{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:09:41Z","timestamp":1791324581619,"version":"4.3.1"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T00:00:00Z","timestamp":1714953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Treatment of chronic plantar fasciitis is challenging given that there are various of available treatment options with no clear gold standard. The aim of the study was to examine the dose-escalation effect of rESWT on the biomechanical parameters of the plantar fascia and pain ailments. Materials and Methods: In the experimental group (n = 30), the intensity of the shock wave was increased every two subsequent treatment sessions. In the control group (n = 32), the treatment parameters were not changed. In both groups, six treatments were performed, with two treatment sessions a week. In order to assess the biomechanical parameters of the plantar fascia, myotonometric measurements were performed. The pain intensity was assessed using the Visual Analog Scale (VAS). Results: The tension of the plantar fascia attachment in the experimental group decreased from 27.69 \u00b1 2.06 [Hz] before treatment to 26.29 \u00b1 1.69 [Hz] after treatment (p = 0.009) and to 26.03 \u00b1 2.15 [Hz] 1 month after the beginning of treatment (p = 0.003). In the control group, the frequency results did not change significantly (p &gt; 0.05). Flexibility increased in both groups. The test results before treatment and 1 month after the beginning of the treatment showed statistical significance in the experimental group (p = 0.001) vs. (p = 0.002) in the control group. The differences were not statistically significant between groups (p &gt; 0.05). The assessment of pain intensity carried out 1 month after the end of treatment in the experimental group amounted to 3.14 \u00b1 2.28 points, which was statistically significantly lower compared to that in the control group, where it amounted to 5.14 \u00b1 1.92 points. (p &lt; 0.001). Conclusions: The use of rESWT performed with an increasing intensity of impact during subsequent treatment procedures demonstrated greater effectiveness in improving the biomechanical parameters of the plantar fascia and was also more effective in reducing the pain ailments. Our results are encouraging. The dose escalation in the treatment cycle is worth considering. To prove that this method of treatment is more effective, a randomized controlled trial should be carried out on a representative sample.<\/jats:p>","DOI":"10.3390\/medicina60050766","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T15:09:36Z","timestamp":1715008176000},"page":"766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Dose Escalation Can Enhance the Therapeutic Potential of Radial Extracorporeal Shock-Wave Therapy in the Treatment of Plantar Fasciitis in Runners"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4983-8018","authenticated-orcid":false,"given":"Sebastian","family":"Szajkowski","sequence":"first","affiliation":[{"name":"Faculty of Medical and Social Sciences, Warsaw Medical Academy of Applied Sciences, 8 Rydygiera St., 01-793 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6181-337X","authenticated-orcid":false,"given":"Jaros\u0142aw","family":"Pasek","sequence":"additional","affiliation":[{"name":"Collegium Medicum im dr W\u0142adys\u0142awa Biega\u0144skiego, Jan D\u0142ugosz University in Cz\u0119stochowa, 13\/15 Armii Krajowej St., 42-200 Cz\u0119stochowa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2210-8744","authenticated-orcid":false,"given":"Grzegorz","family":"Cie\u015blar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Stefana Batorego St., 41-902 Bytom, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,6]]},"reference":[{"key":"ref_1","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 fasciitis: A randomized, controlled multicenter study","volume":"97","author":"Gollwitzer","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1002\/acr.24208","article-title":"Measures of foot pain, foot function, and general foot health","volume":"72","author":"Whittaker","year":"2020","journal-title":"Arthritis Care Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1136\/bjsports-2015-094695","article-title":"Higher body mass index is associated with plantar fasciopathy\/\u2018plantar fasciitis\u2019: Systematic review and meta-analysis of various clinical and imaging risk factors","volume":"50","author":"Rogers","year":"2016","journal-title":"Br. J. Sport. Med."},{"key":"ref_4","first-page":"86","article-title":"Heel pain: Diagnosis and management","volume":"97","author":"Tu","year":"2018","journal-title":"Am. Fam. Physician"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ribeiro, A.P., Jo\u00e3o, S.M., Dinato, R.C., Tessutti, V.D., and Sacco, I.C. (2015). Dynamic patterns of forces and loading rate in runners with unilateral plantar fasciitis: A cross-sectional study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0136971"},{"key":"ref_6","first-page":"11","article-title":"Plantar heel pain and plantar fasciitis","volume":"12","author":"Landorf","year":"2015","journal-title":"BMJ Clin. Evid."},{"key":"ref_7","first-page":"11","article-title":"Foot and ankle conditions: Plantar fasciitis","volume":"465","author":"Carek","year":"2018","journal-title":"FP Essent."