Shockwave therapy (ESWT)

How it works

A handpiece placed on the skin sends a series of pressure waves into the painful tissue. The exact way it relieves pain is still being studied; it is thought to stimulate a healing response in tissue that has stalled, and to calm pain signaling. Treatments typically take a few minutes and are given as a short series, usually weekly.

What it treats

• Plantar fasciitis and chronic heel pain. The most studied use. A meta-analysis found shockwave had a large effect on pain and function for plantar fasciitis,^[1] another found it better than corticosteroid injections at three and six months,^[2] and across treatments for plantar fasciitis it was the one that improved pain in the medium and long term.^[3] See heel pain.
• Insertional Achilles tendinopathy, where evidence favors shockwave, alone or combined with eccentric exercise.^[4] For midportion Achilles tendinopathy the benefit over exercise alone is small or unclear.^[1] See Achilles tendon.
• Other foot and ankle problems, such as heel spurs, where a systematic review found it safe with a favorable complication profile but called for more research.^[6]

Is it right for you?

Shockwave is usually considered when heel or tendon pain hasn’t settled after several weeks of stretching, strengthening, footwear changes and inserts. It is not a replacement for those basics: in a randomized trial, a plantar-fascia stretching program did better than low-energy shockwave as the very first treatment,^[7] and in another, adding shockwave to a structured home exercise program didn’t improve results over exercise alone at 12 weeks.^[8] We’ll talk through where it fits for you.

It may not be suitable during pregnancy, over an open growth plate in children, over an area of infection or tumor, or with some bleeding disorders; we check before treatment.

What to expect

• During: the pulses feel like a firm, rapid tapping; the intensity is adjusted to what you can tolerate.
• After: some soreness or redness for a day or two is common. Local pain and slight redness were the most frequent side effects in trials.^[2] Most people return to normal activities the same day.
• Results: improvement is gradual over the following weeks to months.

Our article does shockwave therapy work? looks at the research in more detail.

Common questions

How many sessions will I need?

Shockwave is given as a short series, usually a week apart, rather than a single treatment. We reassess at the end of the series; because improvement builds over the following weeks, the full effect is judged a couple of months later, not on the day.

Can I keep exercising?

Yes, and you should keep up your stretching and strengthening program, which does much of the work.^[5] We may suggest easing off running and jumping for a day or two after each session if the area is sore.

Is shockwave better than a cortisone injection?

For plantar fasciitis, a meta-analysis found shockwave gave better pain relief than corticosteroid injections at three and six months.^[2] It also avoids a needle. Injections still have a place for some people, and we discuss both.

What if it doesn’t help?

Most heel pain improves with a combination of treatments over time. If yours hasn’t, we look again at the diagnosis (nerve irritation and stress fractures can mimic plantar fasciitis) and discuss other options, including PRP injections and, rarely, surgery. See heel pain.

Insurance

Coverage for shockwave therapy varies from plan to plan. We’ll confirm your cost with you before you start.

When to seek care