Extracorporeal Shockwave Therapy Versus Platelet Rich Plasma Injection in Patients of Chronic Plantar Fasciitis: A Randomized Controlled Trial From a Tertiary Center of Eastern India
TL;DR
This study addresses a common clinical question for patients with chronic heel pain that hasn't responded to basic treatments: should they try shockwave therapy or PRP injections? The findings suggest both work, but with different timelines. Patients needing quick relief may benefit from ESWT's faster initial response, while those seeking longer-lasting improvement may do better with PRP. The study provides real-world guidance for treatment selection based on patient priorities and timeline expectations.
Key Numbers
PRP reduced pain by 49% at 90 days vs only 15% for ESWT
ESWT showed faster initial relief at day 15 (VAS 4.67 vs 6.67)
PRP reduced plantar fascia thickness by 25.7% vs 6.8% for ESWT
PRP improved functional scores by 27% vs 6.5% for ESWT at 90 days
72 patients enrolled with chronic plantar fasciitis unresponsive to conservative treatment
Key Findings
ESWT provides faster initial pain relief than PRP
Shockwave therapy reduced pain faster in the first two weeks - patients felt relief sooner compared to those who got PRP injections.
At day 15, ESWT group VAS was 4.67±1.45 vs PRP group 6.67±1.35 (p<0.001)
PRP provides superior long-term outcomes compared to ESWT
After 3 months, PRP patients had significantly less pain than shockwave patients. PRP reduced pain by about half, while shockwave only reduced it by about 15%.
At day 90, PRP group VAS was 3.36±0.96 vs ESWT group 5.47±1.63 (p<0.001). PRP showed 49% pain reduction vs 15% for ESWT.
PRP causes greater reduction in plantar fascia thickness
PRP injections shrank the thickened plantar fascia tissue nearly 4 times more than shockwave therapy did.
PFT% change: PRP group 25.71±11.33% vs ESWT group 6.80±8.07% (p<0.001)
PRP produces better functional improvement long-term
After 3 months, PRP patients had better foot function scores, improving by 27% compared to only 6.5% improvement in the shockwave group.
At day 90, AOFAS score: PRP 81.08±6.01 vs ESWT 72.75±7.90 (p<0.001). AOFAS% change: PRP 27.36% vs ESWT 6.52%
Both treatments are safe with no major adverse effects
Both shockwave therapy and PRP injections were well-tolerated with good safety profiles.
No major adverse effects reported in either group
Our Take
This study offers valuable insights for patients weighing their options for stubborn plantar fasciitis. While the results show PRP outperforming ESWT at the 90-day mark, there's an important caveat: the ESWT protocol used only a single session at relatively low energy (0.2 mJ/mm²). Most clinical protocols for plantar fasciitis involve 3-6 sessions of shockwave therapy, which may explain why the ESWT benefits plateaued. The finding that ESWT provided faster initial pain relief (by day 15) is clinically meaningful for patients who need to get back on their feet quickly. For our patients, we typically recommend a series of shockwave treatments rather than a single session, which may yield better long-term results than this study suggests. PRP remains an excellent option, particularly for patients who prefer a single injection approach and can wait a few weeks for benefits to manifest. The ideal approach may even be combining both modalities, though this wasn't studied here.
Treatment Protocol
- Device
- HC SWT MODEL, Electronica Pagani, Roland Healthcare
- Frequency
- Single session
Study Limitations
- • No blinding of participants - potential for patient-related bias
- • ESWT applied only once (typically given in multiple sessions)
- • Role of comorbidities on outcome not assessed
- • Short follow-up period (90 days maximum)
- • Small sample size (36 per group)
- • Assessor was blinded but patients knew their treatment group
