The Effectiveness of Combined Extracorporeal Shockwave Therapy and Exercise for Plantar Heel Pain: A Systematic Review

Plantar heel pain (PHP) is a common musculoskeletal disorder that is effectively treated with extracorporeal shockwave therapy (ESWT) and exercise. This review aimed to evaluate the effectiveness of combined ESWT and exercise versus other interventions in treating PHP. A systematic review of effectiveness was conducted, adhering to the PRISMA guidelines. Five databases were searched for studies published between January 2000 and September 2021 with 12 studies (n = 861) meeting the inclusion criteria, which compared ESWT and stretching to various other treatments. High-quality evidence indicates that combined ESWT and stretching interventions are more effective than their individual use or botulinum toxin injections, and low-quality evidence of superiority versus ultrasound and stretching. There was moderate quality evidence that combined ESWT and stretching is no more effective than corticosteroid injection, and high-quality evidence that the combination is no more effective than blood-derived injection therapies, custom orthotics, or low-level laser therapy combined with stretching. There is high-quality evidence that topical corticosteroid or laser therapy in combination with ESWT and stretching increases its effectiveness and moderate-quality evidence for the additive effective of dry needling. Overall, combined ESWT and stretching treatments are effective and may be recommended where they are available and practical to implement. Further high-quality studies comparing combined interventions for PHP, including different exercise activities like resistance training, are required. PROSPERO registration number: CRD42020213286