Pulsed Electromagnetic Field Therapy for Plantar Fasciitis: Study Finds Improvements in Ultrasound and Function

Key Takeaways 

• In 12 patients with plantar fasciitis, mean plantar fascia thickness decreased 34%, from 6.5 mm at baseline to 4.3 mm at 12 weeks, while mean hypoechoic region width decreased 79%, from 32 mm to 6.6 mm. 

• Patient-reported function also improved: mean Foot and Ankle Disability Index (FADI) scores increased 46%, while Patient-Specific Functional Scale (PSFS) scores increased 166% over 12 weeks. 

• The findings suggest PEMF therapy may have potential as a conservative treatment for plantar fasciitis, but the study included only 12 patients, had no concurrent control group, and combined PEMF with stretching, limiting conclusions about the independent effect of PEMF. 

Evaluating PEMF Therapy for Plantar Fasciitis 

Plantar fasciitis is a common cause of heel pain, although the authors note that the underlying pathologic changes are more consistent with degeneration than inflammation, making terms such as plantar fasciosis or plantar fasciopathy potentially more appropriate.¹ Ultrasound findings associated with the condition include plantar fascia thickening greater than 4 mm and hypoechoic abnormalities reflecting microtrauma and degeneration. 

In this case series, Bromley and colleagues evaluated pulsed electromagnetic field therapy as a conservative, noninvasive, nonpharmacologic approach to plantar fasciitis. PEMF delivers an electromagnetic field into target tissue without direct contact. The authors describe a proposed mechanism involving calcium-calmodulin signaling and nitric oxide production, which may contribute to anti-inflammatory and tissue-repair responses.¹ 

Study Design and Treatment Protocol 

Adults aged 18 to 65 years with persistent heel pain attributed to plantar fasciitis for more than 2 weeks were enrolled consecutively from an urban, hospital-based podiatry clinic. Patients with several conditions or treatments—including diabetes, smoking, plantar fascia surgery, corticosteroid injection within 6 months, tarsal tunnel syndrome, and lumbar radiculopathy—were excluded.¹ 

Participants used a specific PEMF foot device for 2 hours daily for 12 weeks, together with at-home stretching exercises and appropriate footwear. They were also advised to avoid walking or standing barefoot and oral anti-inflammatory medications. Outcomes were evaluated at baseline and at weeks 4, 8, and 12. Ultrasound measured maximum plantar fascia thickness and hypoechoic region width, while functional outcomes were assessed with the FADI and PSFS. Twelve patients with complete data were included in the final analysis.¹ 

Ultrasound Measures Improved Over 12 Weeks 

The 12-patient cohort included nine women and three men, with a mean age of 51 years. No adverse effects were reported.¹ 

Mean plantar fascia thickness decreased from 6.5 mm at baseline to 4.3 mm at week 12, representing a 34% reduction (P = .005). Mean hypoechoic region width decreased from 32 mm to 6.6 mm, a 79% reduction (P = .004). The study's serial data also show that hypoechoic width declined at each assessment, whereas plantar fascia thickness decreased at week 4, increased at week 8, and then fell substantially by week 12.¹ 

The authors acknowledged this variation in plantar fascia thickness and suggested it could reflect variation in measurement technique. In contrast, the other measured outcomes improved more linearly over the study period.¹ 

Functional Outcomes Also Showed Significant Gains 

Functional improvements accompanied the ultrasound findings. Mean FADI scores increased from 55 at baseline to 81 at 12 weeks, a 46% improvement (P < .001). Mean PSFS scores increased from 2.9 to 7.7, corresponding to a 166% improvement (P < .001).¹ 

The investigators reported statistically significant improvement across all measured outcome variables. They also observed that reductions in ultrasound-measured plantar fascia thickness and hypoechoic region width were consistent with the improvements recorded on the functional assessments.¹ 

What Should Podiatrists Take From the Findings? 

The results support further investigation of PEMF therapy as a potential conservative option for plantar fasciitis, but the study design is important when interpreting the findings.¹ Only 12 patients with complete data were analyzed, and enrollment ended earlier than planned. The treatment protocol also incorporated stretching, appropriate footwear, and behavioral recommendations alongside PEMF, and there was no concurrent control group described in the study.¹ 

The authors additionally noted that PEMF treatment parameters vary considerably across available technologies, making comparisons between studies difficult. They recommended future studies evaluating different PEMF signal parameters and directly comparing PEMF with other plantar fasciitis treatments.¹ 

Overall, this small case series found that 12 weeks of PEMF therapy combined with stretching was associated with significant improvements in plantar fascia ultrasound findings and patient-reported function. The authors concluded that PEMF shows promise as a conservative treatment option for plantar fasciitis.¹