ESWT Shockwave Therapy

Extracorporeal Shock Wave Therapy (ESWT)

What Is ESWT Shockwave Therapy?
Extracorporeal Shock Wave Therapy (ESWT) is a noninvasive surgical procedure that uses sound waves to stimulate healing in some physical disorders, including plantar fasciitis. “Extracorporeal” means “outside of the body” and refers to the way the therapy is applied. Because there is no incision, ESWT offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity. ESWT has been used extensively for several years to treat plantar fasciitis and other disorders.

What is the origin of ESWT?
The basic science behind ESWT, the technology that uses acoustic shockwaves.  The technique of using shockwaves to break up kidney stones has been around for a nearly a quarter century now, and in the process of treating thousands and thousands of patients, it was found that many people undergoing the procedure had other unrelated aches and pains disappear.  It was at this point that scientists began to consider that shockwaves may have an effect to heal other sorts of tissues.
Specialized machines were then developed specifically with the idea of using these shockwaves on other parts of the body, and this is the origin of ESWT.
The type of shockwave therapy we use, then, is specialized to specifically help treat musculoskeletal conditions.

What conditions can be treated with ESWT?

Extracorporeal Shock Wave Therapy can be used to treat a wide variety of musculoskeletal conditions–particularly those involving where major connective tissues attach to bone.
Complaints involving attachment points for tendons and ligaments in major joints like the shoulder (such as the rotator cuff), elbow (epicondylitis or tennis elbow), hip, and knee (tendonitis or “jumper’s knee) are common sites for ESWT.
One of the area’s most frequently treated with ESWT, however, is the foot.  This is our specialty.  Some conditions in the foot that have been treated with ESWT include:

  • Plantar Fasciitis or Fasciitis (Strained Arch)
  • Achilles Tendinitis / Tendinitis
  • Calcific Tendinitis / Tendinosis
  • Connective Tissue Pain
  • Degeneration Muscle Pain and Injuries
  • Joint Injuries
  • Morton’s Neuroma
  • Hallux Limitus / Rigidus
  • Non Healing ulcers and Wounds. Exciting new research has shown that Electrohydraulic ESWT increases wound healing significantly. One study showed that in non healing wounds, over 50% had a 95% healing rate after 12 weeks when combined with standard wound healing therapy. The remainder of the group healed in 20 weeks.  This is significant as non healing wounds often lead to amputation and a significant reduction of life span. When a patient loses a limb, the 5 year survival rate is less than that of many major cancers.

And as ESWT encourages bone healing, it has been used to help treat:

  • Stress Fractures
  • Avascular Necrosis (A dead portion of bone) Including Freiburg’s Infraction
  • Slow-healing bone (Delayed unions)
  • Non-healing bone (Non-unions)

There are also urological conditions that respond to ESWT, such as Peyronie’s Disease and the case of the Shockwave unit Cardiac tissue regeneration.

When is ESWT considered as a treatment the above conditions?
Extracorporeal Shock Wave Therapy is generally considered when the following criteria are met:
When patient has a diagnosis that is considered to be responsive to ESWT.
When simpler and less expensive treatment alternatives have failed or aren’t appropriate for some reason.
When surgery or other more invasive treatments are alternatives.
When the patient fully understands the procedure.
When there are no known contraindications to the procedure.

When can’t ESWT be used as a treatment therapy?
ESWT is not typically used:

  • In the presence of bone tumors, certain metabolic bone conditions
  • Rare nerve or bleeding disorders
  • ESWT isn’t typically used in pregnant patients
  • Within 2 cm of and open growth plate, (where the bone is still growing).
  • It’s not currently used in areas where an infection is present, (though there is some early research suggesting ESWT may actually help with infection).
  • It cannot be used around the lungs
  • Or for other conditions as determined by your provider.

How effective is Focused ESWT?

Assuming you have an injury appropriate to extra-corporeal shockwave technology treatment, most recent independent studies suggest somewhere between a 65% and a 95% “success” range, with values around 80% being the most commonly cited number.  And it’s important to note that most of these studies have success rates as determined by the patient, himself, in terms of pain and function.

With regards to wound healing, new research has shown that Electrohydraulic ESWT increases wound healing significantly. One study showed that in non healing wounds, over 50% had a 95% healing rate after 12 weeks when combined with standard wound healing therapy. The remainder of the group healed in 20 weeks.  This is significant as non healing wounds often lead to amputation and a significant reduction of life span. When a patient looses a limb, the 5 year survival rate is less than that of many major cancers.

