What is extracorporeal shock-wave therapy (ESWT)?

Extracorporeal (outside the body) shockwave (high energy sound wave) therapy is a non-invasive treatment designed to treat the causes of chronic pain without the need for injections, medication or surgery.

What can be treated using ESWT?

Extracorporeal shockwave therapy is used in a variety of clinical applications including the management of musculoskeletal conditions. Beneficial effects have been shown in the management of musculoskeletal disorders including insertional Achilles tendinopathy and plantar fasciitis.

How does ESWT work?

These waves are mechanical not electrical. They make the area inflamed, which speeds up the body’s healing process by increasing blood circulation and metabolism.

Risks of ESWT treatment

This treatment is safe. However, not everyone can have this treatment, and there is a chance it may not help your symptoms.

Who can have ESWT treatment

You are not allowed ESWT if any of the following apply to you:

• Allergy to gels used when having an ultrasound scan
• Tendon rupture/fascial tear
• Aged under 18
• Haemophilia/clotting disorder/risk of haemorrhage
• Unstable heart condition such as chest pain or blood pressure which is too high
• Taking certain type of antibiotics known as fluoroquinolones
• Inherited brittle bone diseases (osteogenesis imperfecta)
• Taking warfarin
• You have a fracture near the site to be treated.

Treatment will not be given if you:

• Are pregnant/trying to conceive
• Have electronic implants (pacemakers/cardiac device) in the area to be treated
• Have cancer in the area to be treated
• Have infection in the area to be treated
• Have severely impaired circulation
• Have severe inflammation in the treatment area.

You may not be allowed to have this treatment if:

• Taking anticoagulant medication, for example rivaroxaban
• Taking anti-platelet medication, for example aspirin, clopidogrel
• You have a joint replacement near the treatment area
• You have an inflammatory disease such as rheumatoid arthritis (treatment will not be given during a flare up)
• You've had a previous Achilles tendon rupture (until it is confirmed fully healed)
• You have increased sensitivity over the area to be treated. If the area is still sore after previous treatment, this will need to settle before starting the next treatment.
• There is marked reduction in sensation to the treatment area, for example, neuropathy linked with having diabetes
• You have epilepsy. We need to ensure that this is managed well and stable
• You've had a steroid injection to the area within the last three months.

Side-effects of ESWT treatment

Local Effects:

• Bruising
• Pain
• Local swelling
• Skin reddening
• Numbness or altered sensation
• Sores to the skin
• Damage to the tendon or plantar fascia.

Systemic effects:

• Headache
• Migraine.

These side effects should resolve over the week leading to your next treatment. There is a small risk of tendon rupture and damage to the soft tissue.

How should I prepare

You must refrain from taking any anti-inflammatory medication for two weeks prior to the treatment and throughout the treatment.

You can eat and drink normally before the procedure.

Continue with previous treatments advised.

Ensure your footwear promotes support and stability.

Asking for your consent

It is important that you are involved in decisions about your care and you are required to sign a consent form to indicate that you agree to have the treatment and understand what it involves. You can change your mind at any time, even if you have signed the consent form.

Who will do the treatment

The treatment will be given by a healthcare professional; a podiatric surgeon, specialist podiatrist or podiatry assistant.

What happens during the procedure

The symptomatic area is located through palpation and then a gel is applied to improve the transmission of the shockwaves. The shockwave is delivered to the tissue via a compressed air impulse exerted by a hand device. The shockwave radiates to the area where pain occurs.

Usually no more than three or four sessions are needed at intervals of one or two weeks apart. Each treatment takes between five and 10 minutes.
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Will I feel pain during treatment

The treatment can be painful, but if the pain gets too much, the setting can be adjusted to reduce it.

What can I expect after the treatment

You will normally experience a reduced level of pain or no pain immediately after the treatment. You may also have a mild ache after the treatment which should ease after a few hours. You can take over-the-counter pain relief such as paracetamol.

Don’t put ice on the treated area or take non-steroidal anti-inflammatory medication such as aspirin, ibuprofen, Naproxen or diclofenac as this will interfere with healing.

You should avoid strenuous exercises or impact such as running for 48 hours following treatment.

It may take several months before maximum effect is achieved.

Will I need a follow-up appointment

You will be discharged after the final treatment.