Original Research| Volume 56, ISSUE 4, P768-772, July 2017

Treatment of Chronic Plantar Fasciitis with Noninvasive Interactive Neurostimulation: A Prospective Randomized Controlled Study


      The initial treatment of plantar fasciitis should be conservative, with most cases responding to standard physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), heel pads, and stretching. In cases of chronic refractory symptoms, more invasive treatment could be necessary. Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that works by locating areas of lower skin impedance. The objective of the present prospective randomized controlled study was to evaluate whether the use of NIN for chronic plantar fasciitis could result in greater improvement in a foot functional score, lower levels of reported pain, reduced patient consumption of NSAIDs, and greater patient satisfaction compared with electric shockwave therapy in patients without a response to standard conservative treatment. The patients were randomized using random blocks to the NIN program (group 1) or electric shockwave therapy (group 2). The outcome measurements were the pain subscale of the validated Foot Function Index (PS-FFI), patient-reported subjective assessment of the level of pain using a standard visual analog scale, and daily intake of NSAID tablets (etoricoxib 60 mg). The study group was evaluated at baseline (time 0), week 4 (time 1), and week 12 (final follow-up point). Group 1 (55 patients) experienced significantly better results compared with group 2 (49 patients) in term of the PS-FFI score, visual analog scale score, and daily intake of etoricoxib 60 mg. NIN was an effective treatment of chronic resistant plantar fasciitis, with full patient satisfaction in >90% of cases. The present prospective randomized controlled study showed superior results for noninvasive neurostimulation compared with electric shockwave therapy, in terms of the functional score, pain improvement, and use of NSAIDs.

      Level of Clinical Evidence


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        • Thomas J.L.
        • Christensen J.C.
        • Kravitz S.R.
        • Mendicino R.W.
        • Vanore J.V.
        • Weil Jr., L.S.
        • Zlotoff H.J.
        • Bouché R.
        • Baker J.
        • American College of Foot and Ankle Surgeons Heel Pain Committee
        The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010.
        J Foot Ankle Surg. 2010; 49: S1-S19
        • Rompe J.D.
        • Furia J.
        • Weil L.
        • Maffulli N.
        Shock wave therapy for chronic plantar fasciopathy.
        Br Med Bull. 2007; 81-82: 183-208
        • Uden H.
        • Boesch E.
        • Kumar S.
        Plantar fasciitis—to jab or to support? A systematic review of the current best evidence.
        J Multidiscip Healthc. 2011; 4: 155-164
        • Lemont H.
        • Ammirati K.M.
        • Usen N.
        Plantar fasciitis: a degenerative process (fasciosis) without inflammation.
        J Am Podiatr Med Assoc. 2003; 93: 234-237
        • Amis J.
        • Jennings L.
        • Graham D.
        • Graham C.E.
        Painful heel syndrome: radiographic and treatment assessment.
        Foot Ankle. 1998; 9: 91-95
        • Buchbinder R.
        Clinical practice: plantar fasciitis.
        N Engl J Med. 2004; 350: 2159-2166
        • Irving D.B.
        • Cook J.L.
        • Menz H.B.
        Factors associated with chronic plantar heel pain: a systematic review.
        J Sci Med Sport. 2006; 9: 11-22
        • Gill L.H.
        Plantar fasciitis diagnosis and conservative management.
        J Am Acad Orthop Surg. 1997; 5: 109-117
        • Schabrun S.M.
        • Cannan A.
        • Mullens R.
        • Dunphy M.
        • Pearson T.
        • Lau C.
        • Chipchase L.S.
        The effect of interactive neurostimulation therapy on myofascial trigger point associated with mechanical neck pain: a preliminary randomized, sham-controlled trial.
        J Altern Complement Med. 2012; 18: 946-952
        • Gorodetskyi I.G.
        • Gorodnichenko A.I.
        • Tursin P.S.
        • Reshetnyak V.K.
        • Uskov O.N.
        Use of noninvasive interactive neurostimulation in the post-operative recovery in patients with trochanteric fracture of the femur: a randomised controlled trial.
        J Bone Joint Surg Br. 2007; 89: 1488-1494
        • Nigam A.K.
        • Taylor D.M.
        • Valayeva Z.
        Non-invasive interactive neurostimulation (InterX™) reduces acute pain in patients following total knee replacement surgery: a randomised, controlled trial.
        J Orthop Surg Res. 2011; 6: 45
        • Gorodetskyi I.G.
        • Gorodnichenko A.I.
        • Tursin P.S.
        • Reshetnyak V.K.
        • Uskov O.N.
        Use of non-invasive interactive neurostimulation to improve short term recovery in patients with surgically repaired bimalleolar ankle fracture: a prospective, randomized clinical trial.
        J Foot Ankle Surg. 2010; 49: 432-437
      1. Neuro Resource Group I. InterX Therapy. Available at: Accessed January 2015.

        • Kapoor S.
        Pain management in patients with plantar fasciitis: the emerging role of radial extracorporeal shock-wave therapy.
        J Foot Ankle Surg. 2012; 51: 541
        • Rompe J.D.
        • Cacchio A.
        • Weil Jr., L.
        • Furia J.P.
        • Haist J.
        • Reiners V.
        • Schmitz C.
        • Maffulli N.
        Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy.
        J Bone Joint Surg Am. 2010; 92: 2514-2522
        • Buchbinder R.
        • Ptasznik R.
        • Gordon J.
        • Buchanan J.
        • Prabaharan V.
        • Forbes A.
        Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial.
        JAMA. 2002; 288: 1364-1372
        • Gollwitzer H.
        • Diehl P.
        • von Korff A.
        • Rahlfs V.W.
        • Gerdesmeyer L.
        Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device.
        J Foot Ankle Surg. 2007; 46: 348-357
        • Budiman-Mak E.
        • Conrad K.J.
        • Roach K.E.
        The Foot Function Index: a measure of foot pain and disability.
        J Clin Epidemiol. 1991; 44: 561-570
        • Wessel J.
        The reliability and validity of pain threshold measurements in osteoarthritis of the knee.
        Scand J Rheumatol. 1995; 24: 238-242
        • Sluka K.
        • Walsh D.
        TENS: basic science mechanisms and clinical effectiveness.
        J Pain. 2003; 4: 109-121
        • Macias D.M.
        • Coughlin M.J.
        • Zang K.
        • Stevens F.R.
        • Jastifer J.R.
        • Doty J.F.
        Low-level laser therapy at 635 nm for treatment of chronic plantar fasciitis: a placebo-controlled, randomized study.
        J Foot Ankle Surg. 2015; 54: 768-772
        • Costantino C.
        • Vulpiani M.C.
        • Romiti D.
        • Vetrano M.
        • Saraceni V.M.
        Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs: a randomized controlled clinical study.
        Eur J Phys Rehabil Med. 2014; 50: 39-47
        • Arslan A.
        • Koca T.T.
        • Utkan A.
        • Sevimli R.
        • Akel İ.
        Treatment of chronic plantar heel pain with radiofrequency neural ablation of the first branch of the lateral plantar nerve and medial calcaneal nerve branches.
        J Foot Ankle Surg. 2016; 55: 767-771
        • DiGiovanni B.F.
        • Nawoczenski D.A.
        • Lintal M.E.
        • Moore E.A.
        • Murray J.C.
        • Wilding G.E.
        • Baumhauer J.F.
        Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain: a prospective, randomized study.
        J Bone Joint Surg Am. 2003; 85: 1270-1277