Radial Pressure Wave ESWT units that are currently being used (such as the Dolorcast and the Storz) have no such research showing that they are effective on wound healing.

How safe is ESWT?
The basic technology involved with extracorporeal shock wave therapy has been used for decades now on quite literally millions of people.  The technology has been used most extensively in Europe, particularly the German-speaking countries, where this technology originates.  In all its use, ESWT of the musculoskeletal system has been found to have virtually no serious side-effects.  In fact, even mild side effects like tingling, aching, redness, or bruising are relatively rare, modest and short-lived.
Further, effects like these appear to be more common with higher energy treatments (the ESWT we use is a low energy treatment with the benefits but not the cost of a high energy treatment), particularly those from earlier generations of ESWT technology than that which we use.  More discussion about the different ESWT technologies is to follow.

How does ESWT work?
Simply put, extracorporeal shockwaves stimulate certain components within the body so the body is able to heal.  And ESWT is able to accomplish this even in chronic cases, when the body has demonstrated a previous unwillingness or inability to do so by itself.
In addition to stimulating the healing process, ESWT seems to have a direct effect on nerves, diminishing pain.
Many traditional therapies–such as anti-inflammatory medications, steroid injections, physiotherapy, massage, acupuncture, and so forth–can assist the body during the early, acute phase of an injury.  However, they are much less effective in assisting the body to heal when an injury becomes chronic.  As an example, many patients can relate to a history where a steroid injection (like cortisone) seemed to be effective in resolving pain early in their healing process, but subsequent injections were much less effective.  This isn’t really surprising when you realize that a chronic-state, degenerative injury isn’t likely to respond well to a medication designed to affect an acute-phase, inflammatory condition.
What makes ESWT unique is that it is one of the very few technologies in any field of medicine that seems to work best when an injury reaches the chronic, non-healing state.  ESWT appears to be able to jump start the healing process in chronic, non-healing injuries and move them back into the acute phase of healing.

How do the physics of ESWT promote tissue healing?
While investigations are still being conducted to more fully understand the precise mechanism behind ESWT’s effects on injured tissues, the picture is becoming much clearer.
True ESWT produces a very strong energy pulse (5-100 MPa) for a very short length of time, (approximately 10 milliseconds).
The energy pulse quite literally breaks the sound barrier, and this is what creates the shockwave.
Shockwaves produced by an Extracorporeal Shockwave machine are identical to a shockwave over a plane breaking through the sound wave barrier, only on a smaller scale.
However, one difference with the shockwaves our ESWT machine is able to produce is that the shockwave is generated, controlled, and focused precisely. More importantly, there is high positive amplitude and negative return amplitude. This causes the shockwave to go deep into the body where it is most effective.  Other low intensity units, mainly Radial Shockwave Units (such as the Storz and the Dolorcast) use older technology that do not penetrate deep into the body but rather the pulse wave breaks up in the surface layers of the tissue. These older technology machines also don’t produce a high amplitude wave form, but a low amplitude wave form that has less effectiveness.

In fact, the machine we use allows us to be able to control and focus the shockwaves to such an extent we are able to pass the shockwaves through the uninjured portions of the body without any effect, and deliver the energy to a focus point at the level of the injured tissue, where it has several known medicinal effects:
First, this shockwave exerts a mechanical pressure and tension force on the afflicted tissue.  This has been shown to create an increase in cell membrane permeability, thereby increasing microscopic circulation (right) to the tissues and the metabolism within the treated tissues, both of which promote healing and subsequent dissolution of pathological calcific deposits. 

Second, the ESWT shock waves pressure front creates behind it what are known as “cavitation bubbles”.  An example of a single cavitation bubble is pictured to the right.
Cavitation bubbles are simply small empty cavities created behind an energy front.  They tend to expand to a maximum size, then collapse, much like a bubble popping.
As these bubbles burst, a resultant force is created.  In the human body, this force is strong enough to help break down pathological deposits of calcification in soft tissues.

Third, as cavitation bubbles collapse, they create smaller, secondary energy waves known as microjets.  You can see how a microjet forms in the diagram to the right, and you can see it pictured in the center of the cavitation bubble in the photograph immediately above.
These microjets also create a lot of force that also breaks down pathological deposits of calcification in the soft tissues through direct, mechanical means.

