AAOS 2009: Shock-Wave Therapy Effectively Eases Chronic Plantar Heel Pain

Barbara Boughton

March 05, 2009

March 5, 2009 (Las Vegas, Nevada) — Focused extracorporeal shock-wave therapy (ESWT) can significantly alleviate chronic plantar heel pain and improve function and quality of life, according to a randomized controlled trial presented here at the American Academy of Orthopaedic Surgeons 2009 Annual Meeting.

The study tested ESWT against placebo treatment in a prospective randomized multicenter trial and found that ESWT can reduce heel pain by 69%, according to lead researcher Ludger Gerdesmeyer, MD, from Kiel, Germany.

"Compared with placebo treatment, shock-wave therapy produces significant decreases in pain with only minor side effects," Dr. Gerdesmeyer said.

In the study, 250 patients were randomized to therapy with either ESWT or a similar placebo treatment. Participants in the trial were all diagnosed with chronic plantar heel pain; those who had received previous corticosteroid treatment underwent a 6-week washout period before randomization. The end point of the study was reduction in visual analog scale (VAS) pain scores; secondary outcomes were local pain on pressure, SF-36 score, and Roles and Maudsley test score. Patients were followed and assessed 3 months after therapy.

Patients in the treatment group received 2000 treatment impulses applied at 0.25 mJ/mm2 without local anesthesia for 3 sessions, 2 weeks apart. The device used was a Storz Duolith.

At baseline, both groups of patients had similar VAS pain scores. After treatment with ESWT, the composite VAS pain score of the treatment group decreased from 8.3 to 2.7, compared with 5.31 in the placebo group. Pain scores decreased by 69% after ESWT, but only by 34% after placebo. All findings in the study were statistically significant (P < .025).

Patients who received ESWT also showed significantly improved scores on the Roles and Maudsley and SF-36 tests, and they experienced significantly less pain upon pressure, Dr. Gerdesmeyer said. He noted that there were some device-related adverse events, including pain during treatment, pain after treatment, swelling and reddening of the foot, and petechial bleeding. However, no severe adverse effects were noted in either group. Some patients in the placebo group experienced pain, but significantly less so than that experienced in the treatment group, Dr. Gerdesmeyer said.

"In our study, focused shock-wave therapy was effective, as well as safe, and performed without relevant side effects," he said.

Although noting that the study was an interesting one, Paul Fortin, MD, questioned whether the treatment and placebo groups were truly blinded. "If the treatment group experienced pain, then they may not have been blinded to the means of treatment," he said. Dr. Fortin is director of foot and ankle surgery at the William Beaumont Hospital, in Royal Oak, Michigan, and he moderated the session at which the paper was presented.

Dr. Gerdesmeyer responded that in a study of focused ESWT it is often difficult to make the active and placebo treatment similar. However, he commented that patients in the placebo group also experienced pain with treatment, which he found surprising. "This was a sign to us that patients may not have been able to tell the difference between active and placebo treatment," he said.

Dr. Gerdesmeyer disclosed unpaid consultant positions with Storz and Electro Medical Systems. Dr. Fortin has disclosed no relevant financial relationships.

American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting: Abstract 663. Presented February 27, 2009.

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