Comparison of extracorporeal shock wave therapy targeting the posterior myofascial chain and plantar tenderness points versus plantar tenderness points alone in patients with plantar fasciitis: a randomized controlled trial

Aim Plantar fasciitis is a common cause of heel pain. Although extracorporeal shock wave therapy (ESWT) targeting plantar tenderness points is widely used, outcomes remain unsatisfactory in some patients. This study aimed to compare the clinical efficacy of ESWT targeting both posterior myofascial-chain trigger points and plantar tenderness points with that of conventional ESWT targeting plantar tenderness points alone in patients with plantar fasciitis. Methods Eighty patients with plantar fasciitis were randomly assigned to a control or treatment group ( n = 40 per group). The control group received conventional ESWT applied only to the local plantar tenderness point, whereas the treatment group received ESWT applied to both gastrocnemius trigger points and the plantar tenderness point. Treatment was administered once weekly for four consecutive weeks. Participants were evaluated at baseline and at 1 and 3 months after treatment. Outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, visual analog scale (VAS), strain ratio (SR), plantar fascia thickness, and Y-Balance Test (YBT) score. Repeated-measures analysis of covariance was used to examine group, time, and group × time effects, with adjustment for prespecified covariates. Results Significant group × time interactions were observed for VAS, AOFAS, and YBT scores. Post hoc comparisons showed statistically significantly lower VAS scores and higher AOFAS and YBT scores in the treatment group than in the control group at follow-up (all P < 0.01). These statistical differences should be interpreted separately from clinical relevance. For SR and plantar fascia thickness, the main effect of time was significant (both P < 0.001), whereas the group and group × time effects were not significant (all P > 0.05). Conclusion The combined protocol was associated with greater short-term improvements in pain, ankle–hindfoot function, and dynamic balance than plantar-focused ESWT alone. The clinical importance of some between-group differences remains uncertain. These findings do not establish a myofascial-chain mechanism or treatment safety, and conclusions are restricted to short-term comparative effectiveness. Clinical Trial Registration https://www.chictr.org.cn/index.html , identifier ChiCTR250010696