From the Guidelines
Extracorporeal Shock Wave (ESW) therapy is not recommended for the management of diabetes-related foot ulcers due to the lack of strong evidence supporting its effectiveness, as stated in the most recent guidelines 1.
Overview of ESW Therapy
ESW therapy, also known as Extracorporeal Shock Wave Therapy (ESWT), is a non-invasive treatment that uses high-energy acoustic waves to stimulate healing in various musculoskeletal conditions. However, its application in diabetes-related foot ulcers has been explored in several studies.
Evidence for ESW Therapy in Diabetes-Related Foot Ulcers
The most recent guidelines on interventions to enhance healing of foot ulcers in people with diabetes 1 found that the evidence to support the use of ESWT for diabetes-related foot ulcers is weak. The guidelines recommend against the use of physical therapies, including ESWT, for the management of diabetes-related foot ulcers due to the lack of strong evidence supporting their effectiveness 1.
Previous Studies on ESW Therapy
Previous studies on ESWT for chronic foot ulcers in diabetes have shown mixed results 1, 1. However, these studies were often at high risk of bias or showed no evidence of benefit. A systematic review of interventions to enhance healing of chronic foot ulcers in diabetes found that ESWT was not effective in improving ulcer healing 1.
Other Applications of ESW Therapy
While ESWT may not be recommended for diabetes-related foot ulcers, it has been shown to be effective in treating various musculoskeletal conditions, such as plantar fasciitis, tennis elbow, and Achilles tendinopathy 1. The therapy typically involves 3-5 sessions spaced 1-2 weeks apart, with each session lasting about 10-15 minutes.
Safety and Precautions
ESWT is generally considered safe, but it should be avoided during pregnancy, in patients with blood clotting disorders, or those taking anticoagulants 1. It should not be applied directly over bone, lungs, or major nerves.
Key Points
- ESWT is not recommended for the management of diabetes-related foot ulcers due to the lack of strong evidence supporting its effectiveness 1.
- ESWT may be effective in treating various musculoskeletal conditions, such as plantar fasciitis, tennis elbow, and Achilles tendinopathy 1.
- The therapy is generally considered safe, but precautions should be taken to avoid certain complications 1.
From the Research
Definition and Mechanism of Extracorporeal Shock Wave Therapy
- Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment that uses high-intensity mechanical waves to induce tissue repair and regeneration 2, 3, 4.
- The mechanism of action of ESWT is based on mechanotransduction, which induces neoangiogenesis, osteogenesis, and improves local tissue trophism, regeneration, and remodeling 2, 4.
Applications of Extracorporeal Shock Wave Therapy
- ESWT is used to treat various musculoskeletal disorders, including plantar fasciitis, calcific or non-calcific tendonitis of the shoulder, patellar tendinopathy, and lateral epicondylitis of the elbow 5, 3, 6.
- It is also used to treat non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers, and ischemic heart disease 3.
- ESWT has been shown to be effective in managing foot and ankle disorders, such as plantar fasciitis, calcaneal spur, Achilles tendinopathy, and Morton's neuroma 6.
Efficacy and Safety of Extracorporeal Shock Wave Therapy
- Studies have shown that ESWT is a safe and effective treatment for various musculoskeletal disorders, with significant improvements in pain and function 5, 6, 4.
- The success rate of ESWT ranges from 65% to 91%, with low and negligible complications 3.
- ESWT has been demonstrated to be a safe treatment option with a favorable complication profile, and can be used alone or in conjunction with other physical therapies 4.