have demonstrated with in-vitro studies.64 Thus, the combination of growth and anti-inflammatory components of PRP are suited to initiate a healing phase in chronic plantar fasciopathy.65 

In terms of plantar fasciopathy, hypovascularity and hypocelluarity are thought to be contributors to poor healing of degeneration of the plantar fascia at the insertional site on the calcaneus.66 Platelet-rich plasma may partially reverse this hypovascularity through the release of cytokines to stimulate cellular proliferation and angiogenesis.67

A Closer Look At Recent Studies Of PRP For Plantar Heel Pain

Most clinical studies evaluating PRP fail to adequately report the preparation methods so clinicians are unable to duplicate the protocols to reproduce the same outcomes.68 Also, we now know that various levels of leukocyte concentration in the PRP mixture can have differing effects on various pathologies.69,70 Finally, the method of administration of the PRP mixture, the timing and number of injections as well as the post-treatment activity protocols vary among clinical studies.71

Despite these shortcomings, it is worth evaluating clinical studies testing the efficacy of PRP to treat plantar heel pain. To this date, there are at least 20 randomized controlled trials reporting the results of treating plantar heel pain with PRP and the majority of these studies used a corticosteroid injection as a control treatment.71-73 

Hurley and coworkers published a systematic review of nine randomized controlled trials comparing PRP treatment with corticosteroid injection.71 At all follow-up assessments (one, three, six and 12 months), VAS scores showed significant differences in pain with PRP having better results. Functional outcomes using the AOFAS score showed no difference between PRP and corticosteroid injection at one and three months. However, at six and 12 months, AOFAS scores were higher in patients treated with PRP.

There are two different published meta-analyses of nine RCTs comparing the effectiveness of PRP and corticosteroid injection.72,73 One study showed a significantly improved efficacy of PRP over corticosteroid injection at a 24-week follow-up.72 Functional scoring using the Foot and Ankle Disability Index (FADI), the AOFAS score, and the Roles and Maudsley score (RMS) showed no differences in the efficacy of PRP versus corticosteroid injection treating plantar heel pain at any point in follow-up although both groups demonstrated improvement.72 

Another study showed no difference in pain reduction comparing PRP and corticosteroid injection at one, three and six months.73 However, at a 12-month follow-up, PRP showed significant reduction in VAS pain score in comparison to steroid injection. With AOFAS scoring, PRP and steroid injection had similar improvements at one, three and six months with PRP showing superior improvement only at the 12-month follow-up.73

Two other studies show that PRP and corticosteroid injection are similar in reducing plantar heel pain at three- and six-month follow-ups.74,75 However, a study with a 12-month follow-up demonstrated superiority of PRP over steroid injection in long-term pain relief.76

Alkhatib and coworkers published the most recent systematic review and meta-analysis of PRP treatment.77 In comparison to the previously discussed meta-analyses,72,73 Alkhatib and team included two recent randomized controlled trials and four prospective cohort studies, providing a total number of 679 patients from 13 studies. Similar to findings from previous meta-analysis studies, PRP did not show superiority over corticosteroid injection until the six- and 12-month follow-up intervals using VAS and AOFAS scores.77 

These systematic reviews comparing PRP to corticosteroid injection show consistent findings. Both PRP and steroid injection can provide rapid pain relief at a one-month follow-up. In some cases, the pain relief is more profound with steroid injection but over time, PRP shows better long-term pain relief at six and 12 months. It is important to note that PRP has immediate pain relief effects owing to the anti-inflammatory properties of released cytokines while the longer-term effects are thought to be due to augmentation of the natural healing response through cellular proliferation and neoangiogenesis.67  

Comparing PRP And ESWT: Which Modality Provides Better Results For Chronic Plantar Heel Pain? 

Two studies compare the effectiveness of PRP to ESWT. In a randomized study, Chew and coworkers assessed 54 patients with chronic plantar heel pain (six months or greater), who were divided into three treatment groups.78 The three treatments were either focused high-intensity ESWT, PRP or “conventional treatment,” consisting of stretching and two visits of physical therapy. There was no statistically significant difference in VAS pain score improvements between the PRP and ESWT groups at one, three and six months. However, there was a significant improvement of pain with both of these treatments in comparison to conventional treatment. The PRP group demonstrated significant improvements in plantar fascia thickness at the three- and six-month follow-ups in comparison with the ESWT group.   

