This blog post explains more about the use of ESWT to treat Achilles tendinopathy and plantar fasciitis. It includes information on the benefits, risks and any alternative treatments, as well as what you can expect when you come to the podiatry clinic. If you have any further questions, please speak to the podiatrist you visit.
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 (swelling) 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 ESWT?
ESWT is a procedure where shockwaves are passed through the skin to the injured part of the foot. 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 course of three to six treatments, 1-2 weeks apart.
Why should I have ESWT?
ESWT is offered to patients who have not responded well enough to other treatments, such as rest, physiotherapy, orthotics (insoles or leg braces), rest, ice therapy and pain relief. It is a minimally invasive treatment that is carried out on an outpatient basis, 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?
You will experience some pain/discomfort during the treatment, but you should be able to cope with this. Following the treatment, you may experience more pain, redness, bruising, swelling and numbness to the area at first. These side effects should resolve within a week, before your next treatment. Studies have shown that 5-7 out of 10 patients have found it to be effective.
There is a very small risk of tendon or ligament rupture, and damage to the soft tissue.
You must not have ESWT for Achilles tendinopathy or plantar fasciitis 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 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.
Are there any alternatives?
If ESWT does not help your pain, then sometimes an injection option or operation may be available, depending on your condition. Your podiatrist will discuss this with you.
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 podiatrist, 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 and you understand what it involves. If you would like more information about our consent process, please speak to the podiatrist caring for you.
Who will carry out the procedure?
Your ESWT will be carried out by one of the podiatrists all of who have undertaken special training to carry out the procedure.
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 clinician will put some ultrasound gel on the injured area and then place the hand piece of the device on the gel. The ESWT is delivered using this hand piece – it delivers compressed air pulses through the ultrasound gel. Each treatment will take approximately 20-30 minutes.
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.
