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Extracorporeal shock wave therapy for heel pain

October 1, 2019

Extracorporeal shock wave therapy for heel pain

Extracorporeal shock wave therapy (ESWT) for heel pain

Clinical use of ESWT was first introduced into practice in 1982 for urologic conditions. The success of this technology for the treatment of urinary stones quickly made it a first-line choice for the non-invasive, effective treatment of other conditions including but not limited to; heel pain, Achilles tendonitis, Plantar Fasciitis and ankle pain.

ESWT is an intervention that stimulates the body’s natural healing process. Additionally, SWT has been shown to have a direct effect on local nerve endings resulting in a decrease in pain.

It is important to understand the difference between low energy (Radial) and high energy   (Focal) ESWT when considering whether you are an appropriate candidate for ESWT and which type of ESWT is most likely to yield positive results in the treatment of your condition.

Focal shock wave therapy

High energy ESWT (Focal shock wave therapy ) or “true” shockwaves are classified as short duration (approx. 10msec) high energy pulses (5-100MPa) that break the sound barrier resulting in a shockwave.  Our high energy shockwave technology allows the shockwave to be focused directly through the affected tissue, resulting in several effects:

  • Mechanical pressure and tension forces on the tissue which has been shown to increase cell membrane permeability, thereby increasing microscopic circulation and therefore the metabolism within the treated area. This promotes healing and may result in the dissolution of calcific deposits.
  • The pressure front creates behind it a “cavitation bubble” which are small empty cavities created behind this pressure front.  When the bubbles collapse, they create a resultant force that has a mechanical impact on the treated tissue. This force helps to break down calcific deposits embedded in damaged tissue.
  • Shockwaves stimulate osteoblasts that are cells responsible for bone healing and new bone production.
  • Shockwaves stimulate fibroblasts that are cells responsible for healing of connective tissue such as tendons.
  • Diminishes pain by two mechanisms: Hyper-stimulation anaesthesia – local nerve endings are overwhelmed with so many stimuli that their activity diminishes resulting in short-term reduction in pain. Gate-control mechanism – whereby local nerves are stimulated to recalibrate perception of pain and result in longer-term reduction in pain.

There are three different mechanisms for generating high energy shock waves resulting in three different types of SWT device:

  • Electromagnetic shockwave (Sonocur and Dornier Epos machines)
  • Piezoelectric shockwave (Piezoson) * Electrohydraulic shockwave (I.E. HMT OssaTron machine)

Radial Shock wave therapy

Low energy shockwaves are generated by a radial pressure wave. This type of shockwave is more accurately described as a pressure wave and differs from “true” shock wave technology in the following ways:

  • Low energy shockwaves travel at a much slower speed and don’t break the sound barrier and hence a “true” shockwave is not produced.
  • Low energy shockwaves are longer, slower and less intense.
  • Radial pressure waves diverge from the source unlike high energy shockwaves that converge on a target, resulting in less energy applied to the tissue with low energy SWT vs. high energy SWT.

The Foot Centre’s Podiatric Surgeon, Stefan Edwards is proud to be able to offer both Radial and Focal shock wave therapy.

We use advanced technology manufactured by the most recognised manufacturer in this field of medicine, Storz medical.

Due to the reduced cost of low energy shockwave machines many patients may have the impression that they have received “true” (Focal) shockwave therapy.  Unfortunately this impression is often generated by misinformed patients and uninformed practitioners.  There certainly can be differences in effectiveness of high energy vs. low energy shockwave therapy.

Depending on the condition, e.g., reduction of scar tissue, bony cartilaginous tissue, heel pain heel spur formations, plantar fasciitis / heel pain and Achilles tendonitis the effectiveness of “true” or Focal Shock wave therapy ESWT tends to be between 60%-80%.

Compliance with treatment and rehabilitation recommendations are important factors in achieving optimal results.

The type of ESWT that is best suited for a particular patient is determined after consultation.

By Stefan R. Edwards FNZCPS