949469

research-article2020
FAIXXX10.1177/1071100720949469Foot & Ankle InternationalErden et al

Article

Foot & Ankle International®

Outcome of Corticosteroid Injections,

1­–7
© The Author(s) 2020
Article reuse guidelines:
Extracorporeal Shock Wave Therapy, and sagepub.com/journals-permissions
DOI: 10.1177/1071100720949469
https://doi.org/10.1177/1071100720949469

Radiofrequency Thermal Lesioning for journals.sagepub.com/home/fai

Chronic Plantar Fasciitis

Tunay Erden, MD1 , Berkin Toker, MD1, Omer Cengiz, MD2, Bugra Ince, MD3,
Seyda Asci, PhD4, and Ali Toprak, PhD5

Abstract
Background: Chronic heel pain with plantar fasciitis is relatively common and can affect adults of all ages regardless of an
active or sedentary lifestyle. The purpose of the present study was to evaluate the effectiveness of corticosteroid injection
(CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL) treatments in chronic
plantar heel pain that has been unresponsive to other conservative treatments.
Methods: We retrospectively analyzed the results of 217 patients treated with CSI (n = 73), ESWT (n = 75), and RTL
(n = 69). The treatment efficacy and pain intensity, as measured using the visual analog scale, were recorded and compared
at the 6-month follow-up.
Results: Pain intensity decreased significantly in all patients. However, it decreased significantly more in the CSI and RTL
groups than in the ESWT group (P < .001). Age, sex, body mass index, calcaneal spur presence, and symptom duration
were similar among 3 groups (P > .05). No complications were noted after the CSI, ESWT, or RTL sessions.
Conclusion: CSI, ESWT, and RTL successfully treated chronic plantar heel pain that did not respond to other conservative
treatments; however, CSI and RTL yielded better therapeutic outcomes.
Level of Evidence: Level III, retrospective comparative study.

Keywords: corticosteroid injection, extracorporeal shock wave therapy, calcaneus, heel pain, plantar fasciitis,
radiofrequency