In the application of an ESWT treatment in a medical setting, however, it’s not just one cavitation bubble or just a few cavitation bubbles being produced, but hundreds and thousands.
To the right you can see what hundreds of cavitation bubbles formed from a single shockwave looks like.
Multiply this by several thousand shockwaves being administered to an injured tissue through a course of ESWT treatment and you can imagine the forces that can be mustered to break down deposits of calcification that are found in joints, soft tissues and spurs.

Beyond breaking down pathological calcification deposits, ESWT has been shown to stimulate cells in the body known as osteoblasts.  These bone cells, are responsible for bone healing and new bone production, so stimulating them obviously enhances the healing process of bone.
ESWT shockwaves have also been shown to stimulate fibroblasts.  Fibroblasts are the cells responsible for the healing of connective tissues such as tendon, ligaments, and fascia.

ESWT also diminishes pain.  It does so in two ways.  First, as mentioned above, ESWT initially diminishes pain through what is known as hyperstimulation anesthesia.  This is where the nerves sending signals of pain to the brain are stimulated so much that their activity diminishes, thereby decreasing or eliminating pain. This effect is usually, (but not always), short lived.
ESWT is also believed to diminish pain over longer periods of time through the stimulation of what is known as the “gate-control” mechanism, where nerves can be stimulated to “close the gate” to pain impulses sent to the brain.  It is sometimes thought of as activating a sort of “reset” button that recalibrates pain perception.
Interestingly, and in apparent support of this theory, it was demonstrated by research presented at the 2005 conference in Vienna that using anesthesia with ESWT alters the sensor input – motor output balance of nerve fibres, inhibiting the pain-killing effect of ESWT.   In other words, ESWT appears to be most helpful for patients who are not anesthetized.   (This explains why some early studies where anesthesia was used before the administration of extracorporeal shockwave therapy did not get results as good as what is found in patients where no anesthesia is used.)
The low intensity Electrohydraulic version of shockwave we use does not require anesthesia, this serves as one explanations as to why Electrohydraulic shockwave works so well.

Our staff have used and been experienced with the early uses of High intensity shockwave units that required general anesthesia. We had the opportunity to purchase these units, but the pain level and cost to the patient were much greater without an increase in the healing outcome.
While ESWT is used on a wide variety of body tissues and medical conditions (see what conditions can you treat with ESWT? section above), the effects of shockwaves are best documented in areas of changes in tissue density, such as where tendon attaches to bone (enthesiopathies) and where bone attaches to ligaments (desmopathies).  For this reason, it is very effective for painful connective tissue pain in such locations as the foot, knee, hip, elbow, and shoulder.

Are there different forms of shockwave therapy?
While there are numerous shockwave machines on the market today, they are all based on one of four basic shockwave (or shockwave-like) technologies.  Listed in the order in which they were introduced in Canada, they are:

  • Electrohydraulic shockwave High Intensity (such as the HMT OssaTron machine)
  • Electromagnetic shockwave (such as the Sonocur and Dornier Epos machine)
  • Radial pressure wave (such as the Dolorcast and Storz systems)
  • Piezoelectric shockwave (such as the Piezoson)
  • Electrohydraulic shcokwave Low Intensity (such as the machine we use)

