Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy

Clin J Sport Med. 2005 May;15(3):119-24. doi: 10.1097/01.jsm.0000164039.91787.dc.


Objective: To compare the efficacy of low-energy extracorporeal shock wave therapy (ESWT) and intralesional corticosteroid injection (CSI) for the treatment of plantar fasciopathy present for at least 6 weeks.

Design: A prospective, randomized, controlled, observer-blinded study over a period of 12 months.

Setting: Primary care and hospital setting.

Patients: A total of 132 patients were enrolled in the study, and 125 completed the study. Nineteen nonrandomized patients acted as a surrogate control group.

Interventions: All patients performed a standardized Achilles tendon and plantar fascia stretching program. The patients were randomly allocated to either treatment group A or B. Group A received a single CSI, while group B were referred for a course of low-dose ESWT comprising 3 treatments over a period of 3 weeks. Group C consisted of 19 nonrandomized patients who performed the standardized stretching program only.

Main outcome measurements: The worst daily pain recorded on a visual analogue scale (VAS), and the tenderness at the plantar fascia insertion as determined by an algometer. These measures were recorded immediately prior to the commencement of treatment and 3 months and 12 months posttreatment.

Results: With regard to VAS pain scores, values for the CSI (1.48; 0-7) were significantly lower than both ESWT (3.69; 0-8), and controls (3.58; 2-5) at 3 months. At 12 months, VAS scores for CSI (0.84; 0-7) and ESWT (0.84; 0-4) were both significantly lower than controls (2.42; 1-4). The tenderness values at 3 months were significantly higher for CSI (9.42; 7-11) than both ESWT (6.72; 4-11) and controls (7.63; 6-9). P < 0.05 was used throughout.

Conclusions: Corticosteroid injection is more efficacious and multiple times more cost-effective than ESWT in the treatment of plantar fasciopathy that has been symptomatic for more than 6 weeks.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Fasciitis, Plantar / diagnosis
  • Fasciitis, Plantar / therapy*
  • Female
  • Follow-Up Studies
  • High-Energy Shock Waves / therapeutic use*
  • Humans
  • Injections, Intralesional
  • Linear Models
  • Male
  • Middle Aged
  • Pain Measurement
  • Probability
  • Prospective Studies
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Single-Blind Method
  • Treatment Outcome


  • Adrenal Cortex Hormones