Introduction (excessive pronation of the foot); and certain extrinsic

Chronic heel pain associated with plantar fasciitis (PF) is
one of the most common clinical entities encountered by
foot and ankle specialists and affects adults of all ages with
either an active or sedentary lifestyle.9 Within their lifetime,
10% of the general population is expected to present to
orthopedic surgeons with heel pain due to degenerative
changes in the plantar fascia.19,20 PF results from the cumu-
lative effect of recurrent microinjuries and chronic damage
in the plantar aponeurosis at the insertion of the plantar fas-
cia on the medial process of the calcaneal tuberosity.7
Severe pain in the medial tubercle of the calcaneus during
weightbearing in the morning that decreases in intensity
during standing is the main symptom of PF.30,33 The main
predisposing risk factors include an older age; certain ana-
tomic risk factors, such as leg length discrepancy, high body
mass index (BMI), thick plantar fascia, and pes planus
factors, such as previous injury to the heel, improper shoe
fit, and improper running pattern.1,5
1
Department of Orthopaedics and Traumatology, Acıbadem Fulya
Hospital, Istanbul, Turkey
2
Department of Orthopaedics and Traumatology, Istanbul Kartal Dr.
Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
3
Department of Physiotherapy and Rehabilitation, Faculty of Medicine,
Bezmialem Vakif University, Istanbul, Turkey
4
Vocational School of Health Services, Gelisim University, Istanbul,
Turkey
5
Department of Biostatistics and Medical Informatics, Faculty of
Medicine, Bezmialem Vakif University, Istanbul, Turkey
Corresponding Author:
Tunay Erden, MD, Department of Orthopaedics and Traumatology,
Acıbadem Fulya Hospital Sports Medicine Center, Dikilitaş, Hakkı Yeten
Cd. No. 23, Istanbul, 34349, Turkey.
Email: doktorerden@hotmail.com
2 Foot & Ankle International 00(0)
Table 1.  Inclusion and Exclusion Criteria for the Study.
Inclusion criteria
1. ≥18 and <65 years of age  
2. Heel pain present for at least 6 months  
3. ≥5 of the VAS present at the first steps taken in  
the morning  
4. Previously attempted at least 2 of the following  
conservative measures:  
 Arch supports  
 Physical therapy
 Home stretching  
 Oral anti-inflammatories
 Night splint  
 Taping/strapping
10. Chronic heart disease; neurologic, hepatic, and/or metabolic disease; or
11. Seronegative spondyloarthropathy
Abbreviations: ESWT, extracorporeal shock wave therapy; RTL, radiofrequency thermal lesioning; VAS, visual analog scale.
PF is typically a self-limiting condition, and none of the
current treatment modalities have shown superiority when
used alone.36 Based on the natural course of the disease,
nonsurgical treatments are usually administered, including
rest, cold and warm water compression, plantar stretching
exercises, braces and orthoses, nonsteroidal anti-inflamma-
tory drugs (NSAIDs), corticosteroid injections (CSIs),
platelet-rich plasma (PRP) injections, botulinum toxin
injections, transcutaneous electrical nerve stimulation,
cryotherapy, radiofrequency thermal lesioning (RTL), and
extracorporeal shock wave therapy (ESWT).3,7,19,36
Nonsurgical management of PF is successful in approxi-
mately 90% of patients.3,18 Surgical procedures, including
the removal or release of the fascia and removal of bone
spurs, are indicated if conservative treatment fails after 6
months to 1 year.7,36,40
There is no definitive treatment for PF; therefore, physi-
cians and patients choose a treatment based on their own
experiences and interests. Of the 30 nonoperative treat-
ments recommended for patients with PF, CSI, ESWT, and
RTL have been compared in a few studies, but no studies
have compared the 3 methods as the primary treatments for
chronic plantar fasciitis (CPF).
The purpose of the present study was to evaluate the
effectiveness of CSI, ESWT, and RTL treatments on chronic
plantar heel pain that has been unresponsive to other con-
servative treatments. Our hypothesis was that in the treat-
ment of chronic plantar heel pain, treatment with CSI would
be more successful than the RTL and ESWT treatment
methods.
Methods
After we received institutional review board approval, we
retrospectively analyzed the results of 304 patients treated
Exclusion criteria
1. History of trauma or calcaneal fracture
2. Osteoarthritis, diabetes mellitus, pregnancy
3. Pain related to peripheral neuropathy or ischemia
4. Inability to tolerate injections to the heel region
5. Allergy to local anesthetics or steroids
6. Open wounds on the study foot
7. Local or systemic infection on the date when the procedure was to be
performed
8. Previous use of steroidal injection to the heel, previous use of ESWT,
previous use of RTL
9. History of surgical intervention to the heel or any functional limitation of
the affected foot
dermatologic infections
for CPF between 2016 and 2019. Eighty-seven patients who
did not attend regular follow-ups or did not meet the inclu-
sion criteria were excluded from the study (21 patients from
group 1, 36 patients from group 2, and 30 patients from
group 3), and the results of the remaining 217 patients were
reviewed. All of the patients had heel pain that had been
present for at least 6 months and did not respond to multiple
conservative treatments. The full inclusion and exclusion
criteria are presented in Table 1. The follow-up examina-
tions were performed by 2 physicians and examination
results were recorded. All patient results were investigated
via the electronic records system. The patients who met the
inclusion criteria were divided into CSI (group 1; n = 73),
ESWT (group 2; n = 75), and RTL (group 3; n = 69)