In a 2018 randomized study, Ugurlar and colleagues compared the use of PRP, ESWT (radial), corticosteroid injection (40 mg betamethasone) and prolotherapy (5% dextrose) injection in 154 patients with chronic plantar heel pain (average 12 months duration).79 Clinicians administered each treatment three times over a three week period. At the end of the 36-month follow-up period, there were no differences between any of the four treatment groups in visual analog scale scores and Foot Function Index, and all regressed back to their original pain levels. At six and 12 months, ESWT had the best improvement of visual analog scale pain score in comparison to the other three treatments. This study demonstrates that when patients experience heel pain for greater than 12 months, any intervention given over a limited three week treatment time may not provide long-standing relief beyond 12 more months.79 It is likely that those patients with 12 months of heel pain or more will require extended treatment beyond three weeks. 

In the final analysis, when comparing PRP to corticosteroid injections, PRP appears to have some superiority in both reduction of pain and improvement of function. However, the reduction of pain at six and 12 months, while statistically significant, only differs by about two points on a 10-point scale in favor of PRP over steroid injection. The increased cost of PRP in comparison to corticosteroid injection may not justify the small but significant improvement of pain relief. The cost versus benefit ratio of PRP over steroid injection is ultimately determined by the patient, who is paying for the treatment. Certainly, the potential adverse effects of a corticosteroid injection for plantar heel pain, including fat pad atrophy and potential rupture of the plantar fascia, warrant consideration by the patient and the treating physician.80,81 Conversely, multiple studies show that PRP injections into the proximal calcaneus do not demonstrate any adverse reactions.71-73 

In Conclusion

When evaluating the biologic effects of ESWT, PRP and laser therapy, all three technologies reduce inflammation, stimulate angiogenesis and have the capacity to release growth factors to enhance tissue healing. Considering the histopathology of plantar fasciopathy, these interventions appear to have the potential to address the multiple factors leading to degeneration and an impaired healing response of the injured tissue. 

In comparison to local corticosteroid injection, multiple studies show the superiority of ESWT, PRP and laser therapy to achieve long-standing reduction of pain. Future studies are necessary to clarify how to achieve optimal outcomes with each of these treatments in terms of technology options as well as the appropriate dosage and frequency of application.  

Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Richie is the author of a new book titled “Pathomechanics of Common Foot Disorders,” which is available from Springer at https://www.springer.com/us/book/9783030542009 .

Features
Topics
24
33
By Doug Richie Jr., DPM, FACFAS, FAAPSM
References

1. Wearing SC, Smeathers JE, Urry SR, Henning EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med. 2006;36(7):585-611.

2. Riel H, Cotchett M, Delahunt E, et al. Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on. Br J Sports Med. 2017;51(22):1576–1577.

3. Thomas JL, Christensen JC, Kravitz SR, et al. American College of Foot and Ankle Surgeons Heel Pain Committee. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3)(Suppl):S1-19.

4. Schepsis AA, Leach RE, Gorzyca J. Plantar fasciitis: etiology, treatment, surgical results, and review of the literature. Clin Orthop. 1991;266:185-196.

5. LeMelle DP, Kisilewicz P, Janis LR. Chronic plantar fascial inflammation and fibrosis. Clin Podiatr Med Surg.1990;7(2):385-389.

6. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234-237.

7. Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg. 2014;20(3):160-165.

8. McMillan AM, Landorf KB, Barrett JT, Menz HB, Bird AR. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res. 2009;2:32.

9. Grasel RP, Schweitzer ME, Kovalovich AM, et al. MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome. AJR Am J Roentgenol. 1999;173(3):699–701.

10. Chimutengwende-Gordon M, O’Donnell P, Singh D. Magnetic resonance imaging in plantar heel pain. Foot Ankle Int. 2010;31(10):865–870.

