The therapeutic effect of extracorporeal shock wave therapy combined with Kinesio Tape on plantar fasciitis

Abstract

BACKGROUND:

Extracorporeal shock wave therapy (ESWT) combined with Kinesio Tape (KT) for plantar fasciitis (PF) is lacking in the literature.

OBJECTIVE:

This study aimed to investigate the effect of ESWT combined with KT on foot pain and function in patients with PF based on ultrashort wave therapy and stretching.

METHODS:

A total of 91 patients with PF were randomly divided into the ESWT group (ETG, $n=$ 23), KT group (KTG, $n=$ 23), combined treatment group (CTG, $n=$ 22) and control group (CG, $n=$ 23). Herein, changes in visual analysis scale (VAS) score, plantar fascia thickness (PFT) and American Orthopaedic Foot and Ankle Society (AOFAS) score were examined.

RESULTS:

The groups were compared after 4 weeks and the results showed that the VAS scores of ETG, KTG and CTG were significantly smaller than that of CG ( $P<$ 0.05). In addition, the VAS score of CTG was significantly smaller than that of KTG ( $P<$ 0.001). Meanwhile, the AOFAS scores of ETG and CTG were significantly greater than that of CG ( $P<$ 0.001). Moreover, the AOFAS score of CTG was significantly greater than those of ETG and KTG ( $P<$ 0.01). Comparisons within groups were also conducted at weeks 0 and 4 and the results showed that the VAS scores of ETG, KTG and CTG significantly decreased ( $P<$ 0.001); the PFT of ETG and CTG significantly decreased ( $P<$ 0.05); and the AOFAS score of ETG, KTG and CTG significantly increased ( $P<$ 0.001).

CONCLUSION:

Based on ultrashort wave therapy and stretching, ESWT and KT therapy could improve the foot pain and function of patients with PF, and the combined modality therapy is more effective. ESWT and combined treatment has a positive effect on patients’ PFT. However, single KT treatment has a limited effect on PFT.

Keywords

Physicotherapeutics pain visual analysis scale therapy

1. Introduction

Plantar fascia originates from the fibrous tissue of the medial calcaneal tubercle and extends forward to the proximal phalanx of each toe [1, 2]. It acts as a bowstring; maintains and supports the longitudinal direction of the foot arch; and assists in dynamic shock absorption, which plays an important role in maintaining the normal biomechanics of the foot [3, 4]. Plantar fasciitis (PF) is a local aseptic inflammation caused by chronic injury of the plantar fascia caused by multiple factors, such as excessive exercise, excessive weight bearing or foot arch structure and biomechanical abnormalities [5, 6]. PF is a common cause of heel pain [7]. Up to 10% of the population may present with heel pain in their lifetime. Prevalence rates of PF among a population of runners are between 4% and 22% [8]. The main symptoms include evident heel pain after getting up in the morning or starting from a sedentary stand and then gradually becoming light but with a long time of walking or standing, the pain worsens again [9].

The current treatment methods primarily include exercise treatment [10], extracorporeal shock wave therapy (ESWT) [11, 12], Kinesio Tape (KT) [13, 14], stretching [15, 16], drug injection [17, 18], foot orthoses [19, 20] and surgery [21, 22]. Nevertheless, various treatment methods have different therapeutic effects, most of which are combined modality therapy and some have long treatment cycles, high costs and a certain risk of complications [23, 24]. Amongst them, ESWT is an effective and convenient method recommended to treat patients with chronic PF with poor efficacy [11, 12]. Meanwhile, KT is widely used in musculoskeletal diseases. It effectively relieves muscle spasm pain, improves joint stability and promotes motor sensory input; it also relieves pain symptoms of patients with PF [13, 14]. Two previous studies compared the efficacy of ESWT and KT in treating PF and both treatments improved the pain levels and quality of life in patients with PF [25, 26]. However, another study compared the treatment difference between ESWT combined with KT and ESWT and found that the two treatment methods did not provide a significant benefit on pain and heel tenderness caused by PF [13]. Nevertheless, no relevant literature has been reported on whether or not the additional ESWT and KT treatment and the separate ESWT or KT treatment have a better effect based on ultrashort wave and stringing treatments.