groups. The patients were distributed to the groups accord-
ing to their first day of arrival in the hospital. Patients arriv-
ing on Monday and Tuesday were added to group 1, those
arriving on Wednesday and Thursday were added to group
2, and those arriving on Friday and Saturday were added to
group 3. The patients in the groups were also evaluated by
their age, sex, BMI, and symptom duration. All the patients
underwent lateral and axial radiographs to rule out the pres-
ence of any possible lesions, such as osteomyelitis, tumors,
or fractures. All patients underwent clinical evaluations at
baseline and at 1, 3, and 6 months after treatment. The
severity of the pain before and after the CSI, ESWT, and
RTL during the last 24 hours at rest, at the first step in the
morning, and during daily activities at the area of the plan-
tar fascia origin on the medial tubercle was recorded using
a visual analog scale (VAS), ranging from 0 to 10, with 0
indicating no pain and 10 indicating severe pain.
Of the 217 patients, 184 (84.79%) were female and 33
(15.21%) were male. The right foot of 140 patients (64.5%)
and the left foot of 77 patients (35.5%) were affected. There
were 73 patients in the CSI group (group 1), 75 in the ESWT
Erden et al 3
Table 2.  Characteristics of the 217 Patients in the CSI, ESWT, and RTL Groups.
Group 1 (CSI)
Sex, M/F 11:62
Age, y
 Mean ± SD 45 ± 9.1
 Range 27-65
Affected foot, right/left 46:27
BMI, kg/m2 29.1 ± 2.4
Symptom duration, mo
 Mean ± SD 8.1 ± 1.5
 Range 6-10
Presence of plantar spur (%) 58.9
Abbreviations: CSI, corticosteroid injection; ESWT, extracorporeal shock wave therapy; RTL, radiofrequency thermal lesioning.
group (group 2), and 69 in the RTL group (group 3). There
were no significant differences in age, sex, BMI, symptom
duration (month), or side of involvement across the groups
(all P > .05) (Table 2). The relationships between BMI and
age and VAS score changes were evaluated with the
Spearman test, and no statistically significant differences
were detected (P = .24, P = .32, and P =.52 and P = .24, P
= .55, and P = .41 for groups 1, 2, and 3, respectively).
The radiographic evaluations showed calcaneal spurs in
43 patients (58.9%) in group 1, 36 patients (48%) in group
2, and 40 patients (57.9%) in group 3. No statistically sig-
nificant differences were found between sex and spur exis-
tence or VAS score changes (P = .38, P = .83, and P = .98
and P = .82, P = .18, and P = .19 for groups 1, 2, and 3,
respectively).
Corticosteroid Injection
For the CSIs, 1 mL of methyl prednisolone acetate (40 mg)
and 1 mL of lidocaine 2% were injected into the site of max-
imal tenderness at the inferomedial calcaneal tuberosity.20
Care was taken so that the skin, subcutaneous tissue, and/or
fat pad were not injected. The procedure was performed by
a single orthopedic surgeon (B.T.). All patients were
instructed to practice stretching exercises and wear silicone
heel cups following the CSI.
Extracorporeal Shock Wave Therapy
ESWT (Masterpuls MP100; Storz Medical, Tägerwillen,
Switzerland) was administered once a week for 3 weeks;
2000 impulses were administered to the plantar heel region
with a frequency of 15 Hz and pressure of 1.8 bar.23 After
each patient lay down in a comfortable position, the area of
maximum tenderness was marked with a skin marker, and
the procedure was performed by a single physical therapy
and rehabilitation specialist (B.I.). No anesthetics or narcot-
ics were used during the treatment protocol. All patients
Group 2 (ESWT) Group 3 (RTL)
9:66 13:56
43 ± 9.6 41 ± 10.1
26-62 29-65
56:19 38:31
29.7 ± 3.0 30.4 ± 2.9
7.8 ± 1.0 8.6 ± 1.6
7-11 6-11
48.0 57.9
were instructed to practice stretching exercises and wear
silicone heel cups following ESWT.
Radiofrequency Thermal Lesioning
The NeuroTherm NT1100 device (NeuroTherm, Wilmington,
MA) was used during each session. For RTL, we applied the
same technique employed by Arslan et al.2 The plantar fascia
was palpated with the patient in the prone position, and the
painful and tender region was marked by a skin marker.
Under sterile conditions, 0.5 mL of lidocaine was adminis-
tered at the entry points of the cannula, and a 22-gauge radio-
frequency (RF) cannula was inserted into the plantar heel
at an angle of 120 degrees. Initially, a low voltage, such as
1 V, was used, and the occurrence of any type of stimula-
tion, movement of the toes, or fasciculation was noted.
When an involuntary foot or toe contraction was recorded,
the probes were removed and repositioned to the heel to
prevent neurological injuries. To find the appropriate posi-
tion, we initially used a frequency of 50 Hz and voltage of
0 V and gradually increased the voltage until the patient
experienced a tingling sensation; at this point, we began to
reduce the voltage. A tingling sensation at a voltage of
<0.5 V indicated that the probe was close to a sensory
nerve. The settings of the machine were then fixed, and
after a temperature of 90 °C was reached, 90-second ther-
mal ablation was performed. This process was applied to 1
to 3 different points of pain, with consideration of the
potential variations in neural anatomy. At the end of the
procedure, the heel area was covered with sterile bandages.
The procedure was performed by a single orthopedic sur-
geon (T.E.). All patients were instructed to apply ice packs
for 3 days, practice stretching exercises, and wear silicone
heel cups following RTL.
Statistical Analysis.  The statistical analyses were performed
using IBM SPSS Statistics for Windows version 22 (IBM
Corp, Armonk, NY). First, a Kolmogorov-Smirnov test was
4 Foot & Ankle International 00(0)

