The influence of local steroid injections, body weight and the length of symptoms in the treatment of painful subcalcaneal spurs with extracorporeal shock wave therapy

Objective: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of painful subcalcaneal spurs and evaluate whether local steroid injections, body weight and the length of symptoms can affect the clinical results. Design: Subjects were selected through clinical examination and heel radiograms according to diagnosis of painful subcalcaneal spurs. Subjects: Sixty-four subjects were divided into two groups of treatment depending on their past history of previous local steroid injections. Interventions: Each subject received a three-session ESWT (performed weekly). A rehabilitative programme was instituted, consisting of self-assisted plantar fascia and plantar ‘exors stretching exercises. Main outcome measures: The Mayo Clinical Scoring System (MCSS) was utilized to evaluate each subject before the treatment and at two- and ten- month follow-ups. In addition, standard radiograms were done both before the treatment and at the ten-month follow-up. Results: Patients with no past treatment using steroids did not show any statistically significant improvement of the MCSS at the two-month follow-up. The statistical significance was obtained at the ten-month follow-up. Patients with past treatment using steroids did not show any statistically significant improvement of the MCSS at either follow-up. At the radiogram check, none of the subjects showed any modification of the heel spurs. Conclusions: According to the results of the present study ESWT should be considered as an effective treatment for painful subcalcaneal spurs. Previous local steroid injections may negatively affect the result of ESWT.