The Science Behind ESWT and How it Treats Plantar Fasciitis

April 4, 2023
3:35 pm

Extracorporeal Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) has been a therapeutic option for decades and should not be mistaken for the archaic form of ‘shock treatment.’ Rather, this type of medical intervention is in no way related to its namesake.

This ingenious shock wave device contains a piston that oscillates and strikes a specialized head. As a result, a radial sound wave is emitted into the affected tissue, providing you with four established advantages:

With ESWT, you DON’T need to worry about surgery — this treatment is completely non-invasive!

By numbing the nociceptors, which are responsible for registering pain signals, one can experience a decrease in discomfort.

Collagen generation is invigorated to effectively aid in the mending and reconstruction of muscles, tendons, and soft tissues.

Shock waves activate a process called angiogenesis, resulting in the formation of new blood vessels and enabling more oxygen and nutrients to reach damage sites for injury recovery.

What is the science behind it?

Similarly to an ultrasound scan, ESWT utilizes a gel to transmit sound waves from the transponder into the tissues. This process works by concentrating these soundwaves at a particular spot which creates direct mechanical pressure in deep tissue layers. The energy is then released through “bubble cavitation”. To make it easier to comprehend, think of this as a powerful and accurate massage that no physiotherapist’s fingers can reach. (Extracorporeal Shock Wave Therapy for Tendinopathies – PubMed, 2006)

Shockwave therapy can produce remarkable outcomes for those experiencing pain. It has a direct impact on the nerves in the area, specifically sensory ones that transmit ache signals. Studies have revealed that there is an unmistakable decrease in the number of nerve fibers responsible for transmitting pain sensations to and from the targeted area post-treatment. (Shock Wave Application to Rat Skin Induces Degeneration and Reinnervation of Sensory Nerve Fibres – PubMed, 2001)

ESWT has been proven to be instrumental in the accelerated production of growth factors, with a direct impact on animal tendon healing and recovery. As tendons can take an extensive time limit to recuperate from injury, this benefit is especially significant. (Extracorporeal Shock Waves Promote Healing of Collagenase-induced Achilles Tendinitis and Increase TGF-beta1 and IGF-I Expression – PubMed, 2004)

How does ESWT treat plantar fasciitis?

To provide the most effective treatment for plantar tissue damage, ESWT utilizes a handheld device to send powerful and targeted shockwaves into the affected area. Depending on your provider and desired outcome, these shockwaves can either be high or low intensity.

Targeted shockwaves from ESWT can break up the scar tissue that keeps the plantar fascia from absorbing impact and functioning optimally. This process triggers a healing reaction in your body, encouraging new healthy tissues to grow and replace any damaged or injured ones for lasting results.

What can be anticipated during ESWT for plantar fasciitis

ESWT treatments are normally done in a doctor’s office, and it is considered an outpatient procedure that offers a speedy recovery period.

eswt process — Source: Youtube – ESWT Shockwave Therapy for Heel Pain

When you visit the treatment center for your Extracorporeal Shock Wave Therapy (ESWT) session, you will be greeted by both a doctor and ESWT technician. You’ll then recline in either an armchair or bed as the shockwaves are delivered into the affected area of your fascia – up to thousands within 20 minutes! Afterward, you can seamlessly depart home.

Unlike surgery, there is no extensive downtime or recovery period with low-intensity ESWT. As it’s not particularly painful, anesthesia isn’t required either. When the intensity of shockwaves increases during treatment, however, local anesthesia will be given to make sure that you don’t feel any pain whatsoever throughout your procedure.

Related: What causes heel pain?

How effective is ESWT?

In a recent meta-analysis published in the Journal of Cellular Physiology, Haibo Li and colleagues set out to assess eight prevalent treatments for chronic plantar fasciitis: NSAIDs (nonsteroidal anti-inflammatory drugs), corticosteroid injections, platelet-rich plasma therapies (PRP), extracorporeal shockwave therapy (ESWT), ultrasound treatment, dry needling techniques, and botulinum toxin remedies.

After carefully assessing each of the eight treatments for factors such as improved foot function and pain relief, it was determined that Extracorporeal Shock Wave Therapy (ESWT) emerged victorious in all four outcomes. Therefore, ESWT can be determined to have had the best overall efficacy of these eight interventions. (Comparison of Efficacy of Eight Treatments for Plantar Fasciitis: A Network Meta-analysis – PubMed, 2018)

For whom is shockwave therapy not recommended?

In some cases, individuals may not be suitable candidates for shockwave therapy. These situations might arise due to certain underlying medical conditions or other factors that pose a risk to the patient’s health. It is important for patients to consult with their healthcare provider before undergoing any kind of treatment, including shockwave therapy, to ensure its safety and effectiveness.

Patients who have pacemakers.

Patients utilizing anticoagulants, such as coumadin, that may delay or hinder the blood clotting process are not eligible to receive Extracorporeal Shock Wave Therapy (ESWT).

Patients with tumors.

ESWT treatment is not suitable for either children or pregnant women.

Extracorporeal shock wave therapy is not recommended for individuals suffering from very recent plantar fasciitis that has been present for less than four weeks. Therefore, it is essential to exhaust other conservative treatments before considering ESWT as a viable option.

In conclusion, extracorporeal shockwave therapy (ESWT) has emerged as a promising treatment option for plantar fasciitis. It works by stimulating the body’s natural healing process and reducing pain and inflammation in the affected area. Mid Ohio Foot and Ankle Specialist offers this innovative treatment option to its patients. If you or someone you know is suffering from plantar fasciitis, don’t hesitate to consult with our specialist to see if ESWT can help alleviate your symptoms and get you back on your feet again!