Journal of Food and Nutrition Research
ISSN (Print): 2333-1119 ISSN (Online): 2333-1240 Website: Editor-in-chief: Prabhat Kumar Mandal
Open Access
Journal Browser
Journal of Food and Nutrition Research. 2021, 9(3), 148-153
DOI: 10.12691/jfnr-9-3-7
Open AccessArticle

Efficacy of Shock Waves Combined with Adjuvant Therapy with Tendon Supplement in the Treatment of Plantar Fasciitis: A Prospective Randomized Study

Angela Notarnicola1, 2, , Lorenzo Moretti1, Marco Baglioni1, Ilaria Covelli1, Francesco Paolo Bianchi3, Aurora Citraro1 and Biagio Moretti1, 2

1Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, Aldo Moro University of Bari, Bari, Italy

2Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, School of Medicine, Aldo Moro University of Bari, Bari, Italy

3Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy

Pub. Date: March 18, 2021

Cite this paper:
Angela Notarnicola, Lorenzo Moretti, Marco Baglioni, Ilaria Covelli, Francesco Paolo Bianchi, Aurora Citraro and Biagio Moretti. Efficacy of Shock Waves Combined with Adjuvant Therapy with Tendon Supplement in the Treatment of Plantar Fasciitis: A Prospective Randomized Study. Journal of Food and Nutrition Research. 2021; 9(3):148-153. doi: 10.12691/jfnr-9-3-7


Physical treatment with focused shock waves is effective in the treatment of tendonitis in 60-90% of cases. Plantar fasciitis is attributable to the group of tendon pathologies for its degenerative-inflammatory anatomopathological characteristics. Food supplements could facilitate the healing of tendinopathies when combined with shock wave therapy. We designed a single-blind, randomized prospective study (level of evidence IB). Forty-four patients with plantar fasciitis were recruited and randomized to group A (18 patients) and group B (26 patients), where they were treated with focused shock waves alone and the combination of focused shock waves and tendon supplement, respectively. Statistically significant improvement in pain remission (primary endpoint) and functional recovery (secondary endpoint) occurred in both groups at three time points of the monitoring (Months 0, 3, and 6). The time-group interaction analysis confirmed the best efficacy of the combination treatment with shockwave and supplement (group B). The results of this study demonstrate a positive therapeutic effect of the combination of focused shock wave therapy and a complex tendon supplement in the treatment of plantar fasciitis.

