Location modalities for focused extracorporeal shock wave application in the treatment of chronic plantar fasciitis

Background: Focused extracorporeal shock waves (ESWT) has been used in the treatment of plantar fasciitis with heel spurs. The optimal location for administering treatment, however, has not been determined. The purpose of this study was to determine whether fluoroscopy-guided location of a heel spur or patient location of the maximal point of tenderness is more effective in administering ESWT. Methods: In a prospective, examiner-blinded trial, 41 patients were randomized into two groups for treatment by ESWT: group 1, location of the heel spur for ESWT by fluoroscopy, and group 2, patient location for ESWT by maximal point of tenderness. Each group had three session of ESWT at 1-week intervals. The success rates between the two groups were assessed at 6 and 12 weeks. Results: No significant differences were noted between the groups. Conclusions: Despite the small number of patients in the study, patient location for positioning the focus in ESWT in treatment of plantar fasciitis with a heel spur is recommended.