Abstract
BACKGROUND: Chronic plantar fasciitis is a common cause of persistent heel pain, often resistant to conservative treatments. This prospective, randomized controlled trial (ClinicalTrials.gov: NCT06737445) aimed to compare the effectiveness of corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL) in managing chronic plantar fasciitis. METHODS: Patients with chronic plantar fasciitis, unresponsive to 6 months of conservative treatment, were included. They were divided into three groups: CSI, ESWT, and RTL. Corticosteroid injections were given under ultrasound guidance, ESWT was applied weekly for three weeks, and RTL was a single-session procedure. The primary outcome was change in Visual Analog Scale (VAS) for pain. Secondary outcomes included the Foot Function Index (FFI) and Roles and Maudsley score, assessed at baseline, 1, 6, and 12 months post-treatment. RESULTS: The CSI group included 20 feet from 18 patients, the ESWT group had 19 feet from 15 patients, and the RTL group included 23 feet from 16 patients. At 12 months, the RTL group showed significantly better outcomes in the Roles and Maudsley Score compared to ESWT and CSI, with no significant differences at 1 and 6 months. In FFI, the RTL group had significantly better scores than ESWT at 6 and 12 months. For VAS scores, the CSI group had better outcomes than ESWT at 1 month, but by 6 and 12 months, RTL demonstrated superior pain relief compared to both CSI and ESWT. CONCLUSION: RTL proved to be the most effective treatment for chronic plantar fasciitis, showing superior results, particularly at 12 months, in the Roles and Maudsley Score, Foot Function Index, and VAS scores compared to ESWT and CSI. LEVEL OF EVIDENCE: Level 1, prospective randomized controlled study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-026-09542-1.