Extracorporeal Shockwave Therapy (E.S.W.T)

What is ESWT?

Extracorporeal Shock Wave Therapy is an effective treatment modality used to treat chronic musculoskeletal pathologies. Shockwaves are sent through the hand piece and are used to break up scar tissue and calcification, in turn stimulating the healing process (vascular growth) in tendons and bones. This occurs as the tissues release local growth factors and stem cells, facilitating regeneration by breaking down and removing the chronic scar tissue that prevents the natural healing process. Foot and Ankle Centre of Frisco &Plano, 2014 http://www.dfwfoot.com/services_eswt.html

Indications for ESWT

  • Chronic Plantar fasciitis (heel pain)
  • Chronic Insertional and mid-portion archillies tendinopathy
  • Medial Tibial Stress Syndrome (shin splints)
  • Patella syndrome
  • Osgood-schlatter disease
  • Myofascial pain syndrome
  • Acute and chronic soft tissue wounds
  • Connective Post-trauma ligamentous damage

Contraindications for ESWT

  • Treatment of air filled tissue (lungs and stomach)
  • Treatment of pre-ruptured tendons
  • Pregnant women
  • Treatment of patients under the age of 18 (except for Osgood Schlatter disease)
  • Blood clotting issues (history of thrombosis) and on oral anticoagulants
  • Treatment of tissues with local tumours, with local bacteria and/ or viral infections
  • Patients already treated with cortisone

Effectiveness of ESWT

ESWT is an effective non-surgical treatment option. It can be used in conjunction with conservative treatment modalities including: orthotic therapydry needlingmobilisation, taping, footwear modificationand stretching/strengthening regimes. Depending upon the treatment plan prescribed by your podiatrist, the course of ESWT is generally 3 treatment sessions provided once a week for 3 weeks. In more severe cases the patient may require more than 3 sessions. In most instances, pain levels are reduced after treatment, however the area treated may continue to be tender and it is not unusual to experience some localised swelling or bruising. ESWT facilitates natural healing and its maximum benefit is generally seen 10-12 weeks after the first session.


What to expect during the treatment

At AC Podiatry we require an exact diagnosis using X-ray, Ultrasound or MRI of your condition (s) before you are eligible for ESWT. This ensures that we are treating the area in the optimal stage of healing whilst ensuring no further injury to the area being treated. All patients will be booked in for an initial assessment prior to the commencement of ESWT. Once your eligibility has been confirmed by your podiatrist you will then be booked in for your ESWT appointment. Once the area of concern is palpated and marked out, a water based gel will be applied. Using a hand held piece, shockwaves will be applied against the skin using various amounts of force as dictated by the area being treated. The initial phase of the treatment will cause some discomfort and pain. This reaction also ensures the podiatrist has targeted the area that requires treatment. A feeling of numbness, heaviness or a dull pain usually occurs in the latter stages of the treatment once the body’s natural anaesthesia has been activated.


Post-treatment care

It is extremely important not to partake in any harmful or extreme activities or sports over the duration of the treatment course. This can affect the quality and rate of healing and potentially damage the treated area. If you previously wore orthotics or offloading walkers/boots before the treatment please follow the management plan the podiatrist has provided you. The effects of this treatment takes time, so please do not be discouraged if you are not experiencing pain relief straight away.

Clinical Evidence of Effectiveness of ESWT

“Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up.” Foot and Ankle International, , 2003, vol. 24, iss 11: pp 823-8.Plantar Fasciitis (heel pain)Compared effectiveness of ESWT between 2 groups
Group 1 (25 heels) was treated with 3 sessions of ESWT
Group 2 (24 heels) nonsurgical treatment for 12 weeks.
12 weeks after ESWT, the pain diminished significantly by 62.9% in group 1 and by 63.0% in group 2
2 years after ESWT, pain decreased by 94% in group 1 and by 90% in group 2
Study 2IndicationResults
“Extracorporeal Shock Wave Therapy in Achilles Tendinopathy. A long term follow up observational study.” J Sports Med Fitness, 2009: 49; 171-6Achilles TendinopathyESWT in the effectiveness of symptomatic achilles tendinopathy over time
127 tendons that were diagnostically tested for tendinopathy was treated with 4 sessions of ESWT
Improvement found in 47.2% at 2 months follow up
Improvement found in 73.2% at medium-term follow up
Improvement found in 76% in the last assessment