Plantar Fasciitis, Chronic
Conditions
Brief summary
The goal of this clinical trial is to learn whether focused extracorporeal shockwave therapy (ESWT) provides better outcomes than radial ESWT for adults with plantar fasciitis. It will also learn about the safety and tolerability of both treatments. The main questions it aims to answer are: 1. Does focused ESWT lead to greater improvement in heel pain than radial ESWT? 2. Does focused ESWT improve foot function more than radial ESWT? 3. Do participants experience less discomfort during focused ESWT compared with radial ESWT? 4. What medical problems or side effects occur with either treatment? Researchers will compare focused ESWT to radial ESWT to see whether one treatment offers better clinical outcomes or is better tolerated. Participants will: 1. Receive three shockwave treatment sessions (radial or focused), one week apart 2. Attend clinic follow-up assessments at 6 weeks, 12 weeks, 6 months, and 12 months 3. Complete questionnaires about heel pain and foot function Keep a diary of symptoms, daily pain levels, activity limitations, and any use of pain medication
Interventions
Patients will be randomly allocated to focused shockwave therapy. The settings with regards to the waves will be pre-determined and will be the normal setting usually used by the department They will have one session every week for 3 weeks We will chase them up with outcome at 6 weeks, 12 weeks, 6 months and 12months.
DEVICERadial shockwave therapy
Patients will be randomly allocated to radial shockwave therapy The setting for the shockwave will be pre-determined as advised by the literature and manufacturers of the device They will have one session every week for 3 weeks We will chase them up with outcome at 6 weeks, 12 weeks, 6 months and 12months.
Sponsors
Homerton University Hospital NHS Foundation Trust
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* aged 18 years or older; 2. chronic plantar heel pain for at least 3 months; 3. clinical presentation consistent with plantar fasciitis / plantar fasciopathy; 4. baseline average heel pain of at least 4/10 in at least one heel proposed for study treatment; 5. imaging findings supportive of plantar fasciitis / plantar fasciopathy on either: * ultrasound scan (USS); or * magnetic resonance imaging (MRI); 6. able to understand the study and provide written informed consent; 7. sufficient spoken and written English to understand the study information and complete the planned questionnaires and telephone follow-up assessments
Exclusion criteria
* Participants will be excluded for any of the following: 1. previous ESWT to the affected study foot; 2. corticosteroid injection to the affected region within the preceding 3 months; 3. previous plantar fascia surgery; 4. an alternative diagnosis considered to be the principal cause of the heel pain; 5. current or suspected calcaneal or other relevant stress fracture; 6. relevant inflammatory arthropathy; 7. pregnancy; 8. recognised contraindication to ESWT; 9. inability to provide informed consent; 10. insufficient spoken or written English to understand the study information or complete the planned study procedures where appropriately translated materials and interpreter-supported longitudinal follow-up are unavailable; 11. any other clinical factor considered by the investigator to make participation inappropriate or unsafe
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average Heel pain at 12 weeks using a numerical rating scale ranging from 0 - 10 | 12 weeks | To compare the clinical effectiveness of radial versus focused Extracorporeal shockwave therapy (ESWT) for chronic plantar heel pain by assessing the difference between treatment groups in average heel pain at 12 weeks, adjusted for baseline pain. The numerical rating scale ranges from 0 - 10 with 10 being a worse outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To compare the effect of radial and focused shockwave therapy on foot related function using the modified Foot Function Index (FFI) questionnaire | 12 months | The modified foot function index is a 23 item questionnaire with a 0 - 10 numerical scale response. Higher scoring tends to indicate worse outcome. This questionnaire will be done at baseline, 6 weeks, 12 weeks, 6 months and 12 months |
| Comparing first step heel pain after radial vs focused shockwave therpay using a numerical rating scale from 0 - 10 | 12 months | This will be recorded at baseline, 6 weeks, 12 weeks, 6 months and 12 months. A higher score indicates a worse outcome |
| To compare procedural treatment discomfort after radial vs focused shockwave therapy using a numerical rating scale (ranging 0-10) | 3 weeks | This will be recorded after each treatment session. There are 3 treatment session in total happening in 3 consecutive weeks, once a week A higher score indicates a worse outcome |
| Patient-reported global improvement following radial vs focused shockwave therapy using a Likert scale | 12 months | This will be recorded at 6 weeks, 12 weeks, 6 months and 12 months. The likert scale is as follows: Compared with before shockwave treatment, how is your heel pain now? Much worse Worse no change Better Much better |
| To compare patient satisfaction after undergoing radial vs shockwave therapy using a likert scale | 12 months | Patient satisfaction will be recorded at 12 weeks, 6 months and 12months using a Likert scale in the following format How satisfied are you in the outcome of your treatment? Very dissatisfied Dissatisfied Neutral satisfied Very satisfied |
| To compare willingness to undergo the same treatment after undergoing radial vs shockwave therapy using a qualitative question | 12 months | This will be recorded at baseline 12 weeks, 6 months and 12 months using the following template; If you were int he same situation again, would you choose to have this treatment Yes No Unsure |
| Comparing treatment related adverse events after radial vs focused shockwave therapy using a qualitative question | 12 months | This will be recorded at 6 weeks, 12 weeks, 6 months and 12 months. The question template is as follows; Adverse event since the previous study contact None Bruising New neurological symptoms Pain flare lasting \>48hours Skin irritation Others (please elaborate) |
Contacts
CONTACTDR Mukhey
Outcome results
None listed