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 compared to standard care.
Definition and Mechanism
Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment that uses acoustic pressure waves to stimulate healing in various musculoskeletal conditions and wounds. The mechanism involves triggering microtrauma, which stimulates the body's natural healing response, increases blood flow, breaks down calcium deposits, and releases pain-mediating substances 1.
Clinical Application and Evidence
While ESWT has been explored for its potential in treating chronic foot ulcers in diabetes, the current evidence does not support its use as a recommended intervention. According to the guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update), the evidence for physical therapies, including ESWT, is of low certainty and does not demonstrate significant benefits over standard care 1.
Recommendation
Based on the most recent and highest quality evidence, ESWT should not be used as a treatment for diabetes-related foot ulcers. This recommendation is made considering the low certainty of evidence, the lack of significant benefits, and the potential for additional costs and resources without clear advantages over standard care 1.
Considerations for Practice
In real-life clinical practice, the decision to use or not use ESWT should prioritize the patient's overall morbidity, mortality, and quality of life. Given the current state of evidence, standard care for diabetes-related foot ulcers should be prioritized, and alternative treatments should be considered based on individual patient needs and the strength of evidence supporting their use.
From the Research
Definition and Overview of Extracorporeal Shock Wave Therapy (ESWT)
- Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive therapeutic modality used in the treatment of musculoskeletal disorders, including sports-related over-use tendinopathies 2.
- ESWT is primarily used to induce tissue repair and regeneration, rather than disintegrating tissues 2.
- The therapy involves the use of high-energy acoustic waves generated through electrohydraulic, electromagnetic, or piezoelectric principles 2.
Applications and Effectiveness of ESWT
- ESWT has been shown to be effective in the treatment of various musculoskeletal conditions, including plantar fasciitis, calcific tendinitis, and lateral epicondylitis 3, 2, 4, 5.
- The success rate of ESWT in treating these conditions ranges from 65% to 91%, with low and negligible complications 2.
- ESWT has also been used in the treatment of non-union of long bone fractures, avascular necrosis of the femoral head, and chronic diabetic and non-diabetic ulcers 2.
Treatment Protocol and Energy Levels
- The treatment protocol and energy levels used in ESWT can vary, with some studies suggesting that higher dose regimes may be more effective 3.
- Low-energy ESWT has also been shown to be effective in treating chronic plantar fasciitis, with significant improvements in pain and functional scores 4.
- The FDA (USA) has approved ESWT for the treatment of proximal plantar fasciitis and lateral epicondylitis 2.
Safety and Complications
- ESWT is generally considered a safe and well-tolerated treatment strategy, with rare complications reported, including injury to bone and Achilles tendon rupture in older adults 6.
- No significant side effects were reported in studies examining the use of ESWT in treating chronic plantar fasciitis 4, 5.