Iranian Journal of Medical Sciences

Document Type : Original Article(s)


Department of Physical Medicine and Rehabilitation, School of Medicine. Shahid Sadoughi University of Medical Sciences, Yazd, Iran



Background: The most common cause of heel pain is plantar fasciitis (PF). Although conservative treatments relieve pain in more than 90% of patients, it may remain painful in some cases. This study aimed to compare High-intensity Laser Therapy (HILT) with Extracorporeal Shock Wave Therapy (ESWT) in patients with PF.
Methods: In this double-blinded randomized clinical trial (conducted in Yazd, Iran, from May 2020 to March 2021), patients were classified into two groups, including the ESWT and HILT, using online randomization. Nine sessions, three times a week for 3 weeks, were the treatment period in both groups. Visual Analogue Score (VAS), Heel Tenderness Index (HTI), and the SF36 questionnaire were compared and analyzed statistically at the beginning and 9 months after treatment. 
Results: 38 patients (19 in each group) completed the study. Results showed that pain and patient satisfaction improved significantly 3 months after treatment. The VAS and HTI decreased 3 months after treatment in both groups, which was statistically significant (P<0.001). The SF36 score in both groups increased 3 months after treatment, and this increase was statistically significant (P<0.001). Although the two modalities were effective based on VAS, HTI, and SF36, a significant statistical difference was observed between them (P=0.03, P=0.006, P=0.002, respectively), and the HILT was more effective.
Conclusion: ESWT and HILT decrease pain and increase patient satisfaction in PF. Besides, both methods are non-invasive and safe. However, there is a significant difference between them, and HILT is more effective.
Trial registration number: IRCT20210913052465N1.


