Efficacy of combined versus single-site radial shockwave therapy for chronic plantar fasciitis: A randomized, double-blind controlled trial

We compared the efficacy of radial shockwave therapy (r-ESWT) applied to both the plantar fascia and gastrocnemius muscle versus the plantar fascia alone for chronic plantar fasciitis using a prospective, randomized, double-blind controlled trial. Morning pain, pain on activity, pain frequency/duration, ankle range of motion, and analgesic use were recorded at baseline, twice post-intervention, and at 12, 24, and 48 weeks. Between-group mean differences, effect sizes, and 95% confidence intervals were calculated, and sensitivity analyses for missing values were performed. Fifty-eight of 76 randomized patients were analyzed at the final 48-week follow-up (31 intervention, 27 control). Both protocols successfully reduced pain. The intervention group showed a faster reduction in morning pain and pain frequency than the control group after the first session only ( p = 0.005 and p = 0.034, respectively); these comparisons were not corrected for multiplicity and should be regarded as hypothesis-generating. Ankle dorsiflexion improvement and analgesic use did not differ significantly between groups. Dual-site r-ESWT may be associated with faster early pain relief than plantar fascia treatment alone, though long-term outcomes were comparable. Trial registration: TCTR20250714008, Registration date 14 July 2025 (retrospectively registered).