focused shock waves tendinitis nutraceuticals plantar fasciitis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Vitali, M, Peretti, G, Mangiavini, L, “The treatment with extracorporal shock wave therapy in some of most frequently musculoskeletal pathologies,” Orthopaedic Proceedings, 88-B: 423, 2006.
[2]  Roxas, M. “Plantar fasciitis: Diagnosis and therapeutic considerations,” Altern. Med. Rev, 10: 83-93, 2005.
[3]  Hyer, CF, Vancourt R, Block A, “Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis,” J. Foot Ankle Surg, 2005, 44: 137-143.
[4]  Li, S, Wang, K, Sun, H, Luo, X, Wang, P, Fang, S, Chen, H, Sun, X, “Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: A meta-analysis of randomized controlled trials,” Medicine, 97: e13687, 2018.
[5]  Janisse, DJ, Janisse, E, “Shoe modification and the use of orthoses in the treatment of foot and ankle pathology,” J. Am. Acad. Orthop. Surg, 16: 152–158, 2008.
[6]  Nahin, RL, “Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults,” J. Pain, 19:885-896, 2018.
[7]  Benjamin, M; Kaiser, E, Milz, S, “Structure-function relationships in tendons: a review;” J Anat,; 212(3): 211-28, Mar 2008
[8]  Lin, TW, Cardenas, L, Soslowsky, LJ, “Biomechanics of tendon injury and repair,” J Biomech, 37(6): 865-77, Jun 2004.
[9]  Coombs, R, Schaden, W, Zhou, SS, “Musculoskeletal Shockwave Therapy,” Greenwich Medical Media, Ltd London, UK 2000.
[10]  Agostino, M,C,D, Frairia, R, P, Romeo, E, Amelio, L, Berta, V, Bosco, S, Gigliotti, C, Guerra, S, Messina, L, Messuri, B, Moretti, A, Notarnicola, G, Maccagnano, S, Russo, R, Saggini, M, C, Vulpiani, P, Buselli, “Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice,” J Biol Regul Homeost Agents, 30(2): 323-32, Jun 2016.
[11]  Loiacono, C,Palermi, S, Massa, B, Belviso, I, Romano, V, Di Gregorio, A, Sirico, F, Sacco, “A. Tendinopathy: Pathophysiology, Therapeutic Options, and Role of Nutraceutics. A Narrative Literature Review,” Medicina (Kaunas), 7; 55(8):447, Aug 2019.
[12]  Bokhari, MG; Murrel, Ga. “The role of nitric oxide in tendon healing,” Journal of elbow and shoulder surgery, 2012
[13]  Aiyegbusi, AI, Duru, FI, Awelimobor, D et al. “The role of aqueous extract of pineapple fruit parts on the healing of acute crush tendon injury,” Nigerian quarterly journal of hospital medicine, 2010.
[14]  Shakibaei, M, Buhrmann, C, Mobasheri, “A. Anti-inflammatory and anti-catabolic effects of TENDOACTIVE on human tenocytes in vitro,“ Histology and Histopathology, 2011.
[15]  Fusini, F; Bisicchia, S; Bottegoni, C; Gigante, A; Zanchini, F; Busilacchi, A, “Nutraceutical supplement in the management of tendinopathies: a systematic review,” Muscles Ligaments Tendons J,;6(1):48-57, May 2016.
[16]  Gumina, S, Passaretti, D, Gurzì, MD, Candela, V. Share, “Arginine L-alpha- ketoglutarate, methylsulfonylmethane, hydrolyzed type I collagen and bromelain in rotator cuff tear repair: a prospective randomized study,” Curr Med Res Opin, PMID: 23043451, Oct 2012.
[17]  Notarnicola, A, Maccagnano, G; Moretti, L, Pesce, V, Tafuri, S, Fiore, A, Moretti, B, “Methylsulfonylmethane and boswellic acids versus glucosamine sulfate in the treatment of knee arthritis: Randomized trial,” Int J Immunopathol Pharmacol, 29(1): 140-146, Mar 2016.
[18]  Notarnicola, A, Tafuri, S, Fusaro, L, Moretti, L, Pesce, V; Moretti, B, “The “MESACA” study: methylsulfonylmethane and boswellic acids in the treatment of gonarthrosis,” Adv Ther, 28(10):894-906, 2011 Oct.
[19]  Vitali, M, Naim Rodriguez, N, Pironti, P, Drossinos, A, Di Carlo, G, Chawla, A, Gianfranco, F, “ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study,” J Drug Assess, 8(1):77-86. May 2019.
[20]  Notarnicola, A, Pesce, V, Vicenti, G et al, “SWAAT study: extracorporeal shock wave therapy and arginine supplementation and other nutraceuticals for insertional achilles tendinopathy,” Adv Ther, 29: 799-814, 2012.
[21]  Visco, V, Vulpiani, M.C, Torrisi, M.R, Ferretti, A, Pavan, A, Vetrano, M, “Experimental studies on the biological effects of extracorporeal shock wave therapy on tendon models. A review of the literature,“ Muscles Ligaments Tendons J, 4(3): 357-361, 2014 Jul-Sep.
[22]  Leone, L, Vetrano, M, Ranieri, D, Raffa, S, Vulpiani, M C, Ferretti, A, Torrisi, M R, Visco, V, “Extracorporeal Shock Wave Treatment (ESWT) Improves In Vitro Functional Activities of Ruptured Human Tendon-Derived Tenocytes,” PLoS One,; 7(11): e49759, 2012.
[23]  Loiacono, C, Palermi, S, Massa, B, Belviso, I, Romano, V, Di Gregorio, A, Sirico, F, Sacco, A.M, “Tendinopathy: Pathophysiology, Therapeutic Options, and Role of Nutraceutics. A Narrative Literature Review,” Medicina (Kaunas), 55(8): 447, Aug 2019.
[24]  Butawan, M, Benjamin, R.L, Bloomer, R.J, “Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement,” Nutrients, 9(3): 290, Mar 2017
[25]  Lugo, JP; Saiyed, ZM; Lane, NE, “Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study,” Nutr J, 15: 14., Jan 2016.
[26]  Crowley, DC; Lau, FC; Sharma, P et al, “Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial,” Int J Med Sci, 6(6): 312-21, 2009.
[27]  Oliva, F, Gallorini, M, Antonetti Lamorgese Passeri, C, Gissi, C, Ricci, A, Cataldi, A, Colosimo, A, Berardi, A.C, “Conjugation with Methylsulfonylmethane Improves Hyaluronic Acid Anti-Inflammatory Activity in a Hydrogen Peroxide-Exposed Tenocyte Culture In Vitro Model,” Int J Mol Sci, 21(21): 7956, Oct 2020.
[28]  Du Souich, P, García, A.G, Vergés, J, Montell, E, “Immunomodulatory and anti-inflammatory effects of chondroitin sulphate,” J Cell Mol Med, 13(8a): 1451-1463, Aug 2009.
[29]  DePhillipo, N.N; Aman, Z S; Mitchell, I; Kennedy, J P; Begley, G M; LaPrade, F, “Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review,” Orthop J Sports Med, 6(10): 2325967118804544, Oct 2018.
[30]  Merolla, G, Dellabiancia, F, Ingardia, A, Paladini, P, Porcellini, G, “Co-analgesic therapy for arthroscopic supraspinatus tendon repair pain using a dietary supplement containing Boswellia serrata and Curcuma longa: a prospective randomized placebo-controlled study,” Musculoskelet Surg, 99 Suppl 1():S43-52, Sep 2015.
[31]  Peddada, K V, Peddada, K V, Surendra, K S, Mishra, A, Verma, V, “Role of Curcumin in Common Musculoskeletal Disorders: a Review of Current Laboratory Translational, and Clinical Data,” Orthop Surg, 7(3): 222–231, Aug 2015.
[32]  Mollazadeh, H, Cicero, AFG, Blesso, CN, Pirro, M, Majeed, M, Sahebkar, A, “Immune modulation by curcumin: The role of interleukin-10,” Crit Rev Food Sci Nutr, 59(1): 89-101. 2019.
[33]  Collier, TA; Nash, A; Birch, H L; de Leeuw, N H, “Intra-molecular lysine-arginine derived advanced glycation end-product cross-linking in Type I collagen: A molecular dynamics simulation study,” Biophys Chem, 218: 42-46, Nov 2016.
[34]  Molinari, C, Morsanuto, V, Polli, S, Uberti, F, “Cooperative Effects of Q10, Vitamin D3, and L-Arginine on Cardiac and Endothelial Cells,” J Vasc Res, 55(1):47-60, 2018.
[35]  Onken, JE, Greer, PK, Calingaert, B, Hale, LP, “Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro,” Clin Immunol, 126(3):345-52, Mar 2008.