Extracorporeal Shock Wave Therapy (ESWT)

Extracorporeal Shock Wave Therapy (ESWT) is performed by using shockwaves to treat localized musculoskeletal pain. A shockwave is a very intense, and very brief, wave of energy that travels faster than the speed of sound; the idea of using this type of energy burst to treat musculoskeletal pain was introduced in Europe in the early nineteen-nineties. The idea evolved from the use of lithotripsy, which is a non-surgical, mechanical method used to break up stones in the kidneys, gallbladder and liver using sound waves.

It was then discovered that it was possible to use ESWT to treat lower limb issues such as plantar fasciitis and tendonitis. This procedure is considered preferable to surgery as it is a highly effective way to treat stubborn conditions without the invasiveness, risk, side-effects, and recovery time that accompany surgical intervention. In fact, the FDA first granted permission for ESWT to be used to treat plantar fasciitis in the United States, which was optimal for podiatrists practicing in North America as up to 15% of all podiatric consultations pertain to plantar fasciitis.

Despite its high level of effectiveness ESWT should only be seriously considered if all other conservative treatments have failed. While it is far preferable treatment method to surgery it is a highly involved process that can be both expensive and time consuming.  Additionally, 80-90% of patients with PF are successfully treated within a six-month period of time using standard conservative practices. ESWT is generally reserved for the 10-20% of plantar fasciitis cases that do not respond to these standard treatments in a reasonable period of time.

Likewise, treating heel pain with ESWT has now been approved, but it is also generally reserved for hard to treat cases that would otherwise be considered for surgical intervention or injections of Botox or alcohol, both of which are considered more invasive options than shockwave therapy.

Although it is not the primary treatment option for either plantar fasciitis or chronic heel pain patients who undergo Electronic Shockwave Therapy are typically able to return to work immediately after treatment, as most patients return to their usual level of activity one to two days after the procedure has been performed.

While there are potential complications that can occur, and patients must be made aware of all associated risks, there are very few documented problems or side-effects with this procedure. This biggest concern that most opponents have to ESWT is that it can be much more costly than other procedures, though the shorter recovery times associated with this procedure may offset upfront expenses over the long run.

An article published in the Journal of Foot and Ankle Surgery (JFAS) demonstrated that this procedure has an 82% success rate, which is only 1% less successful than a traditional, minimally invasive plantar fasciotomy, but without the risks, complications, and recovery time that necessarily occurs after a surgical procedure is performed.

Despite these impressive points it is important to remember that Electronic Shockwave Therapy is not a cure and like all other treatments for foot and heel pain, especially those associated with plantar fasciitis, ESWT is most effective when used in tandem with a variety of standard conservative treatments.

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