Focused Extracorporeal Shockwave Therapy versus Prefabricated Insoles for Treatment of Plantar Fasciitis: A Randomized Trial


  • Thitirat Rakwit
  • Wipoo Kumnerddee
  • Chanwit Phongamwong Department of Rehabilitation Medicine, Phramongkutklao Hospital, Bangkok, Thailand


plantar fasciitis, focused extracorporeal shockwave therapy, prefabricated insole, foot function index


Objectives: To compare the clinical effectiveness of focused extracorporeal shockwave therapy (fESWT) and prefabricated insoles among patients suffering from plantar fasciitis (PF).

Study design: Pragmatic randomized open-label trial.

Setting: Rehabilitation Medicine outpatient clinic at a medical school hospital in Bangkok, Thailand.

Subjects: Patients suffering from subacute or chronic PF.

Methods: Participants were randomly allocated (1:1) to receive either 3 weekly sessions of fESWT (2,000 shocks/session of at least 0.2 mJ/mm2) or to wearing prefabricated insoles. All participants were advised to perform stretching of the plantar fascia and gastrocnemius muscle. The clinical outcome measured was an improvement in Foot Function Index (FFI) at 12 weeks. An analysis was done based on the intention-to-treat principle.

Results: Twenty-nine participants were enrolled and randomly assigned to either the fESWT (n = 14) or the insole group (n = 15).  A mean and standard deviation (SD) of the improvement in total FFI at 12 weeks was 65 (25.8) points for fESWT and 65.2 (39.2) points for prefabricated insoles with an adjusted mean difference between two interventions of 14.9 (95%CI: -15.4 to 45.2).

Conclusions: The fESWT did not improve FFI compared with prefabricated insoles among patients with subacute and chronic plantar fasciitis. However, the results should be interpreted with caution because of inadequate statistical power.


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Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25:303-10.

Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ). 2010;39:227-31.

Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician. 2001;63:467-74, 77-8.

Aldridge T. Diagnosing heel pain in adults. Am Fam Physician. 2004;70:332-8.

Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. 2005;72:2237-42.

Rathleff MS, Molgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25:e292-300.

Young JL, Rhon DI, de Zoete RMJ, Cleland JA, Snodgrass SJ. The influence of dosing on effect size of exercise therapy for musculoskeletal foot and ankle disorders: a systematic review. Braz J Phys Ther. 2018;22:20-32.

Lewis RD, Wright P, McCarthy LH. Orthotics compared to conventional therapy and other non-surgical treatments for plantar fasciitis. J Okla State Med Assoc. 2015;108:596-8.

David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 2017;6:CD009348.

Konjen N, Napnark T, Janchai S. A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial. J Med Assoc Thai. 2015;98:S49-56.

Kumnerddee W, Pattapong N. Efficacy of electro-acupuncture in chronic plantar fasciitis: a randomized controlled trial. Am J Chin Med. 2012;40:1167-76.

Akinoglu B, Kose N. A comparison of the acute effects of radial extracorporeal shockwave therapy, ultrasound therapy, and exercise therapy in plantar fasciitis. J Exerc Rehabil. 2018;14:306-12.

Dedes V, Stergioulas A, Kipreos G, Dede AM, Mitseas A, Panoutsopoulos GI. Effectiveness and safety of shockwave therapy in tendinopathies. Mater Sociomed. 2018;30:131-46.

Lou J, Wang S, Liu S, Xing G. Effectiveness of extracorporeal shock wave therapy without local anesthesia in patients with recalcitrant plantar asciitis: a meta-analysis of randomized controlled trials. Am J Phys Med Rehabil. 2017;96:529-34.

Lizis P. Comparison between real and placebo extracorporeal shockwave therapy for the treatment of chronic plantar fasciitis pain in the males. Iran J Public Health. 2015;44:1150-2.

Chang KV, Chen SY, Chen WS, Tu YK, Chien KL. Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: a systematic review and network meta-analysis. Arch Phys Med Rehabil. 2012;93:1259-68.

Kogler GF, Solomonidis SE, Paul JP. Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clin Biomech (Bristol, Avon). 1996;11:243-52.

Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166:1305-10.

Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49:S1-19.

Traijeewornporn P, Leelasamran W. Comparison the effectiveness of dry needling vs extracorporeal shockwave therapy for chronic plantar fasciitis treatment: a randomized control trial. J Thai Rehabil Med. 2016;26:1-7.

Berbrayer D, Fredericson M. Update on evidence-based treatments for plantar fasciopathy. PM R. 2014;6:159-69.

Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46:348-57.

Grady JF, Saxena A. Effects of stretching the gastrocnemius muscle. J Foot Surg. 1991;30:465-9.

Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006;88:1775-81.

Srimakarat P, Jaroenarpornwatana A, Janchai S, Tantisiriwat N. Reliability and validity of Foot Function Index Thai version [FFI-TH]. J Med Assoc Thai. 2018;101:253-60.

Landorf KB, Radford JA. Minimal important difference: values for the Foot Health Status Questionnaire, Foot Function Index and Visual Analogue Scale. The Foot. 2008;18:15-9.

Çağlar Okur S, Aydın A. Comparison of extracorporeal shock wave therapy with custom foot orthotics in plantar fasciitis treatment: a prospective randomized one-year follow-up study. J Musculoskelet Neuronal Interact. 2019;19:178-86.

Baldassin V, Gomes CR, Beraldo PS. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:701-6.

Wang CJ, Wang FS, Yang KD, Weng LH, Ko JY. Long-term results of extracorporeal shockwave treatment for plantar fasciitis. Am J Sports Med. 2006;34:592-6.

Ibrahim MI, Donatelli RA, Hellman M, Hussein AZ, Furia JP, Schmitz C. Long-term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: a prospective, randomized, placebo-controlled trial with two years follow-up. J Orthop Res. 2017;35:1532-8.