How to use shockwave therapy to treat plantar fasciitis

Pursuing innovative, non-invasive treatments for problematic foot ailments is never-ending for those who treat foot and ankle conditions. Plantar fasciitis is among the most prevalent of the many foot problems that patients seek treatment for. In the quest for promising solutions, shockwave therapy for feet has emerged as a regenerative powerhouse offering non-invasive treatment that provides new hope for patients plagued by pain and discomfort associated with plantar fasciitis.  
Insights abound in this comprehensive guide and demonstrate the importance of Extracorporeal Shockwave Therapy (ESWT), the innovative modality revolutionizing medicine and patient care. This guide dives into shockwave therapy, its applications, clinical efficacy focusing on plantar fasciitis, the best devices, and more.
Increasingly, patients are seeking treatment approaches that are efficient, well tolerated, and non-invasive, with no need for downtime – and shockwave delivers that along with optimal patient outcomes. This compendium of information empowers medical professionals  to approach plantar fasciitis treatment with renewed enthusiasm and certainty.

Plantar fasciitis is a common and troubling foot condition that causes adult heel and arch pain. This condition is caused by inflammation of the plantar fascia, which connects the heel bone to the toes.
The condition can cause excruciating pain and be particularly debilitating as it makes walking difficult and standing for extended periods next to impossible. Patients report that the worst pain often occurs in the morning upon rising and stepping out of bed. 
Upon diagnosis, treatment protocols are typically conservative and effective in nearly 90% of all cases and include:

• Physical therapy and stretching exercises
• Heel cups
• Orthotics and shoe modifications
• OTC non-steroidal anti-inflammatory drugs
• Extracorporeal Shockwave Therapy (ESWT) 

Historically, foot and ankle specialists have relied on conservative approaches when addressing plantar fasciitis. Shockwave is a viable option for all podiatrists to consider as a primary approach. As a secondary approach to address plantar fasciitis cases, it’s utilized when a patient’s condition has been non-responsive to the conservative protocols noted above. Increasingly, though, shockwave therapy is being used as a first line and preferential treatment for troublesome plantar fasciitis mainly because it is so effective.

Research abounds on the efficacy of shockwave therapy for plantar fasciitis which has proven to be remarkably promising. Multiple studies confirm that plantar fasciitis patients experience reduced pain and improved functionality post-ESWT treatment.

Extracorporeal Shockwave Therapy is hailed as the most innovative approach to treating acute and chronic musculoskeletal pain and connective tissue disorders. Shockwave therapy, alternatively known as radial pressure wave (EPAT) and focused shockwave (ESWT), stands at the forefront of medical innovation.
Shockwave ignites the body’s natural capacity for healing, and biological effects are triggered, facilitating tissue regeneration.Extracorporeal Shock Wave Therapy (ESWT) has gained widespread acclaim and recognition within the medical community, as a primary approach for plantar fasciitis. The efficacy of ESWT for plantar fasciitis has been clearly established in multiple clinical trials and meta-analyses.

Plantar Fasciitis treatment using ESWT is performed in a comfortable, in-office setting, and patients are not required to remove clothing (other than socks).
Here’s what the treatment looks like:

• Patients remain clothed and remove only their socks or stockings so that the treatment area is exposed.
• Patients are often positioned lying face down on the treatment table with legs supported by a pillow.
• Ultrasound gel is always applied to the affected heel area to optimize shockwave transmission.
• The handheld probe is carefully moved over the heel area, delivering compressed air pulses.
• The shockwaves penetrate the skin of the heel area, facilitating the stimulation of the regenerative healing process.
• In most cases, treatment duration is 7-10 minutes per affected area.
• On average, patients receive 3-6 treatments, one time per week.
• In addition to pain reduction, inflammation is drastically reduced.

Shockwave therapy for feet harnesses the power of targeted acoustic waves to ignite healing, quiet inflammatory responses, and remediate pain. This alternative healing method is a sought-after option that can eliminate the need for surgical intervention or corticosteroid injections. 