11. Schuitema D, Greve C, Postema K, Dekker R, Hijmans JM.  Effectiveness of mechanical treatments for plantar fasciitis: A systematic review. J Sports Rehab. 2020;29(5):657-674.

12. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;(3):CD000416.

13. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of nonoperative treatment. Foot Ankle Int. 1994;15(10):531–535. 

14. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain—plantar fasciitis: clinical practice guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(4):A1–18.

15. Goertz O, Hauser J, Hirsch T, et al. Short-term effects of extracorporeal shock waves on microcirculation. J Surg Res. 2015;194(1):304-311.

16. Visco V, Vulpiani MC, Torrisi MR, Ferretti A, Pavan A, Vetrano M. Experimental studies on the biological effects of extracorporeal shock wave therapy on tendon models. Muscles Ligaments Tendons J. 2014;4(3):357-361.

17. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Res 2012;7(11):1-8.

18. Dizon JNC, Gonzalez-Suarez C, Zamora MTG, Gambito EDV. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis. A metaanalysis, Am J Phys Med Rehabil. 2013;92(7):606-620.

19. Chang KV, Chen SY, Chen WS, Tu YK, Chien KL. Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: a systematic review and network meta-analysis. Arch Phys Med Rehabil. 2012;93(7):1259-1268.

20. Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L. Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res. 2005;23(4):931–941.

21. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288(11):1364–1372.  

22. Haake M, Buch M, Schoellner C, et al. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ. 2003;327(7406):75.

23. Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med. 2003;31(2):268–275.

24. Malay D, Pressman M, Assili A, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: Results of a randomized, placebo-controlled, doubleblinded, multicenter intervention trial. J Foot Ankle Surg. 2006;45(4):196-210.

25. Gollwitzer H, Diehl P, Von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome syndrome: A prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46(5):348-357.

26. Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008;36(11):2100–2109.

27. Gollwitzer H, Saxena A, DiDomenico LA, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015;97(9):701-708.

28. Ibrahim MI, Donatelli RA, Hellman M, Hussein AZ, Furia JP, Schmitz C. Long-term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: a prospective, randomized, placebo-controlled trial with two years followup. J Orthop Res. 2017;35(7):1532-1538.

29. Salviolia S, Guidib M, Marcotullic G. The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: a systematic review with meta-analysis. Foot. 2017;33:57–67.

30. Zhiyun L, Tao J, Zengwu S. Meta-analysis of high-energy extracorporeal shock wave therapy in recalcitrant plantar fasciitis. Swiss Med Wkly. 2013;143:pw13825.

31. Aqil A, Siddiqui MRS, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res. 2013;471(11):3645–3652.

32. Yucel I, Ozturan KE, Demiraran Y, Degirmenci E, Kaynak G. Comparison of high-dose extracorporeal shockwave therapy and intralesional corticosteroid injection in the treatment of plantar fasciitis. J Am Podiatr Med Assoc. 2010;100(2):105-110.

33. Xu D, Jiang W, Huang D, et al.  Comparison between extracorporeal shock wave therapy and local corticosteroid injection for plantar heel pain. Foot Ankle Int.  2020;41(2):200–205.

34. Lai TW, Ma HL, Lee MS, Chen PM, Ku MC. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: a randomized controlled trial. J Musculoskel Neuronal Interact. 2018;18(1):47-54.

35. Hocaoglu S, Vurdem UE, Cebicci MA, Sutbeyaz ST, Guldeste Z, Yunsuroglu SG. Comparative effectiveness of radial extracorporeal shockwave therapy and ultrasound-guided local corticosteroid injection treatment for plantar fasciitis. J Am Podiatr Med Assoc. 2017;107(3):192-199.

36. Djavid GE, Mortazavi SMJ, Basirnia A, et al. Low level laser therapy in musculoskeletal pain syndromes: pain relief and disability reduction. Lasers Surg Med Suppl. 2003;15:43.

37. Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systemic review and meta-analysis of randomized placebo or active-treatment controlled trials. Lancet. 2009;374(9705):1897–1908.