Table 3.  VAS Scores Before and After Treatment in All Groups.

Pretreatment VAS 1st-mo VAS 3rd-mo VAS 6th-mo VAS P value

Group 1 (CSI) (n = 73) Median (Q1-Q3) 9 (8-10) 2 (1-3) 2 (1-2) 1 (1-2) <.001
Mean ± SD 8.9 ± 1.1 2.2 ± 1.1 1.7 ± 0.7 1.4 ± 0.7
Group 2 (ESWT) (n = 75) Median (Q1-Q3) 9 (8-10) 4 (3-5) 4 (4-5) 5 (4-6) <.001
Mean ± SD 8.8 ± 1.0 3.8 ± 1.1 4.2 ± 0.8 4.9 ± 0.8
Group 3 (RTL) (n = 69) Median (Q1-Q3) 10 (8-10) 3 (2-3) 2 (2-2) 2 (2-2.5) <.001
Mean ± SD 9.2 ± 1.1 2.6 ± 1.1 1.9 ± 0.7 2.1 ± 0.7

Abbreviations: CSI, corticosteroid injection; ESWT, extracorporeal shock wave therapy; RTL, radiofrequency thermal lesioning; Q1, quarter 1; Q3, quarter 3;
VAS, visual analog scale.

used to determine which variables should be included in the

data analysis and whether the data for the variables were
normally distributed, but the data were not normally distrib-
uted. Therefore, nonparametric tests were used. The Freid-
man test was used to analyze multiple variables within
groups, and when statistically significant results were
observed, the Wilcoxon matched-pair signed-rank test was
used to compare the corresponding variables. The Wilcoxon
signed-rank test was used to compare 2 variables within the
same group. The Kruskal-Wallis test was used to compare
continuous variables (age, BMI, symptom duration, and
change) across groups 1, 2, and 3, and when statistically
significant results were observed, Dunn’s post hoc test was
used to compare the corresponding variables. The Mann-
Whitney U test was used to compare categorical variables
between 2 groups (sex and spur presence). Relationships
among continuous variables (age and BMI) were evaluated
with the Spearman correlation coefficient. The median (Q1
[1st quarter]–Q3 [3rd quarter]), mean ± standard deviation,
frequency, and percentage constituted the descriptive statis-
tics. The statistical significance level was set to P < .05.
Results
The VAS was used to evaluate all groups before the treat-
ment and at 1, 3, and 6 months after the treatment, and the
posttreatment scores were statistically significantly lower
than the pretreatment scores in all groups (Table 3, Figure 1).
In group 1 (CSI), there was a significant difference between
the pretreatment VAS score and posttreatment VAS scores at
1, 3, and 6 months (all P < .001) (Table 3). In addition, the
VAS score was significantly lower in the sixth month after
the treatment than in the first month (P < .001) (Table 3,
Figure 1). In group 2 (ESWT), for the VAS scores, only the
difference between the first and third months after treatment
was not statistically significant (P > .05), while there was a
significant difference in the other within-group comparisons
(pretreatment vs 1, 3, and 6 months posttreatment, 1 month
vs 6 months posttreatment, and 3 months vs 6 months post-
treatment; all P < .001) (Table 3). In group 3 (RTL), for the
VAS scores, there was a statistically significant difference
between pretreatment and the first, third, and sixth months
Figure 1.  Graphical illustration of the visual analog scale
(VAS) scores before treatment and at 1, 3, and 6 months after
treatment in all groups. CSI, corticosteroid injection; ESWT,
extracorporeal shock wave therapy; RTL, radiofrequency
thermal lesioning.
posttreatment and between the first and third months post-
treatment (all P < .001) (Table 3).
The mean VAS score changes are shown in Table 4. The
changes between the pretreatment VAS scores and the scores
at other time points (first, third, and sixth months) were com-
pared across the groups, and significant results were observed
(Table 4). There was a significant difference between groups
1 and 2 and between groups 2 and 3 in the changes across all
3 time points (P < .001 and P < .001, respectively). The
VAS score change was not statistically significantly different
between groups 1 and 3 because the responses to the treat-
ment were similar (P = .81). No complications were noted
after the CSI, ESWT, or RTL sessions.
Discussion
Heel pain attributed to PF is one of the most common foot
conditions that occurs, and many treatments have been pro-
posed for its management. In this study, the clinical results
