Shock Wave Therapy for Sural Myofascial Pain Associated to Chronic Heel Pain

Shock Wave Therapy for Sural Myofascial Pain Syndrome Associated With Plantar Fasciitis: a Pilot Randomized Controlled Trial

The aim of this randomized controlled study in to investigate if a shock wave treatment extended to the gastrocnemius-soleus trigger points (TrP) is more effective than a standard treatment exclusively targeted at the plantar fascia in a population affected by unilateral plantar fasciitis with concomitant sural myofascial pain syndrome.

Inclusion Criteria:

• Adult age (18 to 75 years) and written informed consent;
• Unilateral heel pain of four weeks or longer duration;
• Pain to digital pressure in the insertional area of the plantar fascia at the calcaneum;
• Sonographic examination showing a plantar fascia thickness greater than 3.8mm (see procedures for details);
• Concomitant presence of a sural myofascial pain syndrome (SMPS), diagnosed on the basis of the finding, at the physical examination, of trigger points of the gastrocnemius-soleus muscle complex, according to Travel and Simons' original description.

Exclusion Criteria:

• No corticosteroid injections or other physical therapies since the onset of the current pain episode (except pharmacological pain treatments and foot orthoses);
• No general contraindication to shock wave therapy (pregnancy, bleeding disorders or anticoagulant drug usage, cancer in the focal area);
• No clinical signs of lumbar radiculopathy at physical examination;
• No ankle osteoarthritis, diagnosed on the basis of clinical and radiographic findings;
• No previous fractures or surgery in the affected ankle and foot;
• No rheumatologic diseases, no plantar fibromatosis