What is Extracorporeal Shockwave Therapy (ESWT)?
Extracorporeal means outside the body. ESWT is a non-surgical procedure where acoustic shockwaves (pressure waves) at low frequency are passed through the skin to the injured part of the foot, using a special probe. The shockwaves are mechanical and not electric. They are audible, low-energy sound waves, aiming to promote and stimulate the body’s natural healing process. The exact mechanism by which this therapy might affect tendinopathy is still unknown.
You will usually require a course of three treatments, one week apart. There is a possibility that further treatments may be required if your condition is very chronic.
What musculoskeletal conditions may benefit from Shockwave Therapy?
Shockwave is an accepted intervention in the UK and treatment that may provide pain relief for chronic tendinopathies. Shockwave therapy treats many problems within soft tissue areas which have proved resistant to more conventional treatments, these include:
- Achilles or patella tendinopathy
- Calcification of tendons
- Chronic tendinopathy
- Plantar fasciitis (Jogger’s heel)
- Ligament injury
Why should I have ESWT?
ESWT is offered to patients who have not responded well enough to conservative treatments such as rest, ice therapy, pain relief medication, physiotherapy and insoles/orthotics. Shockwave therapy may be an appropriate treatment option if injection therapy (corticosteroid) or surgery is not suitable for you. Studies have shown that ESWT can offer relief from pain in approximately 70% of cases.
What happens during ESWT?
The treatment is carried out at Rowlands Foot Care, Everyone Active Fitness & Sports Centre, Back Lane, Cambourne, CB23 6FY. You may be asked to lie on your front with your legs supported by a pillow. The painful area is located by palpation. The treatment is delivered via a compressed air impulse through a hand-held device attached to the shockwave machine. The shockwave radiates out through the head of the probe into the affected area. Contact gel will be applied to the skin to improve the transmission of the shockwave. Each treatment will take approximately five to ten minutes.
How does ESWT work?
The treatment initiates a pro-inflammatory response in the affected tissue that is being treated. The body responds by increasing the blood circulation and metabolism in the affected area which may accelerate the body’s own healing processes. The shockwaves can break down injured tissues and calcifications. As a result of cellular tissue micro-trauma, it can provide a temporary analgesic effect on afferent nerves, providing immediate pain relief, known as ‘hyper-stimulation anaesthesia’.
What are the risks/side effects?
Shockwave Therapy is safe and effective. You will experience some pain/discomfort during the treatment, but the pain should be bearable. The treatment is delivered according to patient response; if a patient is unable to tolerate the pain levels, the settings will be adjusted to reduce the discomfort. Following the treatment, you may experience pain/discomfort, 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 or ligament rupture and damage to the soft tissue.
What happens after ESWT?
After the treatment, you will be able to walk straight away. You may continue with your normal activities or return to work. You can drive immediately after the treatment. If you do experience pain/discomfort following the shockwave treatment you can take over the counter painkillers (such as paracetamol), but do not take anti-inflammatory medication (such as Ibuprofen) and ice therapy.
What do I need to do after I go home?
We advise you are not to undertake any strenuous, pain-provoking activity or high-impact exercise for 48 hours following the procedure. If you experience extreme pain to the area or any loss of function, please contact our podiatrist, your GP or go to your nearest Emergency Department (A&E).
Will I have a follow-up appointment?
You will have a follow-up appointment with your podiatrist 12 weeks after your final treatment. An appointment letter will be automatically sent to you in the post. You will also have a final follow-up one year after your treatment to assess the effectiveness of ESWT.
What if the treatment does not work?
Though the short-term effects are very good, the long-term benefits of this treatment may take up to three months. If, over this time, there is no improvement in your condition, then your consultant will offer you other treatment options.
Further sources of information
National Institute for Health and Care Excellence (NICE)
NICE has produced recommendations for patients on ESWT for Achilles tendinopathy and plantar fasciitis. These documents can be accessed on the NICE website: www.nice.org.uk
If you have any questions or concerns about ESWT, please contact us on (01954)-718741/(07850)-023168 (Monday to Friday, 9am to 8pm).