of CSI, ESWT, and RTL, which are the treatment options
for CPF cases, were compared. The final results of the study
partially supported our hypothesis because RTL treatment
also yielded similar results to CSI. Controversial results
Erden et al 5
Table 4.  Changes in the VAS Score at the First-, Third-, and Sixth-Month Follow-ups.
  1st-mo visit
CSI ESWT RTL
  (n = 73) (n = 75) (n = 69)
Median (Q1-Q3) 7 (6-8) 5 (4-6) 7(6-8)
Mean ± SD 6.7 ± 1.5 5.0 ± 1.5 6.6± 1.5
P value <.001
Abbreviations: CSI, corticosteroid injection; ESWT, extracorporeal shock wave therapy; RTL, radiofrequency thermal lesioning; Q1, quarter 1; Q3, quarter 3;
VAS, visual analog scale.
have been reported regarding whether ESWT is effective in
treating PF.
The effectiveness of ESWT has been reported in some
placebo-controlled studies. Haake et al13 reported that
ESWT is ineffective in treating CPF. Speed29 reported no
beneficial effects of ESWT compared with a placebo during
a 6-month period. Similarly, Buchbinder et al6 found no evi-
dence suggesting that ultrasound-guided ESWT is more
effective than placebo at relieving pain, improving func-
tion, or improving quality of life after 6 and 12 weeks. In
contrast, there have been many studies showing that the
success rate of ESWT in treating CPF is between 48% and
88% and that it significantly decreases the VAS score.12,17,18,22
It has been suggested that ESWT is safer than CSIs, and the
therapeutic benefits of ESWT start 2 weeks after applica-
tion.22,25,29 In contrast to Buchbinder et al, Theodore et al31
reported better results for ESWT in a placebo-controlled
trial. Rompe et al26 observed significant improvements in
56% of the patients treated with ESWT and in 16% of the
patients treated with a placebo at 12 weeks after the treat-
ments, and these proportions increased to 88% and 34%,
respectively, after 1 year. In another study, Melegati et al21
divided patients into 2 groups, those with a history of ste-
roid injections (group A) and those without a history of ste-
roid injections (group B). Three sessions of ESWT were
applied to both groups. After 2 months, no pain was detected
in 31.6% of the patients in group A and 11.5% of the patients
in group B. At 10 months after EWST, 39.5% of the patients
in group A were pain free, but none of the patients in group
B were pain free. Yucel et al41 reported an 88% success rate
in the ESWT group in the third month after treatment. Ozan
et al23 compared the results of RTL and ESWT in patients
with CPF and reported similar success rates. It was also
reported that the VAS score continued to decrease in the
first, third, and sixth months after treatment in both groups.
In a randomized controlled study, Ugurlar et al35 reported
that ESWT was successful, especially in the first 6 months
after treatment, but its effectiveness decreased after the first
year. In our study, the ESWT group had a similar success
rate; although the results worsened after the first month,
VAS score reduction
3rd-mo visit 6th-mo visit
CSI ESWT RTL CSI ESWT RTL
(n = 73) (n = 75) (n = 69) (n = 73) (n = 75) (n = 69)
7 (6-8) 4 (4-5) 7 (6-8) 8 (7-9) 4 (3-5) 7 (6-8)
7.2 ± 1.2 4.5 ± 1.2 7.2 ± 1.2 7.5 ± 1.4 3.8 ± 1.3 7.1 ± 1.1
<.001 <.001
there was a significant reduction in the VAS score in the
first month posttreatment compared with the pretreatment
score. However, it was observed that the VAS score
decreased less in the ESWT group than in the CSI and RTL
groups.
CSI at the point of maximal tenderness upon palpation
is an effective treatment for CPF. Although this treatment
seems to be very effective, there are conflicting results
regarding the duration of its effects after the injection.
Ball et al4 reported significant improvements with CSI in
the short and medium term. Similarly, Crawford and
Thomson10 reported that CSI can be useful in the short
term. Ugurlar et al35 reported that CSIs are more effective
in the first 3 months after treatment than are ESWT, PRP
injections, and prolotherapy. In a systematic review, Uden
et al34 reported similar results for CSI and the use of cus-
tomized functional foot orthoses for PF. Whittaker et al37
