From the Guidelines
Extracorporeal Shock Wave Therapy (ESWT) is not recommended for the management of diabetes-related foot ulcers due to low certainty evidence and lack of significant benefits.
Definition and Mechanism
Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment that delivers high-energy acoustic waves to injured tissues, aiming to stimulate the body's natural healing response, increase blood flow, and promote tissue regeneration.
Clinical Application
The treatment is typically administered in 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.
Evidence and Recommendations
According to the most recent and highest quality study 1, the evidence to support the use of ESWT for diabetes-related foot ulcers is weak, with most studies being at high risk of bias or showing no significant differences in outcomes compared to standard care.
Key Points
- ESWT is not currently recommended for the management of diabetes-related foot ulcers due to low certainty evidence and lack of significant benefits 1.
- The treatment may be considered for other musculoskeletal conditions, such as chronic tendinopathies, but its effectiveness for diabetes-related foot ulcers is not supported by strong evidence.
- Patients with diabetes-related foot ulcers should be managed with standard care, including wound dressing, offloading, and medical treatment, rather than relying on ESWT or other physical therapies.
Limitations and Future Directions
The current evidence on ESWT for diabetes-related foot ulcers is limited by the small number of studies, high risk of bias, and lack of standardization in treatment protocols. Further research is needed to fully understand the potential benefits and limitations of ESWT for this condition.
From the Research
Definition and Mechanism of Extracorporeal Shock Wave Therapy (ESWT)
- Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment that uses high-intensity mechanical waves to treat various musculoskeletal disorders 2.
- The therapy involves the application of radial and/or focused shock waves with low or high energy to promote healing and reduce pain 3.
- The main mechanism of action of ESWT is biological, through a phenomenon called mechanotransduction, which stimulates the body's natural healing processes 2.
Indications for ESWT
- ESWT is commonly used to treat conditions such as plantar fasciitis, calcified shoulder, tennis elbow, Achilles tendinopathy, and delayed healing and chronic wounds 3, 4, 5.
- It is also used to treat other musculoskeletal and non-musculoskeletal indications, including myofascial syndrome, erectile dysfunction, polyneuropathy, and lymphedema 3.
- ESWT has been shown to be effective in reducing pain and improving function in patients with knee osteoarthritis 6.
Safety and Efficacy of ESWT
- ESWT is considered a safe treatment with minimal adverse effects, including transient pain, redness, and swelling 4, 5, 2.
- The therapy has been shown to be effective in improving pain and function in various musculoskeletal disorders, with solid evidence supporting its use in many conditions 2.
- However, further studies are needed to determine the long-term effects and optimal treatment protocols for ESWT 5, 6.