Combination Therapy Versus Exercise and Orthotic Support in the Management of Pain in Plantar Fasciitis: A Randomized Controlled Trial

Foot Ankle Int. 2018 Apr;39(4):406-414. doi: 10.1177/1071100717747590. Epub 2018 Jan 12.


Background: This study aimed at estimating the effectiveness of two commonly used modalities-extracorporeal shock wave therapy (ESWT) and low-level laser therapy (LLLT)-each combined with usual care (exercises and orthotic supports) in comparison to only usual care to relieve pain in patients with plantar fasciitis (PF).

Methods: Participants with PF were randomly allocated into 3 groups: ESWT (n = 25), LLLT (n = 24), and control (n = 17). All participants received a home exercise program with orthotic support. The ESWT group received 2000 shock waves with 0.02 mJ/mm2 for 3 sessions, once a week; LLLT group received gallium-aluminum-arsenide laser with 850 nm wavelength for 10 sessions, 3 times a week. Pain was measured by Foot Function Index-pain subscale (FFI-p) and Numerical Rating Scale for pain (NRS-p). The scores were recorded at baseline, third week, and third month after the treatment. Analysis was performed using repeated measures ANOVA.

Results: There was a significant improvement in pain over the 3 months in all groups on both FFI-p ( P < .001) and NRS-p ( P < .001). In NRS-p, LLLT group had significantly lower pain than ESWT ( P = .002) at the third week and control ( P = .043) and ESWT ( P = .003) at third month. In FFI-p total score, ESWT group had higher pain than LLLT ( P = .003) and control ( P = .035) groups at third week and LLLT ( P = .010) group at third month.

Conclusion: When LLLT and ESWT were combined with usual care, LLLT was found to be more effective than ESWT in reducing pain in PF at short-term follow-up.

Level of evidence: Level II, comparative study.

Keywords: exercise; extracorporeal shock wave therapy; low-level laser therapy; orthotic support; pain; plantar fasciitis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Combined Modality Therapy / methods*
  • Exercise
  • Fasciitis, Plantar / physiopathology
  • Fasciitis, Plantar / therapy*
  • High-Energy Shock Waves
  • Humans
  • Pain Management
  • Treatment Outcome