38. Gam AN, Thorsen H, Lonnberg F. The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis. Pain. 1993;52(1):63–66.

39. AlGhamdi KM, Kumar A, Moussa NA. Low-level laser therapy: a useful technique for enhancing the proliferation of various cultured cells. Lasers Med Sci. 2012;27(1):237–249.

40. Kujawa J, Zavodnik L, Zavodnik I, Buko V, Lapshyna A, Bryszewka M. Effect of low-intensity (3.75–25 j/cm2) near-infrared (810 nm) laser radiation on red blood cell ATPase activities and membrane structure. J Clin Laser Med Surg. 2004;22(2):111–117.

41. Tam G. Low power laser therapy and analgesic action. J Clin Laser Med Surg. 1999;17(1):29–33.

42. Peplow PV, Chung TY, Baxter GD. Application of low level laser Technologies for pain relief and wound healing: overview of scientific bases. Phys Ther Rev. 2010;15(4):253–285.

43. Basford RJ, Malanga AG, Krause AD, Harmsen SW. A randomized controlled evaluation of low intensity laser therapy: plantar fasciitis. Arch Phys Med Rehab. 1998;79(3):249–254.

44. World Association for Laser Therapy (WALT). Dosage Recommendations. Available at: https://waltza.co.za/documentation-links/recommendations/dosage-recommendations/ . Accessed October 9, 2020. 

45. Kiritsi O, Tsitas K, Malliaropoulos N, Mikroulis G. Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial. Lasers Med Sci. 2010;25(2):275–281.

46. Macias DM, Coughlin MJ, Zang K, Stevens FR, Jastifer JR, Doty JF. Low-level laser therapy at 635 nm for treatment of chronic plantar fasciitis: a placebo controlled, randomized study. J Foot Ankle Surg. 2015;54:768–777. 

47. Jastifer JR, Catena F, Doty JF, Stevens F, Coughlin MJ. Low level laser therapy for the treatment of chronic plantar fasciitis: a prospective study. Foot Ankle Int. 2014;35(6):566–571.

48. Cinar E, Saxena S, Uygur F. Low-level laser therapy in the management of plantar fasciitis: a randomized controlled trial. Laser Med Sci. 2018;33(5):949-958.

49. Lamba D. To evaluate the efficacy of 780 nm low level laser therapy for the treatment of plantar fasciitis in South Western Ethiopia. Ind J Physiother Occup Ther. 2019;13(2). Available at: https://medicopublication.com/index.php/ijpot/article/view/3781 . Published April 30, 2019. Accessed October 9, 2020.

50. Kheshie AR, Alayat MSM, Ali MME. High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Laser Med Sci. 2014;29(4):1371-1376.

51. Alayat MSM, Atya AM, Ali MME, Shosha TM. Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebocontrolled trial. Lasers Med Sci. 2014;29(3):1065–1073.

52. Alayat MS, Elsodany AM, El Fiky AA. Efficacy of high and low level laser therapy in the treatment of Bell’s palsy: a randomized double blind placebo-controlled trial. Lasers Med Sci. 2014;29(1):335–342.

53. Dundar U, Turkmen U, Tokta H, Ulaslı AM, Solak O. Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis; a prospective randomized controlled study. Lasers Med Sci. 2015;30(3):1097–1107.

54. Ordahan B, Karahan AY, Kaydok E. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci. 2018;33(6):1363–1369.

55. Sanmak DY, Kulcu DG, Mesci N, Altunok EC.Comparison of effects of low-level laser therapy and extracorporeal shock wave therapy in plantar fasciitis treatment: A randomized, prospective, single-blind clinical study. Turk J Phys Med Rehab. 2019;65(2):184-190.

56. Ulusoy A, Cerrahoglu L, Orguc S. Magnetic resonance imaging and clinical outcomes of laser therapy, ultrasound therapy, and extracorporeal shock wave therapy for treatment of plantar fasciitis: A randomized controlled trial. J Foot Ankle Surg. 2017;56(4):762–767. 

