Six studies with a total of 395 patients with plantar fasciitis were included in this systematic review and meta-analysis comparing small needle-knife therapy (SNK) to extracorporeal shock wave therapy (ESWT). The outcomes of interest included curative effect, pain intensity, and functional improvement. Pooled results showed no significant difference in curative effect or short-term pain improvement between SNK and ESWT. However, SNK demonstrated greater pain reduction in mid-term and long-term follow-ups, especially when combined with corticosteroid injection. Functional improvement was superior in the mid-term follow-up for moderate-quality studies. These findings suggest SNK may offer a promising alternative for pain relief and functional recovery in plantar fasciitis treatment.