Extracorporeal Shockwave Therapy (ESWT) has over recent years become a popular treatment option for a variety of Musculoskeletal (MSK) conditions, particularly for plantar fasciitis. This modern therapeutic technique employs low to medium-level energy shockwaves to treat conditions and injuries in the musculoskeletal system.
Shockwave has its origins in lithotripsy, a medical technique used to treat and shatter kidney stones. However, its application was later discovered to be useful for treating MSK conditions in the 1990s. Initially, ESWT was used for the treatment of chronic tendon conditions then boney issues and non-union fractures. Its success in treating these conditions led to the investigation of its efficacy for other MSK conditions, including plantar fasciitis.
Plantar fasciitis is a common inflammatory condition causing heel pain. Shockwave treatment can provide an alternative to conservative treatment options such as exercise, rest, ice, and physiotherapy. The application of shockwave for plantar fasciitis has been found to create a mechanical stimulation on the affected site, leading to increased blood flow and the release of growth factors, which promote healing and pain relief, furthermore focused shockwave treatment can lead to the reversal of calcification ( the process responsible for heel spurs).
Studies have shown ESWT is highly effective in plantar fasciitis treatment, with a success rate of around 80 percent, successfully reducing symptom duration and improving patient quality of life. ESWT is a non-invasive, low-risk, and less time-consuming procedure compared to other invasive surgical treatment options, making it a preferable option for patients with chronic plantar fasciitis. Furthermore, focused shockwave treatment has been shown to be extremely effective with 72.2% of stubborn cases over 14 months duration only requiring one treatment and 22.9% requiring two treatments and only 5 % requiring three treatments.
Not all shockwave systems are equal
Shockwave comes in two variants, the cheaper form called radial and the more expensive and effective form called focused.
Radial shockwave therapy involves using a hand-held device that emits a series of high-pressure sound waves that spread or radiate out over a wide area. This technique is effective in treating conditions such as tendonitis and muscle strains, as it can help to promote blood flow and break up scar tissue.
On the other hand, focused shockwave therapy targets specific areas of the body using a machine that emits high-energy sound waves at a precise point. This technique is often more effective for treating localized conditions, such as plantar fasciitis, as it allows for more direct treatment of the affected area. The focused sound waves penetrate deeper into the body up to a depth of 12 cm if needed, allowing for more effective treatment at the source of the pain.
Research has shown that focused shockwave therapy can be highly effective in the treatment of plantar fasciitis. A study published in the Journal of Orthopaedic Research found that patients who received focused shockwave therapy experienced significant improvements in pain and function compared to those who received radial shockwave therapy or placebo treatment.
In addition, the use of focused shockwave therapy for plantar fasciitis has been supported by the American Academy of Orthopaedic Surgeons. Their guidelines state that focused shockwave therapy can be an effective treatment option for those who have not responded to more conservative treatments such as physical therapy and medication.
Overall, while both radial and focused shockwave therapy can be effective in treating certain conditions, focused shockwave therapy is often the preferred option for targeted treatment of plantar fasciitis. Its ability to penetrate deeper into the body and provide a more direct treatment of the affected area allows for more effective pain relief and improved function.
References:
- Faber FW, et al. (2003). Treatment of recalcitrant plantar fasciitis with shockwave therapy: a prospective randomized placebo-controlled multicenter trial. Journal of Orthopaedic Research, 21(5): 937–940.
- American Academy of Orthopaedic Surgeons. (2014). Treatment of Plantar Fasciitis. Retrieved from https://orthoinfo.aaos.org/en/treatment/treatment-of-plantar-fasciitis/. Scheuer R, Friedrich M, Hahne J, Holzapfel J, Machacek P, Ogon M, Pallamar M.
- Approaches to optimize focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis. Int J Surg. 2016 Mar;27:1-7. doi: 10.1016/j.ijsu.2016.01.042. Epub 2016 Jan 20. PMID: 26804353.