Extracorporeal Shockwave Therapy Versus Graston Instrument Assisted Soft-Tissue Mobilization in Chronic Plantar Heel Pain: A Randomized Controlled Trial.

BACKGROUND: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization (IASTM) methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. Our goal is to compare the effectiveness of ESWT vs IASTM using Graston Technique® (GT®) instruments in addition to stretching exercises (SEs) in CPHP.

METHODS: Sixty-nine patients were randomly assigned to 3 groups as ESWT+SEs (Gr I), GT®+SEs (Gr II) and SEs (CG) (ratio 1:1:1). SEs program twice/day, for 8-week was standard for all. Gr I received low intensity ESWT while in Gr II, GT® was the selected method. Visual analog scale (VAS) (for initial step and activity pain); foot function index (FFI); short form-12 (SF-12), and Tampa Scale were used at pretreatment, posttreatment and follow-ups (8-week and 6-month).

RESULTS: VAS and FFI scores improved in the posttreatment and follow-ups in all (p<.00) While effect sizes in Gr I and Gr II were greater than CG in initial step pain at posttreatment and 8-week-follow-up, Gr II had highest effect size at 6-month-follow-up. The mean SF-12 scores in Gr I and Gr II showed improvement on the posttreatment assessment. Furthermore, Gr II showed significant improvements in FFI scores compared to other groups in 6-month-follow-up (F=6.33, p=.003).

CONCLUSIONS: Even though ESWT+SEs and GT®+SEs interventions seem to have similar effects on initial step pain at posttreatment and 8-week-follow-up; GT®+SEs was found most effective for improving functional status at 6-month in the management of CPHP.