reported that CSIs are more effective than some other
treatments at relieving pain and improving function in
people with plantar heel pain. However, in another study,
CSIs were not more effective than placebo injections at
reducing pain or improving function. Kane et al16 reported
successful results over a long follow-up period after CSI.
Tsai et al32 reported that the therapeutic effects of steroid
injections lasted approximately 1 year. Porter and
Shadbolt24 compared ESWT with CSI and reported suc-
cessful results with both methods. In their studies, the
level of pain was lower in the 3rd month after CSIs, but
the pain level was similar between the 2 groups at the
12th month. Kalaci et al15 reported there are long-term
positive effects of CSI. Similarly, Genc et al11 reported
that the VAS score continued to decrease at 6 months after
CSI in their long-term follow-up study. In our study, the
VAS scores continued to decrease until the sixth month
after treatment in the CSI group, and the VAS score
decreased more in the CSI group than in the other groups.
RTL acts by dissipating heat from an active electrode
and has been used to treat numerous clinical conditions,
including Morton’s neuroma, trigeminal neuralgia, lumbar
disc herniation, coronary vascular disease, cardiac
6 Foot & Ankle International 00(0)
arrhythmia, cervical pain syndrome, lateral epicondylitis,
and essential tremor.28,39 During the percutaneous RTL
procedure, most surgeons use fluoroscopy to confirm the
location of the electrode.8,14 However, successful results
have been reported without the use of fluoroscopy.14,28
Similarly, we performed RTL without fluoroscopy to con-
firm the location of the electrode. In an ultrasound-guided
percutaneous RTL study for PF, Wu et al38 reported a
reduction in pain in 83.9% of patients and showed that the
VAS score continued to decrease for 1 year. Sollitto et al27
performed RTL for resistant PF and reported that 92% of
the patients experienced a complete resolution of the
symptoms. Cozzarelli et al9 reported a success rate of 89%
for radiofrequency nerve ablation (RFNA) in the treat-
ment of chronic neurogenic heel pain at the 5-, 10-, and
12-year follow-ups. Similarly, Cione et al8 reported a
93.3% success rate of RTL in patients with plantar heel
pain with a neurological origin, such as medial calcaneal
nerve entrapment or heel neuroma. While the average
VAS score before treatment was 9, it was found to be 1 at
a long-term follow-up after treatment. In the study by
Arslan et al,2 at 12 months after RTL, 88% of all patients
rated the treatment as either very successful or successful.
In another study, Liden et al19 reported that the success
rate was 92% in the sixth month after RTL. They reported
that the mean VAS score, which was 8.1 before treatment,
decreased to an average of 2 at the 6-month follow-up. In
the present study, we obtained results similar to the those
reported in literature on RTL without the use of fluoros-
copy to confirm the location of the electrode.
Mardani-Kiwi et al20 reported that there were no signifi-
cant relationships between sex, age, or BMI and VAS score
changes. Similarly, we found that sex, age, BMI, and calca-
neal spur presence had no significant effect on VAS score
change.
Although our sample size was larger than those of other
studies in the literature, our study has various limitations.
First, the present study is a retrospective study, and there
was no control group. Second, our follow-up period was
limited to 6 months. Third, we did not perform an ultra-
sound- or fluoroscopic-guided preassessment to determine
the location of the electrodes during RTL. Fourth, we were
unable to investigate the effects of other factors that may
affect the outcomes, such as activity level and the mean
duration of standing per day.
Conclusion
In our study, 3 common treatments used to treat CPF
were compared; the sample size was larger than those of
other studies in the literature. CSI, ESWT, and RTL suc-
cessfully treated chronic plantar heel pain that did not
respond to other conservative treatments; however, the
CSI and RTL techniques yielded better therapeutic
