Similar benefits seen after radial extracorporeal shockwave therapy or autologous blood injection in patients with chronic plantar fasciitis—a retrospective cohort study

Objective: To compare the outcomes for patients with chronic plantar fasciitis following Extra-Corporeal Shockwave Therapy (ESWT) or Autologous Blood Injection (ABI)
Design: Cohort study – retrospective analysis of prospectively collected data
Setting: Hospital-based Sports Medicine Outpatient Clinic
Patients: 102 consecutive patients with chronic plantar fasciitis, treated with either radial-ESWT (n=54) or ABI (n=48), with minimum three-month follow-up and 96% (98/102) having six-month follow-up. Mean age 49.5 years, mean duration of symptoms 37.5 months prior to treatment.
Interventions: Patients received either three sessions of radial Extra-Corporeal Shockwave Therapy (one session per week for three weeks), or a single ultrasound-guided dry-needling and Autologous Blood Injection (3ml whole autologous blood). All patients received standardised after-care, including progressive structured home exercise programme of flexibility, strengthening and proprioception exercises.
Main Outcome Measures: 0-10 Numerical rating scale (NRS) for self-reported “average pain” and “average stiffness” values. Secondary outcome measures included assessments of local foot function (including Manchester Oxford Foot Questionnaire (MOXFQ), revised-Foot Function Index (FFI-R)) as well as markers of mental health functioning (HAD), global health (EQ-5D-5L) and physical activity (IPAQ) 3
Results: This study demonstrated statistically significant improvements in self-reported measures of pain and local foot function following either procedure at 6-weeks, 3-months and 6-months, but no statistically significant differences were seen between groups at any time-period studied. At 6- months: the average pain using a 0-10 numerical rating scale was improved from 6.8±1.8 to 4.0±2.7 (p<0.001) following ESWT and from 7.1±1.6 to 3.8±2.7 (p<0.001) following ABI. At 6-months, significant improvements were seen following either group using a number of different validated PROMs assessing local foot pain and function e.g. the total score for MOXFQ improved from 56.1±12.8 to 42.5±16.6 (p<0.001) following ESWT and from 58.8±13.2 to 44.2±19.2 (p<0.001) following ABI. However, measures of physical activity or wider aspects of patient functioning did not consistently improve from baseline values to follow-up periods.
Conclusions: Patients with chronic plantar fasciitis improved to statistically significant extent following either radial-ESWT or Autologous Blood Injection procedures, with no significant differences seen between groups. The lack of randomisation in this pragmatic study is noted, which may have influenced outcome seen. Potentially larger and more robust studies are required to investigate this treatment comparison further.
Clinical relevance This pragmatic cohort study demonstrates improvements following either radial-ESWT or ABI procedures, with no significant differences seen between groups.