What’s the difference between these forms of shockwave therapy?
Electrohydraulic, electromagnetic, and piezoelectric technologies are all true forms of extra-corporeal shockwave therapy.  Each technology produces a pulse that literally breaks the speed of sound, thereby creating a shockwave.
These technologies differ in the manner in which the shockwaves are produced, the ability of the shockwave to be controlled and focused, the depth to which the shockwaves can penetrate the intensity of the shockwave being produced, the sorts of conditions they’re able to treat, and whether they require anesthesia.
The third technology on the list above, radial therapy is actually quite different from the other three technologies in several regards and is usually not considered true extracorporeal shockwave therapy–but more of a pressure wave therapy.  However, radial Shockwave therapy units are the mainstay of treatment today as they were the first low intensity units on the market. Their technology and efficacy has been surpassed by the newer units such as the low intensity electrohydraulic machine we use.
We’ll try to differentiate all this for you.  First let’s go through the three true forms of ESWT–Electrohydraulic, electromagnetic, and piezoelectric.
Manner of Generation and Delivery of Shockwaves. Electrohydraulic shockwave therapy uses a type of spark plug to generate a shockwave, with the shockwaves focused by an ellipsoid reflector.
Electromagnetic shockwave therapy machines typically use a cylindrical coil arrangement of an electromagnetic generator and a parabolic reflector to focus the shockwaves.
The piezoelectric shockwave is generated by an electric pulse, and the shockwave focused by thousands of small crystals in the applicator head.
Each of these three technologies is similar in that the shockwaves and force produced in the machines is translated past the skin and superficial tissues without effect, and are instead focused at the desired tissue depth.
The fourth technology, Radial shockwave (RSWT) or more accurately, pressure wave therapy, differs from the other forms of shockwave technology in a couple major regards.  First, in order for a shockwave to truly be defined as a shockwave, the energy wave must literally be faster than the speed of sound, or 1500 meters per second.  This is the speed at which the “shock” of the shockwave is generated, from breaking the sound barrier.
In comparison, RSWT waves travel at speeds of approximately 10 meters per second, a small fraction of true shockwave.  This speed does not break the sound barrier, and hence, no actual shockwave is produced.
Indeed, the very wave form produced by radial technology differs from true shockwave rather noticeably.  True focused shockwaves are very short and very intense; radial pressure waves are slower, less intense, elongated, and more sinusoidal in appearance.
Because no actual shockwave is produced with RSWT, and because the waveform is so different, you can better see why RSWT is not considered a shockwave technology.  It is more accurately described as a pressure wave technology, and most researchers now use this term to describe this technology.    However, some facilities with these machines continue to inaccurately label their technology as shockwave therapy.
Tissue Depth Penetration:
As you might imagine intuitively, being able to aim shockwaves directly on the desired tissues and only the desired tissues is generally considered to be superior to not being able to direct the shockwaves to the specific injured tissues.
Electrohydraulic, electromagnetic, and piezoelectric shockwave can all be aimed and delivered past the skin and down to different tissue depths, allowing for delivery of the therapeutic waves to the injured tissue.
Radial pressure waves are applied to the skin only, and must dissipate to the tissues from there.  They are therefore not able to be aimed to different tissue depths.    Deeper tissue injuries are therefore more difficult to treat with radial shockwave.
Focus Area:
A third characteristic to consider is how precisely the energy waves are able to be focused onto the injured tissue and away from uninjured tissues.
The tighter the focus area, the more precisely the shockwaves can be delivered to specific tissues, and the less energy is wasted in areas not requiring treatment.