outcomes.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this arti-
cle. ICMJE forms for all authors are available online.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Tunay Erden, MD, https://orcid.org/0000-0002-0926-5879
References
1. Allen RH, Gross MT. Toe flexors strength and passive exten-
sion range of motion of the first metatarsophalangeal joint in
individuals with plantar fasciitis. J Orthop Sports Phys Ther.
2003;33(8):468-478.
2. Arslan A, Koca TT, Utkan A, Sevimli R, Akel I. Treatment of
chronic plantar heel pain with radiofrequency neural ablation
of the first branch of the lateral plantar nerve and medial calca-
neal nerve branches. J Foot Ankle Surg. 2016;55(4):767-771.
3. Atkins KL, Chin KF, Noorani AM, Nairn DS. Image inten-
sifier-guided injection of corticosteroid and local anesthetic
agent for the treatment of recalcitrant plantar fasciitis. Foot
Ankle Spec. 2010;3(4):172-176.
4. Ball EM, McKeeman HM, Patterson C, et al. Steroid injec-
tion for inferior heel pain: a randomised controlled trial. Ann
Rheum Dis. 2013;72(6):996-1002.
5. Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J
Med. 2004;350(21):2159-2166.
6. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan
V, Forbes A. Ultrasound-guided extracorporeal shock wave
therapy for plantar fasciitis: a randomized controlled trial.
JAMA. 2002;288(11):1364-1372.
7. Cardenuto Ferreira R. Talalgia: plantar fasciitis. Rev Bras
Ortop. 2014;49(3):213-217.
8. Cione JA, Cozzarelli J, Mullin CJ. A retrospective study of
radiofrequency thermal lesioning for the treatment of neuri-
tis of the medial calcaneal nerve and its terminal branches in
chronic heel pain. J Foot Ankle Surg. 2009;48(2):142-147.
9. Cozzarelli J, Sollitto RJ, Thapar J, Caponigro J. A 12-year
long-term retrospective analysis of the use of radiofrequency
nerve ablation for the treatment of neurogenic heel pain. Foot
Ankle Spec. 2010;3(6):338-346.
10. Crawford F, Thomson C. Interventions for treating plantar
heel pain. Cochrane Database Syst Rev. 2003(3):CD000416.
11. Genc H, Saracoglu M, Nacir B, Erdem HR, Kacar M.
Long-term ultrasonographic follow-up of plantar fasciitis
patients treated with steroid injection. Joint Bone Spine.
2005;72(1):61-5.
12. Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal
shock wave therapy is safe and effective in the treatment of
chronic recalcitrant plantar fasciitis: results of a confirma-
tory randomized placebo-controlled multicenter study. Am J
Sports Med. 2008;36(11):2100-2109.
13. Haake M, Buch M, Schoellner C, et al. Extracorporeal shock
wave therapy for plantar fasciitis: randomised controlled mul-
ticentre trial. BMJ. 2003;327(7406):75.
Erden et al 7
14. Hormozi J, Lee S, Hong DK. Minimal invasive percutaneous
bipolar radiofrequency for plantar fasciotomy: a retrospective
study. J Foot Ankle Surg. 2011;50(3):283-286.
15. Kalaci A, Cakici H, Hapa O, Yanat AN, Dogramaci Y,
Sevinc TT. Treatment of plantar fasciitis using four different
local injection modalities: a randomized prospective clinical
trial. J Am Podiatr Med Assoc. 2009;99(2):108-113.
16. Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O.
Ultrasound guided injection of recalcitrant plantar fasciitis.
Ann Rheum Dis. 1998;57(6):383-384.
17. Konjen N, Napnark T, Janchai S. A comparison of the
effectiveness of radial extracorporeal shock wave therapy
and ultrasound therapy in the treatment of chronic plantar
fasciitis: a randomized controlled trial. J Med Assoc Thai.
2015;98(Suppl 1):S49-S56.
18. Kudo P, Dainty K, Clarfield M, Coughlin L, Lavoie P, Lebrun
C. Randomized, placebo-controlled, double-blind clinical trial
evaluating the treatment of plantar fasciitis with an extraco-
poreal shockwave therapy (ESWT) device: a North American
confirmatory study. J Orthop Res. 2006;24(2):115-123.
19. Liden B, Simmons M, Landsman AS. A retrospective analysis
of 22 patients treated with percutaneous radiofrequency nerve
ablation for prolonged moderate to severe heel pain associated
with plantar fasciitis. J Foot Ankle Surg. 2009;48(6):642-647.
20. Mardani-Kivi M, Karimi Mobarakeh M, Hassanzadeh Z, et
al. Treatment outcomes of corticosteroid injection and extra-