Therefore, this study aimed to explore the clinical effect of ESWT combined with KT in treating PF based on ultrashort wave therapy and stringing to provide a reference for PF treatment. Thus, ESWT combined with KT was hypothesised to be more effective in treating PF than a single treatment.

2. Materials and methods

2.1 Participants

The study was approved by the Human Experimental Ethics Committee of Southwest University of Science and Technology (XKD-2020.12). Confirmed PF patients were treated in the Rehabilitation Department of the Affiliated Hospital of the authors’ school from January 2021 to May 2022.

Inclusion criteria

Patients were included in this study if they comply with the clinical diagnostic criteria of PF. Patients typically report that is often worse with their first steps in the morning or after a period of inactivity. With the gradual increase in activity, the pain tends to lessen but worsens towards the end of the day with an increased duration of weight-bearing activity. There is often a localised area of maximal tenderness over the anteromedial aspect of the inferior heel [5, 6, 8]; their disease course is $\geqslant$ 3 months; their age is 40–60 years; their pain could not be relieved after rest, taking oral non-steroidal drugs or undergoing physical therapy and other conservative treatment; and they have not received ESWT or KT treatment in the last month.

Exclusion criteria

Patients were excluded from the study if their ankle and lower leg had a history of surgery, trauma and arthritis; they have serious medical diseases (such as haemorrhagic diseases, cardiovascular and cerebrovascular dysfunctions and multiple neuropathies), foot skin ulcer, soft-tissue infection or skin damage; and their skin is allergic to KT.

This study considered 4 (number of groups) $\times$ 2 (number of measurements) and a sample loss rate of approximately 10%. Herein, G-power software was used for calculation. The effect size was set to 0.6, the power was set to 0.8 and $\alpha=$ 0. 05, and at least 90 samples were calculated. A total of 100 patients with PF met the criteria. They were randomly divided into (25 ones, 25 twos, 25 threes and 25 fours) extracorporeal shock wave therapy group (ETG), Kinesio Tape group (KTG), combined treatment group (CTG) and control group (CG). Amongst them, nine subjects withdrew at the beginning of the experiment with a sample loss rate of 9%. Finally, 91 patients with PF completed the whole experiment and no significant difference was found in the basic data between the groups (Table 1, Fig. 1).

Table 1
Basic information of the study participants

Group	$N$	Male/female	Age (years)	Height (cm)	Weight (kg)	BMI (kg/m ${}^{2}$ )	Course of disease (months)
ETG	23	10/13	52.3 $\pm$ 4.6	169.1 $\pm$ 3.1	72.1 $\pm$ 7.1	25.2 $\pm$ 2.0	6.5 $\pm$ 1.2
KTG	23	11/12	51.9 $\pm$ 4.2	168.7 $\pm$ 2.6	70.9 $\pm$ 6.5	24.9 $\pm$ 1.8	6.3 $\pm$ 1.1
CTG	22	10/12	52.5 $\pm$ 6.1	170.2 $\pm$ 3.3	71.3 $\pm$ 7.3	24.6 $\pm$ 2.2	6.2 $\pm$ 1.2
CG	23	11/12	52.0 $\pm$ 5.6	169.5 $\pm$ 3.6	72.7 $\pm$ 8.6	25.3 $\pm$ 3.2	6.6 $\pm$ 1.6
Comparison between groups	$X^{2}/F$	1.397	0.049	0.076	0.162	0.060	0.051
	$P$	0.249	0.985	0.923	0.836	0.981	0.985

Note: ETG: Extracorporeal shock wave therapy group, KTG: Kinesio tape group, CTG: Combination treatment group, CG: Control group.

