Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial

摘要

Objectives: Extracorporeal shockwave therapy (ESWT) and corticosteroid injection (CSI) are treatment options for plantarfasciitis. Their clinical outcome comparison remains a debate. Also, the thickness changes of the plantar fascia on objectiveevaluation under the medium energy ESWT and CSI therapy are elusive. Methods: A total of 97 patients with chronic plantarfasciitis were enrolled in the randomized prospective trial. Forty-seven patients received extracorporeal shock wave therapy(ESWT), and fifty patients received corticosteroid injection (CSI). The thickness of the plantar fascia was evaluated respectivelybefore ESWT and CSI, and at the 4th and 12th week after ESWT and CSI by ultrasonography. Pain level and clinical outcomeswere recorded using visual analogue scale (VAS) and 100-points scoring systems. Correlation analysis was performedbetween the thickness change and clinical outcome. Results: Under ultrasonography, we observed more increase of plantarfascia thickness of ESWT group than CSI group at 4th week (p=0.048). VAS of plantar fasciitis patients receiving ESWT waslower than those who received corticosteroid injection (0.001 and p<0.001, at 4th and 12th week). On the assessment of100-points scoring systems, the pain level of patients with ESWT was lower than those with CSI at the 12th week (p<0.001).On the other hand, the increase of plantar fascia thickness at 4th week was positively correlated with the decrease of VASscore at 12th week follow-up (R=0.302, P=0.039). Conclusions: At 4th week after treatment, the thickness of plantarfascia increased. Then it decreased gradually, but not to the baseline at 12th week. On the pain level outcome at 12th week,extracorporeal shockwave therapy (ESWT) was more efficient than corticosteroid injection (CSI) on chronic plantar fasciitis.The more change of plantar fascia after ESWT, the more efficient on clinical outcome.