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

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/mm 2 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.