A Prospective Clinical Series of Outcomes Following Radial Extracorporeal Shockwave Therapy as Part of a Combined Program for Refractory Plantar Fasciopathy.

PURPOSE: Plantar fasciopathy is the most common cause of heel pain in adults and is estimated to affect about 10% of people over their lifetime. The National Institute for Health and Care Excellence notes that extracorporeal shockwave therapy (ESWT) for refractory plantar fasciitis raises no major safety concerns but has inconsistent efficacy evidence and should be used with special governance/audit arrangements; further research with validated outcomes and ≥1‑year follow-up is encouraged. METHODS: This prospective, single-arm clinical series followed consecutive patients treated for refractory plantar fasciopathy in a publicly funded UK musculoskeletal service. Participants received a standardized program of 3 weekly radial ESWT (rESWT) sessions (2500 impulses; 10 Hz; 2-4 bar according to tolerance; no local anesthetic). The primary outcome was participant-level Foot Function Index (FFI) total score at baseline, 6 and 12 months. FINDINGS: Of 50 patients (71 heels) with plantar fasciopathy underwent the treatment protocol. Mean (SD) FFI improved from 60.3 (20.9) at baseline to 37.3 (23.0) at 6 months and remained improved at 39.5 (24.6) at 12 months. Improvements from baseline to 6 months (mean difference 23.0, P < 0.001) and baseline to 12 months (mean difference 20.8, P < 0.001) were statistically significant. There was no significant change between 6 and 12 months (P = 0.451). IMPLICATIONS: In this real-world NHS cohort with refractory plantar fasciopathy, rESWT was associated with substantial improvement in FFI by 6 months, sustained through to 12 months. As the study had no comparator, causality cannot be confirmed in this the single-arm study. However, these findings support further controlled trials and provide useful data to confirm their design and sample size.