Figure 1.

Participant selection flow diagram. Note: ETG: Extracorporeal shock wave therapy group, KTG: Kinesio tape group, CTG: Combination treatment group, CG: Control group.

2.2 Treatment

All patients with PF received unified treatment (ultrashort wave therapy, stretching and the same health education). CG only received unified treatment. Meanwhile, ESWT and KT, as well as ESWT and KTT combined modality therapy were additionally provided in ETG, KTG and CTG, respectively. During the treatment, the groups did not receive additional treatment (such as oral analgesics and therapeutic insoles). Ultrashort wave (Dajia Company, Shantou, China; model: DL-C-M). Two electrodes were placed relatively 2–3 cm away from the foot. The dose was adjusted to grade II micro-caloric and the single treatment lasted for 15 min [3].

Referring to the previous treatment plan for stretching [27, 28], the therapist assisted the patients to perform plantar fascia traction and triceps stringing. (1) For plantar fascia stringing, the patient was placed in a prone position and the affected knee joint was bent at 90 ${}^{\circ}$ . Then, the therapist fixed the patient’s lower leg to relax it and stretched the affected foot from the mother finger to make it fully stretched back until the plantar fascia reached the maximum tension point without pain or slight pain. After stretching to the end, the position was maintained for 1 min. Subsequently, the patient rested for 30 s and then the training was continued. This process was repeated five times. (2) For triceps surae stringing, the patient was placed in the supine position. The therapist supported the lower limb of the patient’s affected side to raise the straight leg. Then, the affected foot was stretched by hand to fully extend the ankle joint back until the maximum tension point of the triceps surae was reached without pain or slight pain. After stretching to the end, the position was maintained for 1 min. The patient rested for 30 s and then the training was continued. This process was repeated five times. The above actions were performed for 4 weeks, five times a week.

In addition, for ESWT (Swiss EMS, Nyon, Switzerland; model: Dolor Clast, 10 mm radial probe), the patient was placed in the prone position, with feet extended over the examination table and knee and hip joints in a neutral position. Then, the extracorporeal shock wave probe was applied to the lower segment of the calcaneus using the ultrasonic gel as a coupling medium. The target area was the maximum tenderness area in the medial calcaneus, without local anaesthesia. The parameters for a single treatment were as follows: frequency of 11 Hz, pressure of 2–3 bars and the number of shocks of approximately 2000 [29]. The treatment was conducted two times a week, eight times in total.

For the first layer (sensory input and spatial taping) of KT (Flitter Company, Chongqing, China; model: F10702/3, 5 cm $\times$ 5 m), when the original length of the taping cloth is the natural neutral position of the foot, the distance from the outer ankle to the inner ankle through the sole. In a prone position, the patient’s foot was suspended at the edge of the bed in a natural neutral position. The middle of the patch was the base. The patch was applied to the pain point area of the heel with the maximum tension (the length of KT is pulled to the maximum) and the extension of the patch on both sides was applied to the inner and outer ankles without tension. For the second layer (lymphatic taping), a claw-shaped taping cloth was used to fix the anchor on the calcaneus. The length of the base was the length of the calcaneus. The tail was claw-shaped, extending along the sole to the distal end of the metatarsophalangeal joint with natural tension. In a prone position, the patient’s feet hung on the bed edge and the foot was fully dorsiflexed. The base was located at the calcaneus and five claws were stretched to 1–5 metatarsophalangeal joints (when the length of KT reaches the maximum, return to the position of 50% length) [30] (Fig. 2). KT treatment was performed twice a week, eight times in total. Moreover, the maintenance time of single sticking was 24 h.

Figure 2.

Kinesio tape treatment.

