Treat tendon pain and plantar fasciitis effectively.
by Lee Short MScDPodM and Bob Longworth MSc DPodM
We have been impressed with the results of using ‘Shockwave’ on plantar heel pains and tendinopathies and are now happy to offer this treatment at our clinics. If your heel pain isn’t responding to the usual treatments then 4 to 6 weekly applications of Shock Wave therapy are recommended.
So what is Shock Wave therapy?
Extracorporeal ShockWave Therapy (ESWT) has been around for a couple of decades but only recently has the overwhelming positive evidence for its use in tendinopathies and plantar fasciitis been published. A rapid pulse from the applicator applies a repeated shock wave to the affected tissue which stimulates healing
What’s the evidence for it?
In 2015 ‘The International Journal of Surgery’ did a whole publication on the benefits of it including articles on its use with bone healing (both non-unions and necrotic femoral heads), myofascial pain and diabetic ulcers as well as positive outcomes with Plantar Fasciitis and Achilles tendinopathy.
In 2016 Scheuer et al used it on 363 feet with recalcitrant plantar fasciitis and found 74% were absolutely or nearly absolutely satisfied with the outcome, another 10% were satisfied with reservations and 16% dissatisfied.
“We conclude that focused ESWT is an efficient treatment option for plantar fasciitis in terms of treatment success, safety, and its independence of socio-demographic, anamnestic, and treatment related factors”
Whilst it has tended to be used on chronic plantar fasciitis (when all else has failed) Saxena et al (2017) showed that it can also be effective in the early stages:
“Our investigation revealed that early treatment with RSWT is as effective when present for three or less months, and can be implemented sooner, before the condition becomes chronic.”
In a paper looking at best practice for plantar heel pain, Morrissey et al (2021) recommend Shockwave therapy if no improvement after 4 weeks of ‘core’ treatment (stretching, strengthening, footwear issues…etc.)
Purcell et al (2018) used it on 111 heels of Military personnel with plantar fasciitis, to good effect. Results were slightly reduced in those still on active duty:
“Significant improvement was observed in both active and non–active duty populations,with a 63% and 79% reduction in pain, respectively”
Whilst there is still some debate as to how it actually works, Bicer et al (2018) showed that the thickness of the plantar fascia (which is associated with the pain) reduced to a more normal size and the surrounding bone oedema also reduced:
“The duration of painless walking according to the 6-point rating scale, the FAOS, and pain showed significant improvements after ESWT (P < .05). Significant decreases in MRI findings, including thickening of the plantar fascia, soft-tissue edema, and bone marrow edema, were observed after treatment (P < .05).
ESWT is safe and there don’t seem to be any major issues with its use. Roerdink et al (2017) did a systematic review of 39 studies (2697 heels) and concluded that :
“…both low- and high-dose ESWT are safe treatments for Plantar Fasciitis. Complications during the first follow-up yearafter the last ESWT treatment are very unlikely. Long-term complications are not described in the current literature. Common side effects are pain during treatment and transient erythema”
If you are struggling with Plantar Fasciitis or Achilles Tendinopathy, Shock Wave can really help reduce pain and speed up healing times.
Make an appointment to discuss this treatment option with us.
References:
Bicer et al (2018) Assessment of the Efficacy of Extracorporeal Shockwave Therapy for Plantar Fasciitis with Magnetic Resonance Imaging Findings. Journal of the American Podiatric Medical Association. 108(2):100-105
Editorial (2015) ESWT is a force to be reckoned with. International Journal of Surgery. 24:113-114Morrissey et al (2021) Management of plantar heel pain: a best practice
guide informed by a systematic review, expert clinical
reasoning and patient values British Journal of Sports Medicine
55:1106–1118Purcell et al (2018) Clinical Outcomes After Extracorporeal ShockWave Therapy for Chronic Plantar Fasciitis in a Predominantly Active Duty Population. The Journal of Foot & Ankle Surgery. 57:654-657
Roerdink et al (2017) Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review. International Journal of Surgery. 46:133-145
Saxena et al (2017) Treatment of Plantar Fasciitis With Radial Soundwave “Early” Is Better Than After 6 Months: A Pilot Study. The Journal of Foot & Ankle Surgery. 56:950-953
Scheuer et al (2016) Approaches to optimize focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis. International Journal of Surgery. 27:1-7
by Lee Short MScDPodM and Bob Longworth MSc DPodM