{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T11:39:55Z","timestamp":1776425995227,"version":"3.51.2"},"reference-count":21,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Chronic plantar fasciitis refractory to conservative treatment is a frequent cause of persistent heel pain and functional limitation. Although radial extracorporeal shock wave therapy (rESWT) has shown potential benefit, the relationship between clinical improvement and structural ultrasonographic changes remains unclear. The aim of this study was to evaluate the clinical, functional, and ultrasonographic outcomes associated with rESWT in patients with refractory plantar fasciitis. Methods: We conducted a prospective observational single-center study including 287 patients with plantar fasciitis refractory to conservative treatment for at least 6 months and confirmed by ultrasonography (plantar fascia thickness &gt;4 mm). All patients received four weekly sessions of rESWT. Pain intensity (visual analog scale [VAS]), foot function (Foot Function Index [FFI]), quality of life (EQ-5D), and plantar fascia thickness were assessed at baseline and 3 months after treatment. Results: Significant improvements were observed in pain (mean VAS change, \u22123.73 points), function (mean FFI-disability change, \u221232.37 points), and quality of life (improvement in at least one EQ-5D dimension in 81.5% of patients) (all p &lt; 0.001). The mean reduction in plantar fascia thickness was 0.14 mm. Most responders (71.8%) showed clinical improvement despite the absence of a relevant structural change, defined as a reduction in plantar fascia thickness &lt;0.5 mm. In multivariate analysis, physically demanding occupations were associated with a lower probability of response (odds ratio, 0.32; 95% confidence interval, 0.17\u20130.63). The prognostic model showed moderate discrimination (area under the curve, 0.71). Conclusions: In this observational cohort, rESWT was associated with improvements in pain, function, and quality of life in patients with refractory plantar fasciitis. Clinical improvement frequently occurred despite minimal changes in plantar fascia thickness, suggesting that ultrasonographic thickness may not adequately reflect symptomatic evolution. However, the absence of a control group prevents causal interpretation of these findings.<\/jats:p>","DOI":"10.3390\/jcm15083068","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:11:04Z","timestamp":1776420664000},"page":"3068","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dissociation Between Clinical and Ultrasonographic Response After Radial Shock Wave Therapy in Refractory Plantar Fasciitis"],"prefix":"10.3390","volume":"15","author":[{"given":"Manuel Novo","family":"Rigueiro","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, \u00c1lvaro Cunqueiro University Hospital, Estrada de Clara Campoamor, 341, 36213 Vigo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio Pires","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Clinical University Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio Lete","family":"Achirica","sequence":"additional","affiliation":[{"name":"Department of Radiology, Clinical University Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9773-4590","authenticated-orcid":false,"given":"Antonio G\u00f3mez","family":"Caama\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Clinical University Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco Javier Rodr\u00edguez","family":"Rigueiro","sequence":"additional","affiliation":[{"name":"Department of Engineering and Advanced Technologies, University of Santiago de Compostela (USC), Choupana, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jes\u00fas Rodr\u00edguez","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Clinical University Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arturo Gonz\u00e1lez","family":"Quintela","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Clinical University Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio Novo","family":"Veleiro","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Clinical University Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1056\/NEJMcp032745","article-title":"Plantar fasciitis","volume":"350","author":"Buchbinder","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Irving, D.B., Cook, J.L., and Menz, H.B. (2007). Obesity and pronated foot type may increase the risk of chronic plantar heel pain: A matched case-control study. BMC Musculoskelet. Disord., 8.","DOI":"10.1186\/1471-2474-8-41"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.jfas.2010.01.001","article-title":"The diagnosis and treatment of heel pain: A clinical practice guideline","volume":"49","author":"Thomas","year":"2010","journal-title":"J. Foot Ankle Surg."},{"key":"ref_4","unstructured":"McMillan, A.M., Landorf, K.B., Gilheany, M.F., Bird, A.R., Morrow, A.D., and Menz, H.B. (2012). Corticosteroid injection for plantar heel pain: A systematic review and meta-analysis. BMC Musculoskelet. Disord., 13."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/bmb\/ldu025","article-title":"Platelet-rich plasma injections for chronic plantar fasciopathy: A systematic review","volume":"112","author":"Franceschi","year":"2014","journal-title":"Br. Med. Bull."},{"key":"ref_6","first-page":"1686","article-title":"Is extracorporeal shock wave therapy effective in the treatment of plantar fasciitis? A meta-analysis of randomized controlled trials","volume":"94","author":"Yin","year":"2014","journal-title":"Phys. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1177\/0363546508324176","article-title":"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","volume":"36","author":"Gerdesmeyer","year":"2008","journal-title":"Am. J. Sports Med."},{"key":"ref_8","first-page":"340","article-title":"Radial extracorporeal shock wave therapy is effective and safe in chronic plantar fasciitis: A meta-analysis","volume":"99","author":"Sun","year":"2020","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"701","DOI":"10.2106\/JBJS.M.01331","article-title":"Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciopathy: A randomized, controlled multicenter study","volume":"97","author":"Gollwitzer","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_10","unstructured":"Wu, Y., Yu, J., Zhang, C., and Xu, Y. (2020). Ultrasonographic evaluation of morphological and elasticity changes in chronic plantar fasciitis after extracorporeal shock wave therapy: A prospective cohort study. BMC Musculoskelet. Disord., 21."},{"key":"ref_11","first-page":"447","article-title":"Focused shock wave therapy for the treatment of chronic plantar fasciitis: A comparative study with ultrasonographic and clinical correlations","volume":"32","author":"Notarnicola","year":"2018","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1136\/bjsports-2012-091961","article-title":"A systematic review of shockwave therapies in soft tissue conditions: Focusing on the evidence","volume":"48","author":"Speed","year":"2014","journal-title":"Br. J. Sports Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/0304-3959(83)90126-4","article-title":"The validation of visual analogue scales as ratio scale measures for chronic and experimental pain","volume":"17","author":"Price","year":"1983","journal-title":"Pain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/0895-4356(91)90220-4","article-title":"The Foot Function Index: A measure of foot pain and disability","volume":"44","author":"Conrad","year":"1991","journal-title":"J. Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"EuroQol Group (1990). EuroQol\u2014A new facility for the measurement of health-related quality of life. Health Policy, 16, 199\u2013208.","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e375","DOI":"10.5114\/pjr.2020.97955","article-title":"Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis","volume":"85","author":"Aggarwal","year":"2020","journal-title":"Pol. J. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/PHM.0b013e31828cd42b","article-title":"Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: A meta-analysis","volume":"92","author":"Dizon","year":"2013","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1016\/j.apmr.2012.02.023","article-title":"Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: A systematic review and network meta-analysis","volume":"93","author":"Chang","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/s00402-012-1505-8","article-title":"Platelet rich plasma for treatment of chronic plantar fasciitis","volume":"132","author":"Ragab","year":"2012","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_20","first-page":"77","article-title":"Predictive factors of clinical outcome in patients with plantar fasciitis treated with radial extracorporeal shock wave therapy","volume":"55","year":"2021","journal-title":"Rehabilitacion"},{"key":"ref_21","first-page":"498","article-title":"Ultrasonography in diagnosing plantar fasciitis: A systematic review and meta-analysis","volume":"43","author":"Wu","year":"2015","journal-title":"J. Clin. Ultrasound"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3068\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:40:05Z","timestamp":1776422405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3068"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":21,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15083068"],"URL":"https:\/\/doi.org\/10.3390\/jcm15083068","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]}}}