Repetitive low‐energy shock wave application without local anesthesia is more efficient than repetitive low‐energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis

Background : It remains unclear whether application of local anesthesia (LA) interferes with clinical efficacy of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis. Aims : To evaluate the effect of local anesthesia on the clinical outcome after repetitive low‐energy ESWT for chronic plantar fasciitis. Methods : Eighty‐six patients with chronic plantar fasciitis were randomly assigned to receive either low‐energy ESWT without LA, given weekly for three weeks (Group I, n = 45; 3 × 2000 pulses, total energy flux density per shock 0.09 mJ/mm 2 ) or identical ESWT with LA (Group II, n = 41). Primary outcome measure was: Reduction of pain from baseline to month 3 post‐treatment in a pain numeric rating scale [0–10 points] during first steps in the morning, evaluated by an independent blinded observer. Calculations were based on intention‐to‐treat. Results: No difference was found between the groups at baseline. At 3 months, the average pain score was 2.2 ± 2.0 points for patients of Group I, and 4.1 ± 1.5 points for patients of Group II. The mean between‐group difference was 1.9 points (95% Cl: [1.1–2.7 points]; P < .001). Significantly more patients of Group I achieved ⩾ 50% reduction of pain compared to Group II (67% vs 29%. P < .001). Conclusion : ESWT as applied should be done without LA in patients suffering from chronic heel pain. LA applied prior treatment reduced the efficiency of low‐energy ESWT. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.