Description of Treatment:

Plantar fasciitis is a common cause of plantar heel pain. The pain is typically centered near the origin of the plantar fascia at the medial calcaneal tubercle and is worse upon weightbearing immediately after an extended period of rest. Conservative therapies for plantar fasciitis include rest, stretching exercises and/or physical therapy, avoidance of flat shoes and barefoot walking, weight loss (if appropriate), non-steroidal anti-inflammatory medications, and padding and strapping to support the foot. Custom orthotics, night splints, and corticosteroid injections may be used if initial conservative therapy fails. Approximately 85% to 90% of patients improve following conservative therapy. For those who do not improve, surgical plantar fasciotomy and extracorporeal shock wave therapy (ESWT) may be options.

ESWT involves the delivery of a shock wave to a focused site creating a controlled acute injury or trauma at the site. It is the repair of the tissue disruption that is theorized to cause pain relief following ESWT although the exact mechanism of action is uncertain. The procedure is performed on an outpatient basis. Both high-energy and low-energy protocols have been used. High-energy protocols typically call for one treatment session while low-energy protocols may include three to five sessions. Two ESWT devices have been approved by the Food and Drug Administration for the treatment of plantar fasciitis.

ESWT has been used for patients with chronic proximal plantar fasciitis that has failed to respond to a conservative treatment program of at least 6 months duration. The procedure is contraindicated for patients with acute soft tissue infections or osteomyelitis, malignancy, or open epiphyses and may be contraindicated for patients with bleeding disorders or pacemakers, or patients who are pregnant. Side effects are rare and generally minor and transient.

Committee Summary

With regard to extracorporeal shock wave therapy (ESWT) for plantar fasciitis, the ICSI Technology Assessment Committee finds:

1. The scientific evidence, to date, does not permit a conclusion to be reached regarding the efficacy of ESWT for plantar fasciitis. (Conclusion Grade Not Assignable)
   
2. ESWT is a safe, non-surgical treatment.