Shockwave Therapy

Extracorporeal Shock Wave Therapy

This page explains about the use of extracorporeal shock wave therapy (ESWT) to treat achilles tendinopathy and plantar fasciitis. It includes information on the benefits, risks and any alternative treatments, as well as what you can expect when you come to Fitter Feet for Life for treatment.

If you have any further questions, please speak to the Podiatrist caring for you.

What is Achilles tendinopathy?

Achilles tendinopathy is a condition that causes pain, swelling, stiffness and weakness to the achilles tendon, the tendon that attaches your calf muscle to your heel bone. It is thought to be caused by repeated small injuries to the tendon that do not heal, and so build up over time.

What is Plantar Fasciopathy or Plantar Fasciitis?

Plantar fasciitis is inflammation of the plantar fascia. This is a thick fibrous band of tissue at the bottom of your foot that lies between your toes and your heel. Repeated small injuries to the plantar fascia are believed to be the cause of the inflammation.

What is ESWT?

ESWT is a procedure where shock waves are passed through the skin to the injured part of the foot, using a special device. Extracorporeal means outside of the body. The shockwaves are mechanical and not electric. They are audible, low-energy sound waves, which deliver impulses of energy, targeted to specific damaged tissues within the abnormal tendon and/or plantar fascia. This increases the blood flow in injured area, stimulating cell regeneration and healing, and decreasing local factors which can cause pain. This speeds up your body’s healing process. You will usually require a course of three to six treatments, one to two weeks apart.

Why should I have ESWT?

ESWT is offered to patients who have not responded well enough to other treatments, such as physiotherapy, orthotics (insoles or leg braces), rest, steroid injection, ice therapy and pain relief. It is a minimally invasive treatment that is carried out on an outpatient basis, which means that you can go home the same day. ESWT can offer relief from pain and other symptoms.

Before shockwave therapy is considered you will have a full clinical assessment. This will include a film of you walking to assess your gait and joint alignment, and may include a referral for an MRI or Ultrsound scan.

What are the risks/side effects?

You will experience some pain/discomfort during the treatment, but you should be able to cope with this. Following the treatment, you may initially experience more pain, redness, bruising, swelling and numbness to the area. These side effects should resolve within a week, before your next treatment. There is a small risk of tendon rupture or ligament rupture and damage to the soft tissue.

You will be asked to complete a questionnaire before your treatment starts, after three months and again one year after your treatment.

You must not have ESWT for Achilles tendinopathy or plantar fasciitis if you

  • are pregnant
  • are taking antiplatelets excluding aspirin 75mgs (for example, clopidogrel) or anticoagulants (such as warfarin or rivaroxaban)
  • have a blood clotting disorder
  • are under the age of 18
  • have been diagnosed with bone cancer
  • have an infection in your foot
  • have a history of Achilles tendon or plantar fascia ligament rupture
  • have had a steroid injection into the affected area in the previous 12 weeks

These will be discussed with you by your specialised Podiatrist when the treatment is offered. Your Podiatrist will discuss the benefits and risks of the procedure with you in more detail – please let them know if you have any questions or would like any further information.

Are there any alternatives?

If ESWT does not help your pain, then sometimes an operation may be available, depending on your condition. You can discuss this with our Consultant Podiatric Surgeon Ms Diane Nicholl Msc FCPodS.

How can I prepare for ESWT?

  • You will need to be available for the full course of treatment.
  • You should not take any non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for two weeks before your first procedure, and throughout your treatment.
  • If you are unsure if any of your medicines contain NSAIDs then please check with your doctor, Podiatrist or pharmacist. Wear comfortable clothing as you will be lying on your front for the treatment.

Giving my consent (permission) for ESWT treatment.

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves. If you would like more information about our consent process, please speak to a member of staff caring for you.

Who will carry out the procedure?

Your ESWT will be carried out by one of our Podiatrists who all of whom have undertaken special training to carry out the procedure.

What happens during ESWT?

The treatment will be given in the ESWT Department at Fitter Feet for Life. You will be asked to lie on your front with your legs supported by a pillow. The clinician will put some ultrasound gel on the injured area and then place the hand piece of the device on the gel. The ESWT is delivered using a hand piece – it delivers compressed air pulses through the ultrasound gel. Each treatment will take approximately five minutes.

Will I feel any pain?

Most patients do experience some pain or discomfort during the procedure. You will be asked how much pain you are experiencing during the treatment, and we will attempt to adjust the treatment to help manage this. If you find the treatment too uncomfortable we can administer a local anesthetic by injection.

What happens after ESWT?

After the treatment you will be able to get up and walk straight away. If you do experience discomfort following the shockwave treatment you can take over the counter painkillers (such as paracetamol) but don’t take anti-inflammatory medication (such as ibuprofen) and ice therapy, as these can interfere with the body’s healing process.

What do I need to do after I go home?

You will be able to return to your usual activities straight away and can return to work immediately. However we advise you not to undertake any strenuous, pain-provoking activity or high-impact exercise for 48 hours following the procedure. If you experience a sudden onset of pain to the area or any loss of function, please contact Fitter Feet for life to be reviewed by a Podiatrist.

Will I have a follow-up appointment?

You will have a follow-up appointment with your Podiatrist 6 weeks after your final treatment. You will also receive a follow up questionnaire at that time, and also one year after your treatment, to assess the effectiveness of ESWT.

The National Institute for Health and Care Excellence (NICE) has produced recommendations for patients on ESWT for Achilles Tendinopathy and Plantar Fasciitis. These documents can be accessed on the NICE website.

 

ESWT for other conditions

In addition to Achilles Tendinitis and Plantar Fasciitis, Extracorporeal Shockwave Therapy treatment is a highly effective treatment available for patients with:

  • Shoulder pain
  • Tennis elbow
  • Trochanteric bursitis (Lateral hip pain)
  • Patellae tendonitis