Not only does this mean a greater concentration of therapeutic energy on the specific injured tissues, it also means fewer traumas to the surrounding uninjured tissues.
As alluded to above, the piezoelectric technology we use has, by far, the tightest focus area of any competing technology in the world.
For instance, even at maximum energy level, the focus area for the Piezoson 100, (the machine we use), is 1.3mm x 1.3mm x 4.2mm.  (This equates roughly to 1/20th of an inch x 1/20th of an inch x 1/6th of an inch.)
In comparison with other machines in North America, the focus area for the OssaTron is 8.7mm x 8.7mm x 67.6mm; the focus area for the Sonocur is 4.8mm 4.8mm x 48.3mm and for the Epos it’s 2.9mm x 2.9mm x 22.0mm.  (Radial pressure waves cannot be focused at all.)
(Source for these statistics, the German site on physical parameters of extracorporeal shock wave therapy technologies:  //
As these statistics make clear, the piezoelectric technology is the most accurate ESWT technology on the market.  Treatment is more precisely directed at injured tissues and the least traumatic to uninjured tissues surrounding the site being treated.
However, because piezoelectric technology is so precise, it needs to be applied carefully and precisely to the correct tissues.  This is why we don’t hire ESWT technicians to perform the therapy.  We only have podiatrists applying the treatment.  This is actually the law in many jurisdictions in Europe, but the exception in North America, where technicians perform most ESWT treatments in the vast majority of facilities.
Energy Level:
Another important differentiating characteristic is how high an energy output the machine produces.  In fact, this characteristic is commonly used in marketing various machines.
For instance, you’ll see many websites touting the benefits of their machine being either “high energy” or “low energy”.  Facilities with “high energy” machines claim, for example, that their technology is superior because only one treatment is typically required and the technology has been around longer.  Facilities with “low energy” machines advertise that it doesn’t require anesthesia and it’s cheaper.
While there is some truth to each of these claims, the larger question is frequently not mentioned.  That is to say, the question that should be asked is what is better at actually treating a particular condition?  High energy or low energy?
Before we can answer this question, you should know that the energy level of a machine is actually a fairly complicated subject and it deserves some discussion.
For instance, you’d think that the energy produced by a machine would be a pretty clear-cut characteristic.  But there are several different–and confusing–ways to measure energy.  For example, you could consider the amount or type of energy produced by the machine, the amount or type of energy delivered into the body, the amount or type of energy delivered into the focus area, the amount or type of energy delivered to a central point inside the focus area, or the amount or type of energy present at a certain radius from that central focus point.
Each of these characteristics is important to the scientists studying various characteristics of ESWT machines, and different manufacturers and scientists use different definitions of “energy”.
As you might expect, so many variables make it rather confusing to both patients and physicians.  After all, even doctors aren’t sure what type of energy is most important when judging which technology is a better in which to invest.
For the purposes of this discussion, we’ll concentrate on the most common standardized measurement of energy in the field, something called the “energy flux density”, expressed in millijoules per millimeter (mJ/mm2).
Energy flux density can be defined as the amount or concentration of energy in the focus area.  In other words, this is the amount of therapeutic energy being delivered to the injured tissue.  The physics of the other measures of energy are interesting, but we feel this is the characteristic in which most patients and physicians are interested.
Now even when we’ve defined what we mean by an energy level and defined the unit of measurement, you should know that different authors use different cut-off measurements to define “high energy” and “low energy”.  One author’s “high energy” setting may only qualify as a “low energy” setting in another author’s opinion.  So the terms “high energy” and “low energy” are rather imprecise and arbitrary.  (This demonstrates why the marketing of “high energy” and “low energy” machines is somewhat dubious.)
For the purposes of this discussion, we’ll define low energy here as less than 0.27 mJ/mm2, medium energy as 0.27 mJ/mm2 to 0.59 mJ/mm2, and high energy as anything over 0.60 mJ/mm2.  These are frequently-used cut-off points, but do keep in mind that other practitioners, researchers, manufacturers, and websites may use different values.
So now that we’ve defined what energy is, what’s considered high, medium, or low energy, let’s get back to the question of what energy settings are better to treat a specific injury.
The answer that seems to becoming clearer in research is that both high energy settings and low energy settings have their indications.
For instance, certain tissues (like bone) appear to respond better to higher energy settings.  Conditions like avascular necrosis and delayed unions and pathological calcifications are examples of conditions that are typically thought of as being more responsive to higher intensity settings.  In addition, the original medical application of shockwaves, the treatment of kidney stones, too, seems to be most effective with higher energy settings.
However, other tissues (like tendons and other more sensitive structures) typically require lower energy settings, as research indicates that these they may be damaged by higher-intensity settings.
Complicating matters further, what does a patient do when both hard and soft tissues need to be treated for a single injury, as is often the case?  For example, what if a patient has both a bone spur and a soft tissue injury like fasciitis or tendonitis?  Is it better to go with a so-called “high energy” machine or a “low energy” machine?
The good news is that it doesn’t have to be an either-or proposition.  The beauty of the piezoelectric ESWT technology we use is that it covers the energy spectra employed by the other technologies.
For instance, piezoelectric ESWT can be applied in energy levels as low as .05 mJ/mm2–obviously well into the lowest levels of energy–and it can be raised as high as 1.48 mJ/mm2–an energy level well above even the classic “high energy” machines.
In other words, in terms of the amount of energy applied in the focus area, (the so-called “energy flux density”), piezoelectric technology can be delivered in energy doses as low as virtually any other competing technology and as high as or higher than virtually any other technology.
Further, piezoelectric technology can be readily adjusted to any energy level, depending upon the specific condition and indication of each individual case.  And as mentioned above, the energy can be precisely focused to the specific depth required.
Our patients don’t have to compromise for a single energy range or a specific tissue type.
And because the machine we use is so precise, we can use high energy settings in areas very close to the most sensitive tissue structures.  This allows the piezoelectric technology noticeable advantages to machines with much less precise focus areas.
Anesthesia Requirements:
The energy the machine produces also affects the need for anesthesia (whether local, general, or spinal) or IV sedation.  All things being equal, it’s obviously preferable for the patient not to have to go through anesthesia or sedation. It’s not only safer, it’s also less expensive.
Beyond the issues of safety and expense, though, there is mounting evidence that the use of anesthesia diminishes the effectiveness of ESWT.  Specifically, the use of anesthesia with ESWT alters the sensory input – motor output balance of nerve fibres, which seems to be why anesthesia diminishes the pain killing effect of ESWT.
So unlike other so-called “high-energy” machines, the piezoelectric technology does not typically require anesthesia–even at high energy settings.  And further, this means it’s more likely to work than versions requiring anesthesia.