2.3 Evaluation index

Visual analysis scale (VAS): After 4 weeks of treatment at baseline, all patients with PF were assessed for the pain degree of the plantar at the first step when they got up in the morning. A 100 mm line was printed on white paper and the patients were informed that 0 mm and 100 mm indicated painless and painful, respectively. The subjects drew a vertical line on the horizontal line based on their subjective feelings and the corresponding length was the pain score (0–10 points). The higher the score was, the more evident the pain. This measurement method has been confirmed in previous studies [31, 32].

Plantar fascia thickness (PFT): The same experienced ultrasound doctor (3 years of relevant clinical treatment experience) used the Voluson E6 ultrasonic instrument (GE, USA; 11L-D high-frequency probe) to measure the PFT of all patients with PF. The patient was placed in a prone position, with the foot hanging down to the bed edge and the ankle joint in a neutral position. The probe was placed on the medial side of the foot calcaneus and slightly moved along the long axis of the foot for adjustment to display the plantar fascia. The joint of the calcaneus and plantar fascia was the measurement site [33]. Three pictures were taken each time to reduce error and the average value was taken. The higher the score was, the more evident the symptoms.

Table 2
Changs in the four groups at different points

Group	$N$	VAS score		PFT (mm)		AOFAS score
		0 weeks	4 weeks	0 weeks	4 weeks	0 weeks	4 weeks
ETG	23	6.02 $\pm$ 1.35	3.51 $\pm$ 1.21 ${}^{\text{AB}}$	5.33 $\pm$ 0.93	4.88 $\pm$ 0.77 ${}^{\text{a}}$	52.9 $\pm$ 7.6	70.3 $\pm$ 10.5 ${}^{\text{ABC}}$
KTG	23	6.11 $\pm$ 1.62	3.92 $\pm$ 1.06 ${}^{\text{AbC}}$	5.36 $\pm$ 0.86	5.00 $\pm$ 1.12	53.5 $\pm$ 9.3	65.6 $\pm$ 8.2 ${}^{\text{AC}}$
CTG	22	5.98 $\pm$ 1.54	2.51 $\pm$ 1.02 ${}^{\text{AB}}$	5.29 $\pm$ 0.79	4.61 $\pm$ 0.83 ${}^{\text{a}}$	52.6 $\pm$ 6.7	79.6 $\pm$ 7.2 ${}^{\text{AB}}$
CG	23	5.95 $\pm$ 2.01	5.10 $\pm$ 1.86	5.40 $\pm$ 1.02	5.12 $\pm$ 0.91	53.2 $\pm$ 9.7	59.2 $\pm$ 6.9

Note: ETG: Extracorporeal shock wave therapy group, KTG: Kinesio tape group, CTG: Combination treatment group, CG: Control group; VAS: Visual analogue scale, PFT: Plantar fascia thickness, AOFAS: American orthopaedic foot and ankle society. Intra-group comparison at 0 weeks and 4 weeks: ${}^{\text{a}}$ is $P<$ 0.05, ${}^{\text{A}}$ is $P<$ 0.01; comparison of CG with other groups after 4 weeks: ${}^{\text{b}}$ is $P<$ 0.05, ${}^{\text{B}}$ is $P<$ 0.01; comparison of CTG with ETG or KTG after 4 weeks: ${}^{\text{C}}$ is $P<$ 0.01.

American Orthopaedic Foot and Ankle Society (AOFAS) score: The foot function of all patients with PF was evaluated, including nine items of patient self-filling and physician’s examination as follows: pain, function and autonomous activity, support, maximum walking distance, ground walking, abnormal gait, fore and aft activity (flexion and extension), hind foot activity (varus and valgus) and ankle hindfoot stability (varus, varus and valgus) and foot force line, with a total score of 100 points [34]. The higher the score was, the lighter the symptom.

