Comparative Outcomes of Percutaneous Plantar Fascia Release, Calcaneal Drilling, and Calcaneal Spur Removal versus ESWT in the Treatment of Plantar Fasciitis

This study aimed to compare the clinical outcomes of percutaneous plantar fascia release, calcaneal drilling, and calcaneal spur excision with extracorporeal shock wave therapy (ESWT) in patients with plantar fasciitis resistant to conservative treatment. A total of 52 patients diagnosed with plantar fasciitis and unresponsive to at least six months of conservative therapy between January 2021 and December 2024 were retrospectively analyzed. Patients were divided into two groups: minimally invasive surgery (n = 18) and extracorporeal shock wave therapy (ESWT) (n = 34). Demographic data, symptom duration, standing time at work, return-to-work time, complications, and clinical outcomes were compared using the Visual Analog Scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Roles & Maudsley (RM) score. There were no significant differences between the groups in terms of age, gender, body mass index (BMI), symptom duration, or standing time at work (p > 0.05). Return-to-work time was significantly longer in the minimally invasive surgery group (13.8 ± 4.5 vs. 4.3 ± 2.8 days, p = 0.001). While both groups showed comparable clinical improvement at the 6-month follow-up, VAS and AOFAS scores were better maintained in the surgical group at 12 months. In contrast, a decline was observed in the ESWT group (p = 0.001 and p = 0.012). Complication rates were similar between the groups (p = 0.99). Minimally invasive surgery provided more sustainable long-term clinical improvement. On the other hand, ESWT offered a predictable short-term cost advantage and enabled earlier return to work. Considering patient expectations and ease of application, ESWT appears to be an effective and practical treatment option that should be considered before proceeding with minimally invasive surgical interventions.