Which is the best version of shockwave therapy?
After using all the different types of machines and having over a decade of experience, starting with the original high intensity units, being able to evaluate and use each form of shockwave technology and each generation of machine, we realized that Electro-Hydraulic ESWT was the superior technology.

It is proven by the clinical results and the broad range of uses that no other ESWT machine can claim.
For example, the technology we use is the only form of ESWT that combines each of these important features:

Advantages of SoftWaves™
are that larger areas can be treated relatively pain-free without the use of anesthesia.

Advantages of SoftWaves™ over focused shockwaves

The proven clinical effects of SoftWave Therapy are:
Bactericidal effects
Cellular production of NO (nitric oxide)
The production of growth factors (VEG F, BMP’s, OP’s)
Stem cell migration and activation
Another advantage is that SoftWaves™ do not cause cellular destruction, thus avoiding the typical bruising and bleeding associated with high-energy focused shockwave therapy, because SoftWave™ energy is dispersed to the body over a much larger area and is limited to levels insufficient to cause cellular damage.

Our machine utilizes SoftWaves™ in its cardiology and dermatology devices and for all soft tissue pathologies.

Where can I get the best, most up-to-date form of focused ESWT?
Northern Ontario Foot and Ankle in Sudbury, Ontario is the only clinic in Ontario utilizing this technology. The technology of Shockwave has been around for many years in Europe and the newest version of Low Intensity Electro-Hydraulic is well used and studied in Europe with an excellent track record; in Canada it is new. It is not yet available in the United States or in many other countries around the world.
For this reason, we welcome patients from any area who are seeking this newest of ESWT technology.  Overnight or longer stays can be arranged at some of the recommended hotels near our facility. Patients can be seen and treated in one day but 3 more treatments are required. The treatments are 2 weeks apart and the last of the forth treatment should be done 4 weeks after the last. The most clinical benefit is felt 4 to 6 weeks after the last treatment.

Who Is a Candidate for ESWT?

ESWT may be considered as a therapeutic option for the patient whose heel pain has not resolved with conservative treatment. Conservative measures include use of anti-inflammatory medications, steroid injections, ice packs, stretching exercises, orthotic devices (shoe inserts), and physical therapy. Some patients should not be treated with ESWT. The procedure is not appropriate for patients who have a bleeding disorder or take medications that may prolong bleeding or interfere with clotting. Your Podiatrist will determine if the procedure is appropriate for you based on your medical history.

What to Expect with ESWT

In preparation for ESWT, the Podiatrist will instruct the patient to stop taking any anti-inflammatory medications (for example, aspirin or ibuprofen) for about five days before the procedure. It is important to avoid these medications because they are known to prolong bleeding under the surface of the skin. ESWT is performed on an outpatient basis, so it does not require an overnight stay in the hospital. Before the procedure begins the patient is comfortably positioned and may receive local and/or sedation anesthesia. The treatment may take up to 30 minutes per foot. During the procedure sound waves penetrate the heel area and stimulate the healing response. Sometimes more than one session is needed to adequately treat the inflammation and reduce the patient’s symptoms.

After the Procedure

The Podiatrist may advise you to have someone drive you home after the procedure. Other instructions may include:

  • Rest and elevate the foot for the remainder of the day and night.
  • Resume gentle stretching exercises the day following the procedure.
  • Avoid taking any anti-inflammatory medication, such as ibuprofen or aspirin, for up to 4 weeks after ESWT.
  • Avoid heavy lifting until the Podiatrist approves resuming this activity.
  • You may walk on the foot.
  • Avoid running or excessive activity.
  • Avoid going barefoot during the healing process.
  • Wear supportive shoes.
  • In some cases, orthotic devices (shoe inserts) will be prescribed.


Although patients sometimes feel they can return to normal activities right away, the Podiatrist will determine when that is appropriate for your situation. It is important to use caution and follow the podiatrist’s instructions to avoid injuring the treated foot.  Because ESWT temporarily reduces or eliminates the sensation of pain, patients sometimes become too active too soon.  ESWT is very safe and effective, but every surgical procedure carries the possibility of complications. In addition to mild pain and tingling or numbness, bruising and swelling sometimes develop after ESWT. There have also been reports of rupture of the plantar fascia and damage to the blood vessels or nerves.

ESWT in the Future

Like many other innovative non-invasive therapies, ESWT is an evolving technology. As the body of information on this technique continues to expand, the result will be additional uses for ESWT that will benefit more patients in the future.


To learn more about NOFA Clinic’s ESWT Therapy: Please Click to Download Our Information Brochure