From the Guidelines
Shockwave therapy is a viable treatment option for plantar fasciitis, particularly for patients who have not responded to conservative treatments after 3-6 months, as it can stimulate healing and improve symptoms. When considering treatment options for plantar fasciitis, it's essential to weigh the potential benefits and risks of each approach.
- Shockwave therapy is a non-invasive procedure that uses sound waves to stimulate healing and reduce pain in the affected area.
- The treatment typically involves 3-5 sessions, spaced one week apart, with each session lasting about 10-15 minutes.
- Patients may experience mild discomfort during treatment and temporary soreness afterward, but can usually resume normal activities immediately.
- The therapy works by increasing blood flow to the area, stimulating tissue repair, and potentially disrupting pain signals.
- Most patients notice improvement within 6-12 weeks after completing treatment. According to the American College of Foot and Ankle Surgeons, as stated in the 2002 guidelines 1, shockwave therapy can be considered for patients who have not responded to initial treatment measures after two to three months. While the more recent study from 2025 1 does not specifically address shockwave therapy for plantar fasciitis, it does discuss the use of extracorporeal shock wave therapy for spasticity management, stating that there is insufficient evidence to recommend for or against its use. However, in the context of plantar fasciitis, shockwave therapy can be a valuable treatment option for patients who have not responded to conservative treatments, offering a middle-ground approach between conservative measures and more invasive procedures like surgery.
From the Research
Shockwave Therapy for Plantar Fasciitis
- Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive treatment option for plantar fasciitis, a common cause of heel pain 2, 3.
- Studies have shown that ESWT can be effective in reducing pain and improving function in patients with plantar fasciitis, with some studies suggesting it may be as effective as other treatment modalities such as platelet-rich plasma (PRP) injections 2, 3.
- A systematic review and meta-analysis found that ESWT performed significantly better than placebo in reducing pain and improving function, but PRP injections outperformed ESWT in terms of pain reduction and functional improvement 3.
- Another study compared ESWT to other conservative treatment options, including custom orthotics, and found that ESWT was a successful treatment for plantar fasciitis, but custom orthotics improved function significantly more than ESWT 3.
Comparison to Other Treatment Modalities
- ESWT has been compared to other treatment modalities, including PRP injections, custom orthotics, and manual therapy interventions, with varying results 2, 3, 4.
- A study found that cross friction massage of the plantar fascia and stretching of the gastrocsoleus complex showed the greatest overall improvement in terms of reducing pain and disability, whereas a combination of manual therapy interventions showed the greatest increase in plantar flexion 4.
- A narrative review of randomized controlled trials found that stretching, prefabricated and custom-made orthotics, and night splints may be effective treatment options for plantar fasciitis, but the evidence is limited by methodological flaws and inconsistent outcome measures 5.
Efficacy and Safety
- The efficacy and safety of ESWT for plantar fasciitis have been established in several studies, with most studies reporting significant improvements in pain and function 2, 3.
- However, the optimal treatment protocol and dosage for ESWT remain unclear, and further research is needed to determine the long-term effects and potential side effects of this treatment modality 2, 3.