  1. Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician. 2011;84:909-16. PubMed PMID: 22010770.
  2. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L, Jr., Weil L, Sr., et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008;36:2100-9. doi: 10.1177/0363546508324176. PubMed PMID: 18832341.
  3. Ibrahim MI, Donatelli RA, Schmitz C, Hellman MA, Buxbaum F. Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int. 2010;31:391-7. doi: 10.3113/FAI.2010.0391. PubMed PMID: 20460065.
  4. Rompe JD, Furia J, Weil L, Maffulli N. Shock wave therapy for chronic plantar fasciopathy. Br Med Bull. 2007;81-82:183-208. doi: 10.1093/bmb/ldm005. PubMed PMID: 17456546.
  5. Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil. 2013;92:606-20. doi: 10.1097/PHM.0b013e31828cd42b. PubMed PMID: 23552334.
  6. Rompe JD. Plantar fasciopathy. Sports Med Arthrosc Rev. 2009;17:100-4. doi: 10.1097/JSA.0b013e3181a3d60e. PubMed PMID: 19440137.
  7. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85:872-7. doi: 10.2106/00004623-200305000-00015. PubMed PMID: 12728038.
  8. Scher DL, Belmont PJ, Jr., Bear R, Mountcastle SB, Orr JD, Owens BD. The incidence of plantar fasciitis in the United States military. J Bone Joint Surg Am. 2009;91:2867-72. doi: 10.2106/JBJS.I.00257. PubMed PMID: 19952249.
  9. Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011;84:676-82. PubMed PMID: 21916393.
  10. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288:1364-72. doi: 10.1001/jama.288.11.1364. PubMed PMID: 12234230.
  11. Williams SK, Brage M. Heel pain-plantar fasciitis and Achilles enthesopathy. Clin Sports Med. 2004;23:123-44. doi: 10.1016/S0278-5919(03)00094-2. PubMed PMID: 15062587.
  12. League AC. Current concepts review: plantar fasciitis. Foot Ankle Int. 2008;29:358-66. doi: 10.3113/FAI.2008.0358. PubMed PMID: 18348838.
  13. Hammer DS, Adam F, Kreutz A, Rupp S, Kohn D, Seil R. Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy. Arch Orthop Trauma Surg. 2005;125:6-9. doi: 10.1007/s00402-003-0591-z. PubMed PMID: 14530990.
  14. Lim AT, How CH, Tan B. Management of plantar fasciitis in the outpatient setting. Singapore Med J. 2016;57:168-70. doi: 10.11622/smedj.2016069. PubMed PMID: 27075037; PubMed Central PMCID: PMCPMC4853481.
  15. Lapidus PW, Guidotti FP. Local injections of hydrocortisone in 495 orthopedic patients. Ind Med Surg. 1957;26:234-44. PubMed PMID: 13428333.
  16. Eslamian F, Shakouri SK, Jahanjoo F, Hajialiloo M, Notghi F. Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial. Pain Med. 2016;17:1722-31. doi: 10.1093/pm/pnw113. PubMed PMID: 27282594.
  17. Ordahan B, Karahan AY, Kaydok E. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci. 2018;33:1363-9. doi: 10.1007/s10103-018-2497-6. PubMed PMID: 29627888.
  18. Macias DM, Coughlin MJ, Zang K, Stevens FR, Jastifer JR, Doty JF. Low-Level Laser Therapy at 635 nm for Treatment of Chronic Plantar Fasciitis: A Placebo-Controlled, Randomized Study. J Foot Ankle Surg. 2015;54:768-72. doi: 10.1053/j.jfas.2014.12.014. PubMed PMID: 25769363.
  19. Jastifer JR, Catena F, Doty JF, Stevens F, Coughlin MJ. Low-Level Laser Therapy for the Treatment of Chronic Plantar Fasciitis: A Prospective Study. Foot Ankle Int. 2014;35:566-71. doi: 10.1177/1071100714523275. PubMed PMID: 24510123.
  20. Wang W, Jiang W, Tang C, Zhang X, Xiang J. Clinical efficacy of low-level laser therapy in plantar fasciitis: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e14088. doi: 10.1097/MD.0000000000014088. PubMed PMID: 30653125; PubMed Central PMCID: PMCPMC6370152.
  21. Yesil H, Dundar U, Toktas H, Eyvaz N, Yesil M. The effect of high intensity laser therapy in the management of painful calcaneal spur: a double blind, placebo-controlled study. Lasers Med Sci. 2020;35:841-52. doi: 10.1007/s10103-019-02870-w. PubMed PMID: 31478095.
  22. Landorf KB, Radford JA. Minimal important difference: values for the foot health status questionnaire, foot function index and visual analogue scale. The Foot. 2008;18:15-9. doi: 10.1016/j.foot.2007.06.006.
  23. Ulusoy A, Cerrahoglu L, Orguc S. Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial. J Foot Ankle Surg. 2017;56:762-7. doi: 10.1053/j.jfas.2017.02.013. PubMed PMID: 28633773.
  24. Montazeri A, Goshtasebi A, Vahdaninia M. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Payesh (Health Monitor). 2006;5.
  25. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2:e088. doi: 10.5435/JAAOSGlobal-D-17-00088. PubMed PMID: 30211382; PubMed Central PMCID: PMCPMC6132313
  26. Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46:348-57. doi: 10.1053/j.jfas.2007.05.011. PubMed PMID: 17761319.
  27. Dastgir N. Extracorporeal shock wave therapy for treatment of plantar fasciitis. J Pak Med Assoc. 2014;64:675-8. PubMed PMID: 25252488.
  28. Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res. 2013;471:3645-52. doi: 10.1007/s11999-013-3132-2. PubMed PMID: 23813184; PubMed Central PMCID: PMCPMC3792262.
  29. Kudo P, Dainty K, Clarfield M, Coughlin L, Lavoie P, Lebrun C. Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study. J Orthop Res. 2006;24:115-23. doi: 10.1002/jor.20008. PubMed PMID: 16435344.
  30. Malay DS, Pressman MM, Assili A, Kline JT, York S, Buren B, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg. 2006;45:196-210. doi: 10.1053/j.jfas.2006.04.007. PubMed PMID: 16818146.
  31. Haake M, Buch M, Schoellner C, Goebel F, Vogel M, Mueller I, et al. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ. 2003;327:75. doi: 10.1136/bmj.327.7406.75. PubMed PMID: 12855524; PubMed Central PMCID: PMCPMC164919.
  32. Cosentino R, Falsetti P, Manca S, De Stefano R, Frati E, Frediani B, et al. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis. Ann Rheum Dis. 2001;60:1064-7. doi: 10.1136/ard.60.11.1064. PubMed PMID: 11602481; PubMed Central PMCID: PMCPMC1753417.
  33. Radwan YA, Mansour AM, Badawy WS. Resistant plantar fasciopathy: shock wave versus endoscopic plantar fascial release. Int Orthop. 2012;36:2147-56. doi: 10.1007/s00264-012-1608-4. PubMed PMID: 22782376; PubMed Central PMCID: PMCPMC3460079.
  34. Rompe JD, Cacchio A, Weil L, Jr., Furia JP, Haist J, Reiners V, et al. Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. J Bone Joint Surg Am. 2010;92:2514-22. doi: 10.2106/JBJS.I.01651. PubMed PMID: 21048171.
  35. Speed CA, Nichols D, Wies J, Humphreys H, Richards C, Burnet S, et al. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. 2003;21:937-40. doi: 10.1016/S0736-0266(03)00048-2. PubMed PMID: 12919884.
  36. Guimaraes JS, Arcanjo FL, Leporace G, Metsavaht LF, Sena C, Moreno M, et al. Effect of low-level laser therapy on pain and disability in patients with plantar fasciitis: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2022;57:102478. doi: 10.1016/j.msksp.2021.102478. PubMed PMID: 34847470.
  37. Koz G, Kamanli A, Kaban N, Harman H. Efficacies of extracorporeal shockwave therapy and low-level laser therapy in patients with plantar fasciitis. Foot Ankle Surg. 2023;29:223-7. doi: 10.1016/j.fas.2023.01.009. PubMed PMID: 36737392.
  38. Tkocz P, Matusz T, Kosowski L, Walewicz K, Argier L, Kuszewski M, et al. A Randomised-Controlled Clinical Study Examining the Effect of High-Intensity Laser Therapy (HILT) on the Management of Painful Calcaneal Spur with Plantar Fasciitis. J Clin Med. 2021;10. doi: 10.3390/jcm10214891. PubMed PMID: 34768411; PubMed Central PMCID: PMCPMC8584509.
  39. Ezzati K, Laakso EL, Salari A, Hasannejad A, Fekrazad R, Aris A. The Beneficial Effects of High-Intensity Laser Therapy and Co-Interventions on Musculoskeletal Pain Management: A Systematic Review. J Lasers Med Sci. 2020;11:81-90. doi: 10.15171/jlms.2020.14. PubMed PMID: 32099632; PubMed Central PMCID: PMCPMC7008744.
  40. Naruseviciute D, Kubilius R. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: randomized participant blind controlled trial. Clin Rehabil. 2020;34:1072-82. doi: 10.1177/0269215520929073. PubMed PMID: 32513018; PubMed Central PMCID: PMCPMC7372589.