Study of plantar fasciitis treatment is flawed

doi:10.1136/bmj.327.7419.870-b

BMJ 2003;327:870 (11 October), doi:10.1136/bmj.327.7419.870-b

Letter

Study of plantar fasciitis treatment is flawed

The first 150 words of the full text of this article appear below.

EDITOR—Haake et al performed a multi-centre randomisedcontrolled trial of extracorporeal shock wave treatment forplantar fasciitis.¹ They say that their study is definitiveand they therefore recommend against any further experimentaltesting of this treatment, but the study has sufficient methodologicalflaws to render their conclusions questionable.

Although the study seems to be well designed statistically,they do not highlight that fewer than half of their patientsreceived minimal conservative care that includes stretchingexercises and casting or night splinting before their inclusionin the study (data available online in web table B).

Such interventions have been shown to be effective.^2
3 Failureof such treatment is an essential aspect of the inclusion criteriafor extracorporeal shock wave treatment. Including such patientsin this study therefore violates one of the precepts of extracorporealshock wave treatment—failure of previous standard conservativecare. Physical treatment is not a substitute for . . . [Full text of this article]

James Michelson, professor, orthopaedic surgery

George Washington University School of Medicine, Medical Education Center, Room 6200, 900 23rd Street, NW, Washington, DC 20037, USA msdjdm@gwumc.edu

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