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1177\/2325967118757983","article-title":"Long-term prognosis of plantar fasciitis: A 5- to 15-year follow-up study of 174 patients with ultrasound examination","volume":"6","author":"Hansen","year":"2018","journal-title":"Orthop. J. Sport. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.foot.2017.05.004","article-title":"The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: A systematic review with meta-analysis","volume":"33","author":"Salvioli","year":"2017","journal-title":"Foot"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.2340\/16501977-2516","article-title":"Radial extracorporeal shock wave device appearance does not influence clinical outcomes: A randomized controlled trial","volume":"51","author":"Morral","year":"2019","journal-title":"J. Rehabil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e12819","DOI":"10.1097\/MD.0000000000012819","article-title":"Comparative effectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis: A systematic review and network meta-analysis","volume":"97","author":"Li","year":"2018","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"107","DOI":"10.11138\/mltj\/2017.7.1.107","article-title":"Plantar fasciitis in athletes: Diagnostic and treatment strategies. A systematic review","volume":"7","author":"Petraglia","year":"2017","journal-title":"Muscles Ligaments Tendons J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1186\/s13018-020-01783-7","article-title":"Outcomes of platelet-rich plasma for plantar fasciopathy: A best-evidence synthesis","volume":"15","author":"Yu","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/PHM.0000000000001070","article-title":"Autologous blood-derived products compared with corticosteroids for treatment of plantar fasciopathy: A systematic review and meta-analysis","volume":"98","author":"Chen","year":"2019","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e6621","DOI":"10.1097\/MD.0000000000006621","article-title":"Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs","volume":"96","author":"Sun","year":"2017","journal-title":"Medicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1007\/s00402-019-03262-z","article-title":"Shock-wave therapy improved outcome with plantar fasciitis: A meta-analysis of randomized controlled trials","volume":"139","author":"Li","year":"2019","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wang, Y.C., Chen, S.J., Huang, P.J., Huang, H.T., Cheng, Y.M., and Shih, C.L. (2019). Efficacy of different energy levels used in focused and radial extracorporeal shockwave therapy in the treatment of plantar fasciitis: A meta-analysis of randomized placebo-controlled trials. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091497"},{"key":"ref_18","first-page":"68","article-title":"How to choose the right shock wave therapy device?","volume":"6","author":"Pasek","year":"2012","journal-title":"Rehabil wPrakt"},{"key":"ref_19","first-page":"115","article-title":"Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: A systematic review on studies listed in the PEDro database","volume":"116","author":"Schmitz","year":"2015","journal-title":"Br. Med. Bull."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.pmrj.2018.05.007","article-title":"Effect of shockwave treatment for management of upper and lower extremity musculoskeletal conditions: A narrative review","volume":"10","author":"Reilly","year":"2018","journal-title":"PMR"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1136\/bjsports-2017-098998","article-title":"Comparative effectiveness of treatment options for plantar heel pain: A systematic review with network meta-analysis","volume":"53","author":"Babatunde","year":"2019","journal-title":"Br. J. Sport. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5","DOI":"10.15621\/ijphy\/2016\/v3i1\/88900","article-title":"Effect of low energy versus medium energy radial shock wave therapy in the treatment of chronic planter fasciitis","volume":"3","author":"Fouda","year":"2016","journal-title":"Int. J. Physiother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s43465-019-00038-w","article-title":"Comparing the role of different treatment modalities for plantar fasciitis: A double blind randomized controlled trial","volume":"54","author":"Gupta","year":"2020","journal-title":"Indian J. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7570","DOI":"10.12659\/MSM.909550","article-title":"Assessment of Passive Stiffness of Medial and Lateral Heads of Gastrocnemius Muscle, Achilles Tendon, and Plantar Fascia at Different Ankle and Knee Positions Using the MyotonPRO","volume":"23","author":"Huang","year":"2018","journal-title":"Med. Sci. Monit."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jbmt.2017.06.015","article-title":"Quantitative tissue parameters of Achilles tendon and plantar fascia in healthy subjects using a handheld myotonometer","volume":"22","author":"Orner","year":"2018","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chen, G., Wu, J., Chen, G., Lu, Y., Ren, W., Xu, W., Xu, X., Wu, Z., Guan, Y., and Zheng, Y. (2019). Reliability of a portable device for quantifying tone and stiffness of quadriceps femoris and patellar tendon at different knee flexion angles. