Radial Extracorporeal Shock Wave Therapy Protocols for Chronic Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials

Background Radial extracorporeal shock wave therapy (rESWT) demonstrates effectiveness for chronic plantar fasciitis, yet heterogeneous protocols across trials limit clinical reproducibility and hinder translation of evidence into standardized, practical treatment parameters. Purpose To systematically synthesize randomized controlled trials (RCTs) applying radial extracorporeal shock wave therapy for chronic/recalcitrant plantar fasciitis and to summarize key protocol parameters to improve clinical reproducibility. Study design Systematic review Methods The review protocol was registered (OSF; DOI: 10.17605/OSF.IO/2CVWR) and conducted in accordance with PRISMA 2020. PubMed, Embase, CINAHL, SCOPUS, Web of Science, and SPORTDiscus were searched (January 2015–December 2025). Three reviewers independently screened studies and extracted data on rESWT protocol parameters (intensity/pressure or energy flux density, frequency, impulses, number of sessions, and treatment interval), outcomes, and risk of bias (Cochrane RoB 1.0). Results Nineteen RCTs (total n=1,738) were included. The most frequently used protocol comprised three sessions delivered at weekly intervals with 2,000 impulses per session and frequencies around 8–10 Hz; intensity reporting was heterogeneous (pressure in bar (approximately 1.4–4.0 bar) vs energy flux density). Across trials, rESWT was associated with improvements in pain and function. When compared with corticosteroid injection, several trials suggested faster short-term pain relief with injection, whereas rESWT demonstrated comparable or more sustained improvements at mid-term follow-up in some studies. Evidence for dose escalation and adjunctive combinations (e.g., stretching, trigger-point therapy, or local vibration) was emerging but remained heterogeneous. Conclusions rESWT is a safe, non-invasive intervention associated with clinically meaningful improvements in chronic plantar fasciitis; however, protocol heterogeneity—particularly inconsistent intensity reporting—limits comparability across studies. Clinically, rESWT may serve as a key “bridge intervention” that reduces pain and facilitates adherence to active exercise-based rehabilitation (e.g., stretching and strengthening), underscoring the need for standardized reporting of core parameters to support reproducible, evidence-based protocols.