Shock Wave Therapy

What is ESWT (Shock Wave Therapy)?

ESWT is a procedure where shock waves are passed through the skin to the injured part of the foot, using a special device. It is often referred to as "Extracorporeal" meaning outside of the body.

The shock waves are mechanical and not electric. They are low energy sound waves, which work by increasing blood flow to the injured area. 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.

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, but studies have shown that five to seven out of ten patients have found it to be effective.

The conditions in which we regularly treat with ESWT are Plantar Fasciitis and Achilles Tendinopathy.

Plantar Fasciitis:

Plantar fasciitis is inflammation of the plantar fascia. This is a thick fibrous band of tissue which spans the arch of your foot from heel to toes. Repeated small injuries to the plantar fascia are believed to be the cause of the pain in some or all of the fascia.

This is a condition that effects 1 in 10 of us during our lifetime. Most people experience pain on the inside of the heel but it can radiate up into the arch of the foot. Pain is often worse in the morning or after periods of rest. If you have been suffering with pain for longer than 6 months then get in touch.

Achilles Tendinopathy:

Achilles tendinopathy is a common condition that causes pain, swelling, stiffness and sometimes weakness to the Achilles tendon. This is the tendon which 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 build up over time.

We are able to apply shock wave to the insertional point and mid-portion of the Achilles tendon.

DO NOT HAVE SHOCKWAVE TREATMENT IF

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 the area to be treated
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 podiatrist when the treatment is offered.

Are there any alternatives?

If ESWT does not help your pain, then sometimes an operation may be available, depending on your condition. We will discuss this with you.

How can you 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
Wear comfortable clothing as you will be lying on your front for the treatment.

Giving your consent (permission)

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 a clinician who has undertaken special training to carry out the procedure. The have completed both theory and practical training in this technique.

What happens during ESWT?

The treatment will be given in clinic.
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 this hand piece.
Each treatment will take approximately five minutes.
The treatment can be a little noisy.

Will you feel any pain?

Most patients do experience some pain or discomfort during the procedure. If the pain is too much during treatment please tell us and we will attempt to adjust the treatment to help manage this.

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 you need to do after you 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 your GP or go to your nearest Emergency Department (A&E).

Will I have a follow-up appointment?

We will arrange your follow-up appointment for you.

Further sources of information

National Institute for Health and Care Excellence (NICE)

NICE has produced recommendations for patients on ESWT for Achilles tendinopathy and plantar fasciitis. These documents can be accessed on the NICE website.

w: www.nice.org.uk