Researchers from Baskent University Medical School conducted a randomized, prospective, double-blind clinical trial on different energy levels of Extracorporeal Shockwave Therapy (ESWT) and the impact on clinical outcomes for participants treated for plantar fasciitis.The study's intended purpose was to explore the efficacy of ESWT and compare its different energy levels and outcomes in the treatment of plantar fasciitis. Further, researchers assessed and compared plantar thickness and accompanying pressure distribution.Explore the valuable insights within this study, which examines ESWT energy levels, by reading it in its entirety. The study titled “Comparison of Plantar Pressure Distribution, Ultrasonographic and Clinical Features Following the Application of Different Energy Levels of Extracorporeal Shockwave Therapy in Patients with Plantar Fasciitis: A Randomized, Prospective, Double-Blind Clinical Trial” was authored by Sukran Guzell, MD, Huma Boluk Selikci, MD, Hakan Suleyman Bal, MD and Bahtiyar Haberal, MD and published by The Journal of American Podiatric Medical Association, (JAPMA 112 4:e1-e26). Access the research document in its entirety to gain a thorough understanding of the study’s valuable insights

In all, 51 participants involving 71 feet presented with heel pain and were diagnosed with plantar fasciitis between July and September of 2021. The diagnosis was made based on clinical presentations and evidence, including heel pain occurring in the first step upon rising or after rest and additional physical findings. An example of other symptomatology includes pain on palpation of the site (plantar fascia insertion to the heel bone).

Patient participant inclusion criteria were as follows:

1. Age 18-85
2. Experiencing heel pain
3. Tenderness at the insertion site
4. Non-response to conservative treatment (over a period of 3 months)

Specific criteria constituted exclusion from the study:

1. Inflammatory rheumatic disease
2. Presence of local dermatological legion or infection
3. Peripheral circulation conditions
4. Radiculopathy and polyneuropathy
5. Congenital or acquired foot deformity
6. Malignancy
7. Cardiac pacemaker
8. Metal implants at the site location
9. Pregnancy

Study participants were randomly divided into three treatment groups reliant upon the sealed envelope method. 

• Group 1 – 25 feet treated with low energy density (0.09 mJ/mm2)
• Group 2 – 25 feet treated with medium energy density (0.18 mJ/mm2)
• Group 3 – 21 feet treated with high energy (0.38 mJ/mm2)

Shockwave therapy for feet was applied using a circular motion over the insertion site of the plantar fascia (1000 shocks) and along the fascia for 1000 shocks, receiving three sessions each with 2000 shocks per session at one-week intervals.All participants within three groups (treated with low, medium, or high energy) were treated using a STORZ Medical radial pressure wave device. During the clinical trial, no participant received additional treatment interventions such as physical therapy, injections, or anti-inflammatory medications.

Pre- and post-treatment participants were evaluated using the following assessments:

• VAS (visual analog scale) for pain
• FFI (Foot Function Index) 
• Plantar thickness (measured with ultrasonography and plantar pressure distribution)

Ultimately, among all participants in all three groups, post-treatment VAS and FFI were found to be statistically significantly lower than initial pretreatment values.

The study additionally concluded that neither of the levels (low, medium, high) of ESWT was found to be superior regarding pain, foot functions, fascia thickness, and pressure distributions while treating plantar fasciitis.

Demonstrating cost-effectiveness and sustained efficacy, shockwave therapy for plantar fasciitis is emerging as a clear frontrunner, far surpassing the success offered by conservative as well as invasive approaches. It should now be considered a cornerstone in managing cases of plantar fasciitis.

The benefits of shockwave for plantar fasciitis are numerous; consider them all:

• Significant pain reduction and taming of inflammation.

Numerous studies have proven shockwave therapy's efficacy and clinical benefits for plantar fasciitis. Reduction of debilitating symptoms spells relief for patients who were initially plagued by pain and limited movement.

• Eliminates or reduces the need for surgical intervention

Before the utilization of shockwave, patients who did not find relief in traditional treatments often had to opt for surgery. With the advent of shockwave, medical professionals can now provide patients with a breakthrough treatment offering optimal outcomes non-invasively. That’s a win-win for providers and patients alike.

• Accelerates healing and recovery timelines

• Improves patients' quality of life

• Practice differentiation

Providers who feature cutting-edge solutions like shockwave therapy for feet define themselves as innovators offering best-in-class care to patients. Become the go-to source for treatment in your region and reap the rewards.

• Increasing practice revenue

Shockwave is like rocket fuel for your practice ROI. Think of the new stream of patients you’ll attract with this innovative medical technology.

Shockwave therapy is considered remarkably safe overall. Despite that, following the procedure, certain patients may encounter temporary discomfort, redness, bruising, swelling, and numbness in the treated area. There exists a slight risk of Achilles tendon or plantar fascia rupture.

Additionally, in some instances, shockwave is contraindicated, including: