Ultrasound-Guided Corticosteroid Injection more effective than Radial Extracorporeal Shock Wave Therapy for Plantar Fasciitis: study

Dr Supreeth  D R

Ultrasound-Guided Corticosteroid Injection more effective than Radial Extracorporeal Shock Wave Therapy for Plantar Fasciitis: study

Written By : Dr Supreeth D R Published On 2025-12-21T20:45:12+05:30 | Updated On 21 Dec 2025 8:45 PM IST

Plantar fasciitis (PF) is one of the most prevalent causes of heel pain, involving inflammation of the plantar fascia leading to pain and functional disability. The treatment options of PF include conservative, minimally invasive procedures, and surgery. Of these, radial extracorporeal shock wave therapy (rESWT) and corticosteroid injections (CSI) are widely practised treatments for PF, but its treatment outcome is often debated.

Aiswarya et al conducted a study to evaluate the early effectiveness of ultrasound-guided CSI and rESWT in the treatment of PF. A hospital-based, randomized, double-blind interventional study was conducted in a tertiary center to evaluate the efficacy of CSI and rESWT in participants presenting with plantar heel pain.

A total of 170 participants were enrolled and randomly assigned to either the CSI or rESWT group. After treatment completion, follow-up was completed in the 70 participants in each group. The CSI group received an injection comprising 2 mL of methyl prednisolone acetate (40 mg/mL) combined with 2 ml of 2% lignocaine, while the rESWT group received 2000 shock impulses at a pressure of 2.5 bars and a frequency of 15 Hz for three consecutive weeks. The participants were assessed at baseline (week 0), 4 weeks, and 8 weeks post-treatment as this study is aimed to focus mainly on the early outcome of both primary modalities. Outcome measures included the visual analogue scale (VAS) at three instances of a day such as ‘first step in the morning’, ‘at rest’ and ‘during activities of daily living’ for pain assessment, the Foot and Ankle Ability Measure (FAAM) with Activities of Daily Living (ADL) and Sports subscales for functional evaluation, and ultrasonographic measurement of plantar fascia thickness.

The key findings of the study were:

• After 4 weeks and 8 weeks, VAS score continued to decrease in all the 3 time instances in the CSI group, whereas even though it started reducing for rESWT at 4 weeks, pain with respect to VAS score showed an increasing trend by 8 weeks.

• By 4 weeks, significant differences appeared within the CSI group compared to rESWT in all three instances.By 8 weeks, these differences became even more pronounced and statistically significant (p < 0.05).

• In terms of the FAAM scale, both groups showed increase in the score, where a higher score indicates better function.

• CSI resulted in more significant improvement in terms of ADL (p = 0.0001) and Sports subscale (p = 0.01). rESWT, while showing some improvement, was less effective than CSI, especially in the ADL subscale at 8 weeks.

• In terms of plantar fascia thickness, both groups showcased reduction in thickness, but there was no statistically significant difference between the two groups at 4 weeks (p = 0.163).

• At 8 weeks, the study showed a statistically significant difference between the two groups (p = 0.042). At this point of time, the reduction in plantar fascia thickness appeared to be greater in CSI compared to the rESWT group.

The authors concluded – “The study indicates that ultrasound-guided CSI and rESWT are both effective in PF treatment, where CSI is more effective with immediate recovery and progressive symptom improvement in contrast to the rESWT.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.