Effectiveness of Radial Extracorporeal Shockwave Therapy Versus Other Electrophysical Modalities on Pain and Functionality in Patients With Plantar Fasciitis: A Systematic Review and Meta-Analysis

Abstract

Background

Plantar fasciitis (PF) is the leading cause of chronic heel pain in adults, impairing mobility and quality of life. Radial extracorporeal shockwave therapy (rESWT) is widely used in physiotherapy for its practicality and cost-effectiveness. However, heterogeneity in study designs and protocols limits conclusions regarding its efficacy compared with other electrophysical modalities (EPMs). This systematic review and meta-analysis aimed to synthesize the immediate effects of rESWT, alone or combined with conventional physiotherapy, versus other EPMs, focusing on pain and functional outcomes.

Methods

A systematic search of PubMed, CINAHL, Scopus, Web of Science, and PEDro was conducted up to April 2025 to identify randomized controlled trials (RCTs) comparing rESWT, alone or combined with non-electrophysical interventions, versus other EPMs in adults with PF. Pain intensity and functional disability were the primary outcomes. Meta-analyses were performed using random-effects models, with sensitivity analyses conducted according to outcome type and comparator. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results

Fourteen RCTs (n = 797) were included, of which 12 contributed to the meta-analysis. Radial extracorporeal shockwave therapy did not demonstrate superiority over other EPMs for pain reduction (standardized mean difference [SMD] = −0.03; 95% confidence interval [CI]: −0.39 to 0.33) or functional improvement (SMD = −0.11; 95% CI: −0.47 to 0.25). Low-level laser therapy showed small but statistically significant advantages over rESWT for functional outcomes. Overall risk of bias (RoB) was high across most studies.

Conclusions

Radial extracorporeal shockwave therapy, alone or combined with physical therapy, does not appear superior to other EPMs for PF. The high heterogeneity and overall elevated RoB limit the certainty of these findings, highlighting the need for high-quality trials to guide clinical recommendations.

Level of Evidence:

Level I: Systematic Review