Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study

Objective: To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur.

Design: Random assignment to two groups of treatment with two and eight months follow-up.

Setting: The data were collected in outpatients.

Subjects: Forty-five subjects with a history of at least six months of heel pain were studied.

Interventions: Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 ± 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 ± 12.3 years).

Main outcome measures: Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up.

Results: Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 ±18.7; group B 53.5 ± 20; P>0.05). In both groups there was a significant (P<0.05) increase in the Mayo Clinical Scoring System score at two months (group A 83.9 ± 13.7; group B 80 ± 15,8) and eight months (group A 90 ± 10.5; group B 90.2 ±8.7) follow-up. No significant differences were obtained comparing the Mayo Clinical Scoring System scores of the two groups at two and eight months follow-up.

Conclusions: There was no difference between the two techniques of using extracorporeal shock wave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.