Meta-analysis of high-energy extracorporeal shock wave therapy in recalcitrant plantar fasciitis

INTRODUCTION: Randomised controlled trials (RCTs) have reported conflicting results on whether extracorporeal shock wave therapy alleviates the pain of recalcitrant plantar fasciitis patients. We focused on high-energy extracorporeal shock wave therapy (HESWT) and aimed to assess the effectiveness and feasibility of HESWT versus placebo in the treatment of recalcitrant plantar fasciitis. PATIENTS AND METHODS: We reviewed all RCTs comparing HESWT and placebo from PubMed, EMBASE, Cochrane Central Register of Controlled Trials and also the reference lists of articles. We used a fixed-effects model or a random model depending on heterogeneity and estimated the odds radio (OR) and 95% confidence interval (95% CI). Study quality was assessed using the Jadad scale. RESULTS: Five placebo-controlled and double-blinded clinical trials including 716 patients were included. Overall, the quality of the trials was good, and a test for heterogeneity confirmed the presence of little heterogeneity (p = 0.31, I-2 = 16%). The pooled OR from the five trials was estimated to be 2.25 (95% CI, 1.66-3.06; p < 0.00001) at 12 weeks after active treatment. CONCLUSION: The results of the meta-analysis provide strong evidence that HESWT was effective in the treatment of recalcitrant plantar fasciitis when compared with placebo. We recommend HESWT as a remedial measure after failure of traditional conservative treatment and ahead of surgical intervention.