corporeal shock wave therapy as two primary therapeutic
methods for acute plantar fasciitis: a prospective randomized
clinical trial. J Foot Ankle Surg. 2015;54(6):1047-1052.
21. Melegati G, Tornese D, Bandi M, Caserta A. The influ-
ence of local steroid injections, body weight and the length
of symptoms in the treatment of painful subcalcaneal spurs
with extracorporeal shock wave therapy. Clin Rehabil.
2002;16(7):789-794.
22. Ogden JA, Alvarez RG, Marlow M. Shockwave therapy for
chronic proximal plantar fasciitis: a meta-analysis. Foot Ankle
Int. 2002;23(4):301-308.
23. Ozan F, Koyuncu S, Gurbuz K, Oncel ES, Altay T.
Radiofrequency thermal lesioning and extracorporeal shock-
wave therapy: a comparison of two methods in the treatment
of plantar fasciitis. Foot Ankle Spec. 2017;10(3):204-209.
24. Porter MD, Shadbolt B. Intralesional corticosteroid injection
versus extracorporeal shock wave therapy for plantar fasci-
opathy. Clin J Sport Med. 2005;15(3):119-124.
25. Rompe JD. Repetitive low-energy shock wave treatment is
effective for chronic symptomatic plantar fasciitis. Knee Surg
Sports Traumatol Arthrosc. 2007;15(1):107-108.
26. Rompe JD, Kullmer K, Vogel J, et al. Extracorporeal shock-
wave therapy. Experimental basis, clinical application. Article
in German. Orthopade. 1997;26(3):215-28.
27. Sollitto RJ, Plotkin EL, Klein PG, Mullin P. Early clinical
results of the use of radiofrequency lesioning in the treatment
of plantar fasciitis. J Foot Ankle Surg. 1997;36(3):215-219,
56.
28. Sorensen MD, Hyer CF, Philbin TM. Percutaneous bipolar
radiofrequency microdebridement for recalcitrant proximal
plantar fasciosis. J Foot Ankle Surg. 2011;50(2):165-170.
29. Speed CA. Extracorporeal shock-wave therapy in the man-
agement of chronic soft-tissue conditions. J Bone Joint Surg
Br. 2004;86(2):165-171.
30. Sullivan J, Pappas E, Burns J. Role of mechanical factors in
the clinical presentation of plantar heel pain: implications for
management. Foot (Edinb). 2020;42:101636.
31. Theodore GH, Buch M, Amendola A, Bachmann C,
Fleming LL, Zingas C. Extracorporeal shock wave ther-
apy for the treatment of plantar fasciitis. Foot Ankle Int.
2004;25(5):290-297.
32. Tsai WC, Wang CL, Tang FT, Hsu TC, Hsu KH, Wong
MK. Treatment of proximal plantar fasciitis with ultra-
sound-guided steroid injection. Arch Phys Med Rehabil.
2000;81(10):1416-1421.
33. Tu P. Heel pain: diagnosis and management. Am Fam
Physician. 2018;97(2):86-93.
34. Uden H, Boesch E, Kumar S. Plantar fasciitis—to jab or to
support? A systematic review of the current best evidence. J
Multidiscip Healthc. 2011;4:155-164.
35. Ugurlar M, Sonmez MM, Ugurlar OY, Adiyeke L, Yildirim
H, Eren OT. Effectiveness of four different treatment modal-
ities in the treatment of chronic plantar fasciitis during a
36-month follow-up period: a randomized controlled trial. J
Foot Ankle Surg. 2018;57(5):913-918.
36. Wang CJ, Wang FS, Yang KD, Weng LH, Ko JY. Long-term
results of extracorporeal shockwave treatment for plantar fas-
ciitis. Am J Sports Med. 2006;34(4):592-596.
37. Whittaker GA, Munteanu SE, Menz HB, Bonanno DR,
Gerrard JM, Landorf KB. Corticosteroid injection for plan-
tar heel pain: a systematic review and meta-analysis. BMC
Musculoskelet Disord. 2019;20(1):378.
38. Wu PT, Lee JS, Wu KC, et al. Ultrasound-guided percutane-
ous radiofrequency lesioning when treating recalcitrant plantar
fasciitis: clinical results. Ultraschall Med. 2016;37(1):56-62.
39. Wu YT, Chang CY, Chou YC, et al. Ultrasound-guided
pulsed radiofrequency stimulation of posterior tibial nerve: a
potential novel intervention for recalcitrant plantar fasciitis.
Arch Phys Med Rehabil. 2017;98(5):964-970.
40. Yalcin E, Keskin Akca A, Selcuk B, Kurtaran A, Akyuz M.
Effects of extracorporal shock wave therapy on symptomatic
heel spurs: a correlation between clinical outcome and radio-
logic changes. Rheumatol Int. 2012;32(2):343-347.
41. Yucel I, Ozturan KE, Demiraran Y, Degirmenci E, Kaynak
G. Comparison of high-dose extracorporeal shockwave
therapy and intralesional corticosteroid injection in the
treatment of plantar fasciitis. J Am Podiatr Med Assoc.
2010;100(2):105-110.