published 6/02/08
Super-duper ultrasound
ESWT is high tech, and expensive … but does it work for plantar fasciitis? A new Belgian study says, “Maybe not so much.”
Dueling Studies!
New research contradicts earlier research on the effects of extracorporeal shock-wave therapy for plantar fasciitis
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Note: even newer research, published in early 2009, confuses the issue even further. See Gerdesmeyer.
Extracorporeal Shock Wave Therapy (ESWT) is a technology that uses strong sound waves to “stimulate healing” in tissues. But does it? There are many unanswered questions about ESWT.
Presently ESWT is actually approved in the US by the Food and Drug Administration (FDA) for treatment of plantar heel spurs, plantar fasciitis (a very common kind of arch pain). It’s still not clear if that approval is justified.
Even the scientists who have done studies with positive results have expressed their concern. Although Kudo et al found clear evidence that ESWT helps plantar fasciitis, they also wrote, “despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition.”
And now, a new paper about ESWT for plantar fasciitis published by Belgian researchers concludes on a distinctly discouraging note. They found “a significant placebo effect with low-energy ESWT” and a “lack of evidence for the efficacy of ESWT when compared to sham therapy.”
Hmmm.
Granted, this always happens: dueling studies, conflicting evidence, what’s a layperson to do? (And what’s a professional to do? You think we don’t shake our heads too? We do!) And this Belgian study was hardly the last word, particularly considering that they only studied 25 people. Still, it was reasonably well-designed and carefully controlled, and they could not find a therapeutic effect.
You have to ask yourself, if researchers sometimes find a therapeutic effect and sometimes don’t … how good can it be?
There’s no way to know where this will land. The point of sharing studies with conflicting results is simply to fully inform you, and to make it clear that no doctor or therapist should ever be confidently telling you that ESWT “works” for plantar fasciitis — no one knows. It might and it might not. Yet, in the wild, you are very likely to encounter just exactly that sort of unjustified confidence … right before they try to get you to spend money on the therapy.
If researchers sometimes find a therapeutic effect and sometimes don’t … how good can it be?
In any case, there’s a risk of caring much too much about ESWT. It needs to be put into perspective: there are highly effective, much cheaper (like free), and more comfortable treatments for plantar fasciitis! ESWT is only a “worth a shot” option for a few plantar fasciitis patients who have already tried everything else and still haven’t gotten relief. My advanced tutorial is by far the best resource available for troubleshooting difficult plantar fasciitis.
Save Yourself from Plantar Fasciitis!
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