Shock-Wave Therapy
Doesn't Ease Heel Pain
Excerpt By Jacqueline Stenson, Reuter's Health

NEW YORK (Reuters Health) - A type of shock-wave therapy that is increasingly used to treat heel pain known as plantar fasciitis is no more effective than sham treatment, according to an Australian study.

"We found no benefit of shock-wave therapy over and above placebo," said investigator Rachelle Buchbinder of the Cabrini Medical Center in Malvern, Victoria.

"Over time there was improvement in both groups with respect to pain, function and quality of life--of similar magnitude," she told Reuters Health. Plantar fasciitis affects as many as 10% of people at some point in their lives, Buchbinder and colleagues note in the September 18th issue of The Journal of the American Medical Association.

The condition, also known as a heel spur, involves inflammation of the plantar fascia--a band of connective tissue that extends along the bottom of the foot--where it attaches to the heel bone. The resulting heel pain is usually worse in the morning or after prolonged periods of sitting. Precisely why it develops is unknown, though people who are obese, middle-aged, regular runners or who spend a lot of time standing or walking, particularly on hardwood floors, are at increased risk.

Many treatments are used, including ice, stretching, heel cushions, anti-inflammatory medications, steroid injections and in some cases surgery, though it is unclear just how well they work, according to Buchbinder. "Evidence that any of these treatments is effective is limited as there is a lack of well-designed and conducted trials," she said.

One of the newest treatments is shock-wave therapy, in which a device positioned over the heel delivers repeated sound waves to the affected tissue. The aim is to break up the scar tissue and stimulate the growth of new blood vessels so that the area will heal. The first shock-wave device for treating plantar fasciitis in the United States was approved in 2000. Shock-wave therapy also is used to break up kidney stones.

In the new study, conducted between April 1999 and June 2001, 160 patients with plantar fasciitis were randomly assigned to receive either shock-wave therapy or placebo treatment involving weak shock waves that could be felt but weren't expected to have any additional effect. The researchers said they used these low-level shock waves in the placebo group so that patients couldn't figure out which treatment they were getting; such knowledge could skew the results.

All patients received three weekly treatments and were then monitored for the next 12 weeks to see if their condition had improved. At the 6-week and 12-week follow-up periods, patients in both groups showed equal improvement on a variety of assessments measuring pain, function and quality of life. For instance, overall pain improved about 35% in each group by 12 weeks.

In the end, a healthy dose of patience may be the best remedy for most people with plantar fasciitis, according to Buchbinder. "Many people don't need any treatment for this condition other than time, as many improve spontaneously over time," Buchbinder said, noting that the condition resolves within a year in more than 80% of patients.

SOURCE: The Journal of the American Medical Association 2002;288:1364-1372.

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