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Experimental Therapy For Sore Heels Has Skeptics


4 Star

Experimental Therapy For Sore Heels Has Skeptics

Our Review Summary

This story is about the use of shockwaves to treat a condition called plantar fasciitis that causes heel pain. The story drives home the point that there are conflicting studies and opinions as to the effectiveness of this treatment, but we wish it had gone further to explore the quality of the underlying data. The story presents opposing expert views but gives us no way to gauge which is supported by the evidence. 

On the whole, though, the story earns high marks for providing detailed cost information, engaging in an extensive discussion of alternative treatments, and generally avoiding hype. Readers & listerners should come away with an accurate picture of the benefits and drawbacks of choosing this approach.   


Why This Matters

There’s no question that we need better treatment options for plantar fasciitis–a common, bothersome problem which is a nuisance for most people but can be a real pain for some. However, tough questions must be asked about a treatment that can cost thousands of dollars more than other remedies and may only be slightly more effective, if at all.


Does the story adequately discuss the costs of the intervention?


Cost is a major part of the story here and NPR doesn’t gloss over it. The cost of shockwave treatment can range anywhere from $500 to several thousand dollars, NPR reports, and usually is not covered by insurance.
NPR could have added some useful context  by mentioning that the shockwave machines themselves can be very expensive to purchase and operate. This can create an incentive for physicians who have bought such a machine to promote shockwave treatments to patients who may not need them. In addition, it would have been helpful to know how this treatment’s costs differ from those of other common treatments.   

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


Even when it’s quoting a doctor who is clearly a proponent of shockwave therapy (as discussed above in the Evidence Quality criterion), the story treats benefits with appropriate caution and doesn’t succumb to hype. This story also seems to have avoided the compulsory anecdote about the patient who is feeling dramatically better after a new high-tech treatment. In fact, the story seems to go out of its way to provide the perspective of someone got better with low-tech standbys such as stretching, taping, and ice — valuable  context that is often lacking in coverage of medical treatments.

On the downside, the story focuses exclusively on pain and doesn’t tell us whether patients who receive shockwave treatment had improved functioning or could participate in more activities afterward. These are important measures of a treatment’s overall effect on patients. 

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The only mention of side effects is the report of some bruising for two days afterwards. Potential risks of this treatment include discomfort soon after the procedure. And then there is the possibility that the procedure may make the condition worse. Some information acknowledging the risks — even if they are minor and temporary — is always appropriate.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

A doctor quoted in the story says that shockwave therapy has a 60 to 80 percent chance of reducing heel pain by half, and that a quarter of patients will become pain-free from the treatment.  While this description of the benefit is impeccably worded, no information is provided that would allow readers to assess the quality of the evidence upon which it is based.

The issue gets more confusing later in the story when we learn that "studies have given conflicting results" about the effectiveness of the shockwave therapy. Again, we receive no guidance that would help us to determine which of these conflicting studies is more likely to be right. Knowing where the evidence comes from would highlight why conflicting results exist.

To its credit, the story does convey the fact that experts disagree sharply about the role of shockwave therapy for heel pain — a characterization which is accurate and important to provide. However, we think the story should have done more to tell us what the best evidence on the subject has to say. It took one of our journalist-reviewers less than a minute to find a systematic review and meta-analysis of controlled clinical trials involving shockwave therapy. This study or something like it would have served as a useful benchmark for discussion of the evidence in this field.     

Does the story commit disease-mongering?


The story did not exaggerate the effects of heel pain.

Does the story use independent sources and identify conflicts of interest?


The story finds experts on both sides of this issue and gives them each a reasonable amount of air time.

Does the story compare the new approach with existing alternatives?


The discussion of alternatives is a real strength of this piece. Instead of relegating this coverage to a throwaway line at the end of the piece as many stories do, this story mentioned 10 low-tech treatments that patients are advised to try before considering shockwave therapy. In addition, the story explained that nearly all patients with heel pain eventually get better regardless of what kind of treatment they receive.   

Does the story establish the availability of the treatment/test/product/procedure?


The story says that shockwave therapy is "beginning to catch on around the U.S." While this gives readers the accurate impression that the treatment is approved for use and available in some places, it doesn’t really give readers a sense as to how likely they are to find it at their local doctor’s or orthopedist’s office. Although it earns a satisfactory, the story could have provided a bit more detail on the history of these devices in the U.S. (they were first approved for use in 2000) and how widespread they have become.

Does the story establish the true novelty of the approach?


This story doesn’t try to oversell the novelty of shockwave therapy.

Does the story appear to rely solely or largely on a news release?


This story is clearly not based on a news release.

Total Score: 8 of 10 Satisfactory


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