Overview

Extracorporeal (outside the body) shockwave (high energy sound waves) 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 your body’s healing process by increasing blood circulation and metabolism.

You are not able to have ESWT if any of the following list apply to you:

• allergy to gels used when having an ultrasound scan
• tendon rupture/fascial tear
• under 18 years of age
• haemophilia/clotting disorder/risk of haemorrhage
• unstable heart condition, such as chest pain, blood pressure that is too high
• taking certain type of antibiotics known as fluoroquinolones
• inherited brittle bone diseases (osteogenesis imperfecta)
• you take warfarin
• you have a fracture near the site to be treated.

Treatment will not be given if you:

• you are pregnant or trying to conceive
• you have electronic implants (pacemakers/cardiac device) in the area to be treated
• you have cancer in the area to be treated
• you have an infection in the area to be treated
• you have severely impaired circulation
• you have severe inflammation in the treatment area

You may not be allowed to have this treatment if you have one of the following conditions:

• 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)
• previous achilles tendon rupture (until it is confirmed fully healed)
• 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
• 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
• 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.

Risks of ESWT treatment

This treatment is safe. However, 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 the previous treatments advised. Make sure your footwear promotes support and stability.

Asking for your consent

It is important 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 to four sessions are needed at intervals of one or two weeks apart. Each treatment takes between five to ten minutes.

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 diclofenacn 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.