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0220521"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e000446","DOI":"10.1136\/bmjsem-2018-000446","article-title":"Objective assessment of stiffness in Achilles tendinopathy: A novel approach using the MyotonPRO","volume":"4","author":"Morgan","year":"2018","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_28","first-page":"e934121","article-title":"Feasibility of Using a Portable MyotonPRO Device to Quantify the Elastic Properties of Skeletal Muscle","volume":"28","author":"Li","year":"2022","journal-title":"Med. Sci. Monit."},{"key":"ref_29","first-page":"e8284","article-title":"Comparison of radial extracorporeal shock wave therapy in plantar fasciitis treatment using two different frequencies","volume":"12","author":"Narin","year":"2020","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jor.2022.06.011","article-title":"Are models of plantar heel pain suitable for competitive runners? A narrative review","volume":"33","author":"Harvey","year":"2022","journal-title":"J. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3352\/jeehp.2021.18.17","article-title":"Sample size determination and power analysis using the G*Power software","volume":"18","author":"Kang","year":"2021","journal-title":"J. Educ. Eval. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1007\/s00256-015-2215-4","article-title":"Plantar fascia softening in plantar fasciitis with normal B-mode sonography","volume":"44","author":"Wu","year":"2015","journal-title":"Skeletal Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1302\/0301-620X.80B3.0800546","article-title":"Dose-related effects of shock waves on rabbit tendo Achilles. A sonographic and histological study","volume":"80","author":"Rompe","year":"1998","journal-title":"J. Bone Jt. Surg."},{"key":"ref_34","first-page":"143","article-title":"An attempt at objective and subjective evaluation of the therapeutic efficacy of focused and radial shockwave applied to symptomatic heel spur","volume":"18","author":"Franek","year":"2016","journal-title":"Acta Bioeng. Biomech."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.ajem.2018.01.008","article-title":"A systematic review of the pain scales in adults: Which to use?","volume":"36","author":"Karcioglu","year":"2018","journal-title":"Am. J. Emerg. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Stecco, A., Giordani, F., Fede, C., Pirri, C., De Caro, R., and Stecco, C. (2023). From muscle to the myofascial unit: Current evidence and future perspectives. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054527"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1186\/s13063-020-04510-z","article-title":"The effectiveness of radial extracorporeal shock wave therapy (rESWT), sham-rESWT, standardised exercise programme or usual care for patients with plantar fasciopathy: Study protocol for a double-blind, randomised, sham-controlled trial","volume":"21","author":"Heide","year":"2020","journal-title":"Trials"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1589\/jpts.29.144","article-title":"Therapeutic effects of massage and electrotherapy on muscle tone, stiffness and muscle contraction following gastrocnemius muscle fatigue","volume":"29","author":"Wang","year":"2017","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/joa.12589","article-title":"Stiffness mapping of lower leg muscles during passive dorsiflexion","volume":"230","author":"Nordez","year":"2017","journal-title":"J. Anat."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.neurom.2022.08.408","article-title":"Targed ultrasound-guided shockwave therapy of low back pain using focused, defocused and radial shockwave: E poster viewing","volume":"25","author":"Kalika","year":"2022","journal-title":"Neuromodulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1002\/jcp.26907","article-title":"Comparison of efficacy of eight treatments for plantar fasciitis: A network meta-analysis","volume":"234","author":"Li","year":"2018","journal-title":"J. Cell. Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"790","DOI":"10.3113\/FAI.2010.0790","article-title":"High-Energy Extracorporeal Shock-Wave Therapy (ESWT) for the Treatment of Chronic Plantar Fasciitis","volume":"31","author":"Metzner","year":"2010","journal-title":"Foot Ankle Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1302\/2058-5241.5.190067","article-title":"Extracorporeal shock wave therapy: An update","volume":"5","author":"Auersperg","year":"2020","journal-title":"EFORT Open Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1126\/science.150.3699.971","article-title":"Pain mechanisms: A new theory","volume":"150","author":"Melzack","year":"1965","journal-title":"Science"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/5\/766\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:40:16Z","timestamp":1760107216000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/5\/766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,6]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["medicina60050766"],"URL":"https:\/\/doi.org\/10.3390\/medicina60050766","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,6]]}}}