57. LaPrade RF, Geeslin AG, Murray IR, et al. Biologic treatments for sports injuries. Current concepts, future research, and barriers to advancement, part 1: biologics overview, ligament injury, tendinopathy. Am J Sports Med. 2016;44(12):3270-3283. 

58. Mishra A, Harmon K, Woodall J, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012;13(7):1185-1195.

59. DeLong JM, Russell RP, Mazzocca AD. Platelet-rich plasma: the PAW classification system. Arthroscopy. 2012;28(7):998-1009.

60. Mautner K, Malanga GA, Smith J, et al. A call for a standard classification system for future biologic research: the rationale for new PRP nomenclature. PM R. 2015;7(4)(Suppl):S53-59.

61. Arnoczky SP, Sheibani-Rad S, Shebani-Rad S. The basic science of platelet-rich plasma (PRP): what clinicians need to know. Sports Med Arthrosc Rev. 2013;21(4):180-185.

62. Kabiri A, Esfandiari E, Esmaeili A, Hashemibeni B, Pourazar A, Mardani M. Platelet-rich plasma application in chondrogenesis. Adv Biomed Res. 2014;3(1):138.

63. Kim HJ, Yeom JS, Koh YG, et al. Anti-inflammatory effect of platelet-rich plasma on nucleus pulposus cells with response of TNF-a and IL-1. J Orthop Res. 2014;32(4):551-556. 

64. van Buul GM, Koevoet WLM, Kops N, et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med. 2011;39(11):2362-2370. 

65. Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med. 2003;33(5):381–394.

66. Martinelli N, Marinozzi A, Carni S, et al. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2013;37(5):839–842.

67. Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009;17(10):602–608.

68. Chahla J, Cinque ME, Piuzzi NS, et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopaedic literature. J Bone Joint Surg Am. 2017;99(20):1769-1779.

69. Cross JA, Cole BJ, Spatny KP, et al. Leukocyte-reduced platelet-rich plasma normalizes matrix metabolism in torn human rotator cuff tendons. Am J Sports Med. 2015;43(12):2898-2906.

70. Dragoo JL, Braun HJ, Durham JL, et al. Comparison of the acute inflammatory response of two commercial platelet-rich plasma system in healthy rabbit tendons. Am J Sports Med. 2012;40(6):1274-1281.

71. Hurley ET, Shimozono Y, Hannon CP, Smyth NA. Platelet-rich plasma versus corticosteroids for plantar fasciitis: a systematic review of randomized controlled trials. Orthop J Sports Med. 2020;8(4):1-8. 

72. Yang W-Y, Han Y-H, Cao X-W, Pan J-K, Zeng L-F, Lin J-T. Platelet-rich plasma as a treatment for plantar fasciitis: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(44):e8475.

73. Ling Y, Wang S. Effects of platelet-rich plasma in the treatment of plantar fasciitis. A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(37):e12110.

74. Aksahin E, Dogruyol D, Yuksel HY, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2012;132(6):781–785.

75. Tiwari M, Bhargava R. Platelet rich plasma therapy: a comparative effective therapy with promising results in plantar fasciitis. J Clin Orthop Trauma. 2013;4(1):31–35.

76. Jain K, Murphy PN, Clough TM. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: a comparative study. Foot (Edinb). 2015;25(4):235–237.

77. Alkhatib N, Salameh M, Ahmed AF, et al. Platelet-rich plasma versus corticosteroids in the treatment of chronic plantar fasciitis: a systematic review and meta-analysis of prospective comparative studies. J Foot Ankle Surg. 2020;59(3):546−552.

78. Chew KTL, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. Phys Med Rehab. 2013;5(12):1035-1043.

79. Ugurlar M, Sonmez M, Ugurlar OY, Adiyeke L, Yildirim H, Eren OT. Effectiveness of four different treatment modalities in the treatment of chronic plantar fasciitis during a 36-month follow-up period: A randomized controlled trial. J Foot Ankle Surg. 2018;57(5):913-918.

80. Acevado JI, Beskin JL. Complications of plantar fascia rupture associated with injections. Foot Ankle Int. 1998;19(2):91-97.

81. Sellman J. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1994;15(7):376-381.

Resource Center
Back to Top