COMPARATIVE EFFECTIVENESS OF EXTRACORPOREAL SHOCKWAVE THERAPY, INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION, AND HIGH-INTENSITY LASER THERAPY ON PAIN AND FUNCTIONAL OUTCOMES IN PLANTAR FASCIOPATHY: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Plantar fasciopathy is a common cause of heel pain resulting from degenerative changes in the plantar fascia, leading to pain and functional impairment. Although extracorporeal shockwave therapy (ESWT), instrument assisted soft tissue mobilization (IASTM), and high-intensity laser therapy (HILT) are widely used, comparative evidence remains limited. Objective: To compare the effectiveness of ESWT, IASTM, and HILT in reducing pain and improving function in individuals with plantar fasciopathy. Methods: In this single-center, parallel-group randomized controlled trial, 60 participants with plantar fasciopathy were randomly assigned to ESWT, IASTM, or HILT (n = 20/group). Interventions were delivered for 4 weeks with a standardized home exercise program. Outcomes included the Numeric Pain Rating Scale (NPRS), Heel Tenderness Index (HTI), Foot and Ankle Outcome Score (FAOS), and Foot Function Index (FFI), assessed at baseline, 4 weeks, and 12 weeks. Mixed repeated-measures ANOVA with Bonferroni-adjusted post hoc testing evaluated time, group, and time × group effects. Results: A significant main effect of time was observed for all outcomes (p < 0.001), whereas no significant main effect of group was found. Time × group interactions were not significant for NPRS or HTI but were significant for FAOS and FFI. At 12 weeks, ESWT and IASTM demonstrated greater functional improvement than HILT, with no significant difference between ESWT and IASTM. Conclusion: All three modalities effectively reduced pain and heel tenderness. However, ESWT and IASTM produced superior medium-term functional outcomes compared with HILT, suggesting greater clinical benefit through restoration of plantar fascia biomechanics.