Evaluation of the efficacy of trigger points combined with extracorporeal shock waves in the treatment of plantar fasciitis: heel temperature and plantar pressure
Authors: Wang Bo , Wang Xiao-Lei , Zheng Yong-Jun , Ma Yan-Tao , Wu Wei 
Published: September 2023

Abstract
Background
Plantar fasciitis (PF) is the most common cause of heel pain. Among several conservative treatments, extracorporeal shock wave therapy (ESWT) is considered an effective treatment for refractory plantar fasciitis. Studies have shown that the trigger points (TrPs) in the triceps surae of ESWT may play an important role in the treatment of pain in PF patients. Therefore, the purpose of this study was to evaluate the efficacy of extracorporeal shock waves combined with TrPs in patients with PF by using heel temperature and plantar pressure based on the concept of trigger pointsand ESWT.
Methods
According to the inclusion and exclusion criteria, 86 patients with plantar fasciitis were recruited from the pain clinic of Huadong Hospital, Fudan University. They were randomly divided into an experimental group (n = 43) and a control group (n = 43). The experimental group was treated with extracorporeal shock waves to treat the medial heel pain point combined with the gastrocnemius and soleus trigger points. The control group was only treated with extracorporeal shock waves to treat the medial heel pain point. The two groups were treated twice, with an interval of 1 week. Primary measurements included anumerical rating scale (NRS) (overall, first step, heel pain during daily activities), andsecondary measurements included heel temperature, Roles and Maudsley score (RMS), and plantar pressure. All assessments were performed before treatment (i.e., baseline) and 6 and 12 weeks after treatment.
Results
During the trial, 3 patients in the experimental group withdrew from the study, 2 patients withdrew from the study due to the interruption of the course of treatment affected by the new coronavirus epidemic, and 1 patient withdrew from the study due to personal reasons. In the control group, 3 patients fell and were removed due to swelling of the heel. Therefore, only 80 patients with PF were finally included. After treatment, the two groups showed good results in NRS (overall, first step, heel pain during daily activities), Roles and Maudsley score (RMS), and plantar temperature, especially in the experimental group. The effect was significantly better than that in the control group.
Conclusion
ESWT of the heel combined with the triceps trigger point of the calf can more effectively improve the pain, function and quality of life of refractory PF than ESWT of the heel alone. In addition, the ESWT of the heel combined with the triceps trigger point of the calf can effectively reduce the skin temperature of the heel on the symptomatic side, indicating that the heel temperature measured by infrared thermal imaging may be used as an independent tool to evaluate the therapeutic effect of patients with chronic plantar fasciitis. Although extracorporeal shock waves combined with TrPs treatment can cause changes in the gait structure of patients, plantar pressure is still difficult to use as an independent tool to evaluate the therapeutic effect of plantar fasciitis.
Trial registration Registered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on12/17/2021 with the following code: ChiCTR-INR-2100054439.