Sixteen studies were included in the review; sample sizes were not reported.
Eccentric exercise versus control: Four of five trials showed statistically significant improvements in pain scores in the eccentric exercise group compared with the control group.
Variations of eccentric exercises, splints or insoles: One RCT found no effect of restriction of running and jumping in patients undergoing eccentric training. A second RCT found that eccentric exercises were more effective in reducing pain than night splints, but that there was no additional advantage for the two treatments combined. A third study found no difference between eccentric exercise and insole therapy, although insoles were superior to control (normal activity).
Extracorporeal shockwave therapy: One RCT showed a statistically significant benefit of extracorporeal shockwave therapy over a wait-and-see group, but no difference between extracorporeal shockwave therapy and eccentric exercise. A second trial found no difference between extracorporeal shockwave therapy and placebo therapy.
Local injections: One of two RCTs found a statistically significant effect of local steroid injection on ambulation pain at four weeks; the second found no difference in pain or return to function at 12 weeks. Trials using injections of other agents found benefits for polidocanol and deproteinised haemodialysate, but not for aprotinin (one RCT in each case).
Other conservative treatments: Benefits were found for iontophoresis with dexamethasone and topical glyceryl nitrate (one RCT in each case).