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Between January 2021 and March 2022, 120 (84 male, 36 female) patients with a confirmed diagnosis of plantar fasciitis were identified. Subjective assessment was done using Mayo Clinical Score, and objective evaluation was done by measuring plantar fascia thickness using ultrasonography. For this study, two groups were made, wherein group A was administered a high dose of extracorporeal shockwave therapy, and group B was administered ultrasound-guided intralesional or local steroid injections.
On the contrary, focal shockwaves have high tissue penetration power of up to 10 cm and impact force (0.08-0.28 MJ/mm2) compared to radial shockwaves. They produce mechanical and biological effects of greater intensity, such as fibrinolysis, and induce neovascularization in tissues, thus initiating healing and reducing inflammation and pain [2-5].
Several studies have been published on the effects of either local steroid injection therapy or shockwave therapy versus laser therapy in plantar fasciitis treatment [17-21]. However, the comparison between the therapeutic effects of intralesional or local steroid injection therapy versus extracorporeal shockwave therapy (ESWT) in plantar fasciitis treatment has not been studied extensively in the literature, especially among the military soldier population.
A high-resolution USG scan was used to measure the thickness of the plantar fascia in the involved foot and on the contralateral normal foot. The thickness of the plantar fascia was measured at its thickest portion. Patients were divided into two treatment groups using the simple randomization method. Group A was administered medium-energy density (0.28 mJ/mm2) shockwave therapy at maximal tenderness point at two-week intervals. Group B was administered USG-guided intralesional injection in two sessions at two-week intervals.
A study by Yucel et al. [32] compared high-dose ESWT and intralesional steroid injection in the treatment of plantar fasciitis. Two groups were treated and showed significant improvements in VAS and heel tenderness index scores; however, there was no significant difference after three months of treatment. Saber et al. [33] divided 60 patients into two equal groups, with one group receiving local steroid injections (two doses two weeks apart) and the other group receiving shockwave therapy (two sessions and two weeks apart). In their study, both groups showed good clinical and radiological improvement in plantar fasciitis. Further, they recommended local steroid injections for faster pain relief.
Ogden et al. [38] noted several issues with ESWT such as shockwave dosage, high- versus low-energy ESWT, and the number of sessions required for pain relief. However, some studies have ascertained that the efficacy of ESWT may be highly dependent upon the type of machine and treatment protocols [39,40]. After a review of the literature, we can conclude that more investigation needs to be done to determine the optimal and appropriate protocols, especially in the military soldier population, for the use of shockwave therapy in plantar fasciitis.
The authors would like to thank all patients, OPD staff, and those who directly and indirectly contributed to this study. The authors would like to thank Mr. D Kumar, who is a physiotherapist and provided shockwave therapy to all included patients. Without his support and dedication, this study would not be possible. 041b061a72