Extracorporeal shockwave therapy
What are Achilles tendinopathy and plantar fasciitis?
Achilles tendinopathy is a condition that causes pain, swelling, stiffness and weakness to the
Achilles 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.
Plantar fasciitis is inflammation of the plantar fascia. This is a thick fibrous band of tissue at the
bottom of your foot that lies between your toes and your heel. Repeated small injuries to the
plantar fascia are believed to be the cause of the inflammation.
What is extracorporeal shockwave therapy (ESWT)?
ESWT is a procedure where shock waves are passed through the skin to the injured part of the
foot, using a special device. Extracorporeal means outside of the body. The shockwaves are mechanical and not electric; they are audible, low energy sound waves, which work by increasing blood flow to the injured area. This accelerates the body’s healing process. You will usually require a course of three treatments, one to two weeks apart.
Why should I have ESWT?
ESWT is offered to patients with Achilles tendinopathy and plantar fasciitis, who have not responded adequately to conservative treatments, such as physiotherapy, rest, ice therapy and painkillers. It is a minimally invasive treatment that is carried in clinic and 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 during the treatment, but you should be able to tolerate this. Following the treatment, you may experience 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. The National Institute for Health and Care Excellence (NICE) have deemed this procedure to be safe,
although there are some uncertainties about how well it works. For this reason, every patient will be monitored before and after the treatments to discover how successful the outcome is. Studies have shown there is a 50% to 70% chance that it will be effective.
You must not have ESWT if you:
are taking antiplatelets (for example, aspirin or clopidigrel) 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 a cardiac pacemaker or other cardiac device
have an infection in your foot or a history of tendon or ligament rupture
have had any steroid injections in the previous 12 weeks
These will be discussed with you by your healthcare professional when the treatment is offered. Your podiatrist will discuss the benefits and risks of the procedure with you in more detail – please let them know if you have any questions or would like any further information.
How can I prepare for ESWT?
You will need to ensure that you are available for the full course of your treatment. You should refrain from taking non steroidal anti-inflammatory medication (for example ibuprofen, aspirin) for two weeks before your first procedure and throughout your treatment. You can eat and drink normally before your treatment. Please wear comfortable clothes as you will be lying on your front for the treatment.
What happens during ESWT?
The treatment will be given in the Dr Foot Podiatry Clinic. You will be asked to lie on your front with your legs supported by a pillow. The podiatrist carrying out the treatment will put some ultrasound gel on the injured area and then place the hand piece of the device over the surface of the skin and the gel. The ESWT is delivered using this hand piece – it delivers compressed air impulses through the ultrasound gel. Each treatment will take
approximately 15 minutes.
Will I feel any pain?
Most patients do experience some pain during the procedure. You will be asked how much pain you are experiencing during the treatment and we will attempt to adjust the treatment to help manage this. The pain will stop at the end of your procedure.
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 you should avoid anti-inflammatory medication (such as aspirin and ibuprofen) and ice therapy, as these can interfere with the body’s healing process. As part of the treatment plan we may also recommend specific exercises and/or orthotics to help with shock absorption or any underlying biomechanical complaint.
What do I need to do after I 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 A&E department.
What are the costs for this procedure?
Costs are £200 for program of 3 weekly treatments which will also include a comprehensive rehabilitation program and semi bespoke orthotics and a special compressive heel pain sock. Please note all shock wave treatment patients need to attend for an initial consultation which is £45 to assess, diagnose and tailor the treatment plan based on your individual needs.
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