2.4 Statistical analysis

The baseline and 4-week test data of the four groups were processed on SPSS 20.0 and expressed as mean $\pm$ standard deviation. Firstly, a Shapiro-Wilk test was used to detect whether or not the data were normally distributed; data were subject to transformation if not normally distributed. Then, the homogeneity of variance was examined [35]. Subsequently, two-factor ANOVA of the mixed design was used to examine the main effects of group (four groups) and time (two measurements) and whether or not the interaction between group and time was present. If the interaction was observed, the differences at different time points in the group were analysed by repeated measurement of one-way ANOVA. If time had a main effect, the differences at different time points were compared afterwards. Meanwhile, if the group had a main effect, the difference between groups at the same time point was compared afterwards. Bonferroni adjustment was adopted for post comparison to ensure that the overall type I rate of each ANOVA was not greater than 0.05 [35, 36]. The significant level was $\alpha=$ 0.05.

3. Results

The test data of the four groups are shown in Table 2. A Shapiro-Wilk test showed that all measured indicators were normally distributed ( $P>$ 0.05). The main effects of group (four groups) and time (two measurements) and whether or not interaction was present between group and time were tested by the mixed design of two-factor ANOVA. The finding showed that in VAS and AOFAS scores, group and time exhibited interaction ( $F=$ 6.370, $P<$ 0.001; $F=$ 10.979, $P<$ 0.001). However, they had no interaction in PFT ( $F=$ 0.967, $P=$ 0.410). In addition, no significant difference was observed in the VAS score, PFT and AOFAS score amongst the four groups ( $P>$ 0.05) at baseline.

Then, a comparison between groups was conducted 4 weeks later. VAS score: The VAS scores of ETG (95% CI: from $-$ 2.6600 to $-$ 0.5391, $P=$ 0.001), KTG (95% CI: from $-$ 2.2404 to $-$ 0.1196, $P=$ 0.021) and CTG (95% CI: from $-$ 3.6622 to $-$ 1.5174, $P<$ 0.001) were smaller than that of CG. PFT: The PFTs of ETG (95% CI: from $-$ 0.9713 to $-$ 0.4913), KTG (95% CI: from $-$ 1.1657 to 0.2970) and CTG (95% CI: from $-$ 1.2498 to 0.2293) were smaller than that of CG, however, the difference was not statistically significant ( $P>$ 0.05). AOFAS score: The AOFAS scores of ETG (95% CI: 4.44–17.73, $P<$ 0.001), KTG (95% CI: from $-$ 0.25 to 13.04, $P=$ 0.066) and CTG (95% CI: 13.70–27.14, $P<$ 0.001) were greater than that of CG. The AOFAS score of CTG was also greater than those of ETG (95% CI: 2.6–16.05, $P=$ 0.002) and KTG (95% CI: 7.30–20.75, $P<$ 0.001). However, although ETG and KTG exhibited differences, it was not statistically significant ( $P=$ 0.359).

Comparisons within groups were performed at weeks 0 and 4. VAS score: The VAS scores of ETG, KTG and CTG significantly decreased ( $P<$ 0.001), whereas no significant difference was found in CG ( $P=$ 0.053). PFT: The PFTs of KTG and CTG significantly decreased ( $P=$ 0.011 and $P=$ 0.012, respectively). Although that PFTs of ETG and CG decreased to varying degrees, the difference was not significant ( $P=$ 0.088, $P=$ 0.390). AOFAS score: The AOFAS scores of ETG, KTG and CTG significantly increased ( $P<$ 0.001), whereas that of CG increased but no statistical significance was observed ( $P=$ 0.061).

4. Discussion

This study aimed to explore the clinical efficacy of ESWT combined with KT in treating PF based on ultrashort wave therapy and stringing to provide a reference for PF treatment. Results showed that ESWT and KT could improve the foot pain and function of patients with PF and the combined modality therapy was found to be more effective. Moreover, ESWT and combined treatment showed a positive effect on patients’ PFT. However, KT had limited influence on PFT.

