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Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study

PainSci » bibliography » Gerdesmeyer et al 2008
Tags: plantar fasciitis, foot, devices, leg, limbs, pain problems, overuse injury, injury, tendinosis, treatment

Two articles on PainSci cite Gerdesmeyer 2008: 1. Complete Guide to Plantar Fasciitis2. Ioannidis: Making Medical Science Look Bad Since 2005

PainSci notes on Gerdesmeyer 2008:

This overconfidently titled paper essentially declares that there is no longer any controversy about radial extracorporeal shock wave therapy for plantar fasciitis (note that this is not quite the same thing as “regular” ESWT, but they are close cousins — basically the same idea, just different settings).

My confidence in their conclusions is suppressed by the fact that the researchers are on the payroll of a company that makes these devices, and the entire study was funded by that company. As always, conflicts of interest are not necessarily a deal-breaker, but they can be, and this one seems particularly strong.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Radial extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials.

HYPOTHESIS: There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis.

STUDY DESIGN: Randomized, controlled trial; Level of evidence, 1.

METHODS: Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm(2); 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks' follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients' and investigators' global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy.

RESULTS: Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P < .025, 1-sided). No relevant side effects were observed.

CONCLUSION: Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.

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