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Shock Wave Therapy for Treatment of Plantar Fasciitis
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To the Editor: Dr Buchbinder and colleagues1 report that low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis offered no measurable benefit. Plantar fasciitis is characterized by poor healing and the formation of scar tissue after an acute or overuse injury. The scar tissue has extremely poor blood supply that inhibits the entry of tissue healing cells (fibroblasts and osteoblasts) into the pathologic site. The delivery of shock waves to this scar tissue is thought to cause microscopic injury with associated deposit of endothelial cells, resulting in re-engineering of the scar tissues.
For this process to occur, we believe that sufficient energy must be delivered to cause the necessary controlled tissue damage. It appears that the use of low-energy devices without anesthesia, such as used by Buchbinder et al, does not create the magnitude of tissue damage necessary to trigger the neovascularization process. We also believe that treatments should be . . . [Full Text of this Article]
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