4.1 ESWT

This study showed that the VAS score and PFT were significantly reduced by 41.7% and 8.4%, respectively, and the AOFAS score was significantly increased by 32.9% when ESWT was added based on ultrashort wave therapy and stringing. As a treatment method, ESWT provides high-amplitude sound waves on the required parts of the human body. Hence, it is widely used in treating PF and its efficacy has been confirmed [11, 12, 25, 26, 37, 38]. Mishra et al. [37] conducted ESWT intervention on 60 patients with PF and found that it could effectively improve the pain, PFT and functional activities of patients. Chew et al. [38] also found that ESWT significantly improved the VAS score, PFT and AOFAS score of patients with PF. The findings of these studies are consistent with those of the present study. However, some studies revealed different opinions. A double-blind randomised controlled trial found that a moderate dose of ESWT seems to have no therapeutic effect on patients with PF [39]. In addition, a systematic evaluation and meta-analysis found that ESWT is beneficial to the treatment of plantar pain, however, its efficacy is limited [40]. The reason for these varying results may be the different intensities or times of ESWT intervention.

Extracorporeal shock wave therapy positively affects PF treatment and its mechanism may be as follows: when EWST enters the human body, different mechanical stresses are generated at the interface of different acoustic impedance tissues because of the different media it contacts, manifested in different tensile stresses and stress effects on tissues [41]. Amongst them, tensile stress could induce interstitial loosening and promote microcirculation and the stress effect could promote cell elastic deformation and increase cell oxygen uptake [41]. Nevertheless, the negative wave band pressure of the pulse tail of the shock wave could cause a cavitation reaction, which is conducive to unblocking occluded micro-vessels and loosening the adhesion of joint soft tissue [42]. Local high-intensity EWST could produce super stimulation on nerve endings, block the transmission of painful information to the cerebral cortex and cause changes in free radicals around cells to release pain-inhibiting substances, thereby achieving an analgesic effect [42]. Shock waves could promote local blood circulation and change the permeability of the local cell membrane of the tissue by promoting the generation of relevant growth factors, thereby speeding up tissue metabolism, reducing the inflammatory reaction of the affected area and accelerating tissue healing [43]. In addition, the plantar fascia may be considered a tendinous structure. Tenocytes may convert mechanical stimulation into a biochemical response, thereby leading to the release of growth factors and cellular adaptation. After ESWT treatment, the tendon was remodelled or degenerated by regulating anabolic and catabolic genes. Therefore, EWST could have a good therapeutic effect on the pain tissues of patients with PF

4.2 Kinesio tape

This study showed that in addition to ultrashort wave therapy and stretching, KT therapy could significantly reduce the VAS score by 35.8% and increase the AOFAS score by 22.6%. However, it showed no positive effect on PFT.

KT is a special tape that could produce a constant shear force [21]. In treating the soft-tissue injury with KT, the location, direction and tension of the ligation are often selected based on the principles of motion analysis and biomechanics. The direction of tension is generally parallel to the muscle fibre and the strength of tension depends on the intensity of the stimulus required and the restrictions on the activities of muscles, tendons and ligaments [17]. Nevertheless, at present, no uniform standard is available for KT binding method but the positive effect on patients with PF has been confirmed [22, 23, 24, 25, 45, 46]. Results of the present study showed that the heel pain and function of patients with PF were improved by KT treatment. Podolsky et al. [45] found that KT effectively treated patients with PF in the short term. In addition, Van et al. [46] found that KT could reduce the pain of patients with PF in a jumping test. The findings of these studies are consistent with the results of the present study. However, some studies provided different opinions. In a systematic evaluation, KT showed a slight effect on the treatment of patients with PF, which may have no clinical significance [47]. Thus, this finding may be related to the individual differences of patients and the different methods of ligation.

