Shockwave therapy is a non-surgical treatment, and works by delivering impulses of energy, targeted to specific damaged tissues within the abnormal tendon.
ESWT is a procedure where shockwaves are passed through the skin to the injured part of the body. 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 speeds up your body’s healing process.
You will usually require a 12 week course which consists of 1 session per week for 3 weeks followed by a 6 week break then up to 3 follow on sessions if required. During the 6 week break it is very important that weight bearing exercises are done as per guidance by the Podiatrist.
Why should I have ESWT?
Extracorporeal Shockwave Therapy treatment is a highly effective treatment available for patients with:-
- Plantar Fasciitis (tendonitis/fasciopathy)
- Shoulder pain (capsulitis/ calcifying tendonitis)
- Tennis elbow (lateral epicondyliti)
- Achilles Tendonopathy (tendonitis)
- Trochanteric bursitis (Lateral hip pain)
- Osgood-Schlatter disease (adolescent knee pain)
This is not an exhaustive list and more conditions are being added with more research.
ESWT is offered to patients who have not responded well enough to other treatments, such as physiotherapy, orthotics (insoles or leg braces), rest, ice therapy and pain relief. It is a minimally invasive treatment, which means that you can go home the same day. ESWT can offer relief from pain and other symptoms.
What are the risks/side effects?
Possible side effects include:-
- Pain during and up to 24 hours after treatment
- Skin reddening around the treatment site
- Minor bleeding from the small blood vessels leading to bruising around the treatment site
- Aching and numbness
The majority of these symptoms, if they do occur, should get better within a couple of days and normally within a week before the next treatment.
Very rare side effects:-
- Small risk of Achilles tendon rupture if working on that area
Is ESWT suitable for everyone?
You must not have ESWT if you:-
- are pregnant
- are taking antiplatelets excluding aspirin 75mgs (for example, clopidogrel) or anticoagulants (such as warfarin or rivaroxaban)
- have a blood clotting disorder
- are under the age of 18
- have been diagnosed with bone cancer or are being treated for active cancer
- have an infection in your foot
- have a history of Achilles tendon or plantar fascia ligament rupture
- have had a steroid injection into the affected area in the previous 6 weeks
These will be discussed with you by the Podiatrist when the treatment is offered. They 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.
Are there any alternatives?
If ESWT does not help your pain, then sometimes an operation may be necessary, depending on your condition.
What is the cost?
- 40 minute appointments which will include an initial assessment and medical history followed by consent for treatment and the ESWT is £60 per session. The course of 3 can be paid either fully upfront or individually per session.
- Stretching exercises will be given after the first session then load/weight bearing exercises will be given for you to follow during the 6 week – these are critical to the success of your treatment (included in the fee)
- At week 9 (6 weeks following the last session of 3 treatments) we will arrange a phone consultation (free of charge) and then up to a maximum of 3 further sessions can be offered for persistant conditions (£60 per session)
How can I prepare for ESWT?
- You will need to be available for the full course of treatment.
- You should not take any non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for two weeks before your first procedure, and throughout your treatment. If you are unsure if any of your medicines contain NSAIDs then please check with your doctor, nurse or pharmacist.
- Wear comfortable clothing as you will be lying on your front for the treatment.
Consent – asking for your consent
We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment, pay the costs and you understand what risks are involved.
Who will carry out the procedure?
Your ESWT will be carried out by our Podiatrist, who has undertaken special training to carry out the procedure.
Our Osteopath is also fully qualified in ESWT and can treat other areas of the body whereas the Podiatrist will just treat the lower leg and foot.
What happens during ESWT?
The treatment will be given in the podiatry clinic. You will be asked to lie on your front with your legs supported by a pillow. The podiatrist will work with you to identify the exact area of pain and a gel will be applied to that area.
The hand piece (probe) will then be placed on to the affected area and the shockwaves are delivered through the skin. The impulses are delivered through the skin as a shockwave that spreads inside the injured tissue as an aspherical ‘radial’ wave. These radial shockwaves initiate an inflammation-like response in the injured tissue that is being treated, and prompts the body to respond naturally by increasing blood circulation, the number of blood vessels and therefore metabolism in the injured tissue.
The shockwaves are felt as pulses which are a little uncomfortable but not painful. Typically your first treatment will start with a low level of intensity and increase this to a point where you feel comfortable. Patients are typically treated in an outpatient environment (not in theatre), and the procedure does not require any type of sedation or anaesthetic.
Shock-wave therapy treatments are usually performed at weekly intervals. Each treatment session takes about 40 minutes and you will need between 3 treatment sessions (and up to a maximum of 6 for resistant problems).
Will I feel any pain?
Most patients do experience some pain or discomfort during the procedure. You will be asked how much pain you are experiencing during the treatment, and we will try to adjust the treatment to help manage this.
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 don’t take anti-inflammatory medication (such as ibuprofen) or use ice therapy, as these can interfere with the body’s healing process.
What do I need to do after I go home?
You will be able to return to your usual activities, including returning to work, straight away. However we advise you not to undertake any strenuous, pain-provoking activity or high-impact exercise for 48 hours after 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 Emergency Department (A&E).
Will I have a follow-up appointment?
You will have a telephone follow-up appointment with the Podiatrist six weeks after your final treatment. At this point it will be decided by both the Podiatrist and yourself whether any further appointments will be beneficial – up to another 3 maximum.
Further sources of information
National Institute for Health and Care Excellence (NICE). NICE has produced recommendations for patients on ESWT. These documents can be accessed on the NICE website: www.nice.org.uk