6533b859fe1ef96bd12b814a

RESEARCH PRODUCT

Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis

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Background: It remains unclear whether application of local anesthesia (LA) interferes with clinical e!cacy of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis. Aims: To evaluate the e"ect of local anesthesia on the clinical outcome after repetitive low-energy ESWT for chronic plantar fasciitis. Methods: Eighty-six patients with chronic plantar fasciitis were randomly assigned to receive either low-energy ESWT without LA, given weekly for three weeks (Group I, n = 45; 3 · 2000 pulses, total energy flux density per shock 0.09 mJ/mm 2 ) or identical ESWT with LA (Group II, n = 41). Primary outcome measure was: Reduction of pain from baseline to month 3 post-treatment in a pain numeric rating scale [0‐10 points] during first steps in the morning, evaluated by an independent blinded observer. Calculations were based on intention-to-treat. Results: No di"erence was found between the groups at baseline. At 3 months, the average pain score was 2.2 ± 2.0 points for patients of Group I, and 4.1 ± 1.5 points for patients of Group II. The mean between-group di"erence was 1.9 points (95% CI: [1.1‐ 2.7 points]; P < .001). Significantly more patients of Group I achieved P50% reduction of pain compared to Group II (67% vs 29%, P < .001). Conclusion: ESWT as applied should be done without LA in patients su"ering from chronic heel pain. LA applied prior treatment reduced the e!ciency of low-energy ESWT.