Moreover, KT has a positive effect on the treatment of PF and its mechanism may be as follows: given that KT is flexible, it could increase the gap between skin and muscle, promote blood circulation to relieve pain [13, 14] and control the tension on the plantar fascia through the retraction force of the patch towards the heel [18]. The plantar fascia of PF patients is supported by the width of KT and large tension and the stress attachment point of plantar fascia moves forward to avoid further damage to reduce the degree of pain after daily activities and improve the foot function status [14]. In addition, KT relaxes tense muscles, increases local sensory input, improves proprioception, stimulates skin mechanoreceptors with pressure and tension on the skin and enhances joint position sense and motion sensing, thereby improving joint stability [5, 26].

4.3 Combined treatment

This study showed that the effect of combined treatment in CTG’s pain degree and AOFAS score was significantly improved as compared with that before treatment; it was better than that of the single treatment (in ETG, KTG and CTG, the VAS scores decreased by 41.7%, 35.7% and 58.0%, respectively, whereas the AOFAS scores increased by 32.9%, 22.6% and 51.3%, respectively). In addition, combined treatment decreased PFT by 12.9%.

Stringing improves the flexibility of the Achilles tendon and plantar fascia of the affected foot and expands the range of ankle dorsiflexion [27]. With assistance from ESWT treatment, stringing could further relieve pain and improve joint activity. However, ESWT causes micro damage to local tissues through acute and rapid mechanical action and then induces reconstruction to increase blood supply. The affected part may have local ecchymosis, hematoma, acid swelling and other discomforts. Meanwhile, increasing KT could cause skin wrinkles, change the space between local skin and muscle by pulling, promote lymph and blood circulation and alleviate the swelling of subcutaneous soft tissues [28, 29], thereby helping to improve the adverse reactions after ESWT treatment. Furthermore, it demonstrated a better therapeutic effect on pain and motor dysfunction caused by PF.

Ultrasound examination results often indicate specific changes in patients with PF, such as PFT increase and calcification [13]. In the present study, the PFT of the affected foot of the four groups significantly increased before treatment, consistent with the result of a previous study [14]. A notable detail is that KT had no statistically significant effect on patients’ PFT, whereas ESWT and combined treatment had a positive effect. This finding indicated that the treatment of 4 weeks may be a better strategy than KT.

However, this study has some limitations. Firstly, the intervention time was only 4 weeks and the period was short, which may have limited the research results. Secondly, a personalised treatment plan based on the patient’s age, weight, disease course and foot structure characteristics was not formulated. Finally, changes in biomechanical parameters, such as plantar pressure and gait, were not evaluated. Thus, this limitation is expected to be studied in the near future.

5. Conclusions

Based on ultrashort wave treatment and stretching, ESWT and KT treatment could improve the foot pain and function of PF patients and combined modality therapy was found to be more effective. ESWT and combined treatment had a positive effect on patients’ PFT, whereas single KT treatment had a limited effect.

Ethics statement

This study was approved by the Human Experimental Ethics Committee of Southwest University of Science and Tchnology (XKD-2020.12). Before the assessment, every participant received the same detailed information about the testing procedure. Every participant signed the informed consent.

Funding

This research was funded by a grant from the Key Projects of Humanities and Social Science of Sichuan Provincial Department of Education (Jing Zhao, 18SA0271).

Author contributions

Conceptualization and design: J. Z., Y. F. J.; Data Collection: J. Z., Y. F. J.; Interpretation: J. Z., Y. F. J.; Writing-original draft: J. Z., Y. F. J.; All authors read and approved the final version of the manuscript.

Footnotes

Acknowledgments

The authors are particularly grateful to everyone who helped them with the article.

Conflict of interest

No conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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The therapeutic effect of extracorporeal shock wave therapy combined with Kinesio Tape on plantar fasciitis

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Materials and methods

2.1 Participants

Inclusion criteria

Exclusion criteria

Table 1 Basic information of the study participants

Table 2 Changs in the four groups at different points

3. Results

4. Discussion

4.1 ESWT

4.2 Kinesio tape

4.3 Combined treatment

5. Conclusions

Ethics statement

Funding

Author contributions

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Basic information of the study participants

Table 2
Changs in the four groups at different points