Shockwave therapy is a non-surgical treatment that uses sound and pressure waves to stimulate a painful area of the plantar fascia, the band of tissue on the bottom of the foot, along with the tissue around it. It is generally considered for heel pain that has lasted for months and has not settled with simpler care, rather than as a first step for new heel pain.
The plantar fascia is a strong, tendon-like band that runs along the bottom of the foot from the heel bone to the ball of the foot. It helps hold up the long arch and keeps the foot stable, so the foot can push the body forward with each step. Pain from plantar fasciitis is usually felt on the bottom of the heel and sometimes extends into the arch. Our guide to foot anatomy explains how these structures fit together.
Tissue like the plantar fascia has a relatively limited blood supply, which is one reason an injury there can be slow to heal. In Dr. Marzano's experience, a common contributor is a flat foot that puts extra strain on the fascia with every step. Excess body weight, overuse, a direct injury and diabetes can also play a part.
During treatment, a handheld device is placed against the bottom of the heel or foot and delivers repeated acoustic pulses into the painful area. As Dr. Marzano's patient handout describes it, the aim is to:
A typical session takes about 10 to 20 minutes. You may feel tapping, pressure or brief sharp discomfort while the device is working. There is usually no anesthesia and no downtime, so most people go back to their normal day afterwards. Treatment is commonly given once a week for several weeks, although the exact schedule varies.
Side effects are usually mild and short-lived: temporary soreness, bruising, redness, or a day or two of increased pain. More serious complications are uncommon when the treatment is given appropriately.
The honest answer is that the research is mixed. Some studies have found that shockwave therapy can reduce pain and improve function in people with chronic plantar fasciitis, particularly when symptoms have not improved with stretching, activity changes, supportive footwear and physical therapy. The American Academy of Orthopaedic Surgeons notes that results are mixed and that it is not clear the treatment helps everyone.
It is also worth knowing that most plantar fasciitis gets better without it. According to the same source, more than 90% of patients improve within 10 months of starting simple treatment. That is why shockwave therapy is usually reserved for heel pain that has not responded to those first steps.
Shockwave therapy may be worth discussing if your heel pain has lasted for months despite consistent conservative care. Before recommending it, Dr. Marzano examines the foot to confirm the pain is coming from the plantar fascia, because other problems, such as a stress fracture or an irritated nerve, can cause heel pain too. Morning pain is a common clue, and we explain why heel pain often feels worse in the morning in a separate article.
Dr. Marzano also puts weight on protecting the injured fascia while it heals: in more severe cases with a walking boot for a short time, and over the longer term with TCS devices that help control how the foot moves as you walk.
Heel pain that lasts more than a few weeks, keeps coming back, or changes the way you walk deserves an evaluation. Seek prompt care for heel pain after a fall or injury, if you cannot put weight on the foot, or if there is marked swelling, redness, warmth, numbness, tingling or fever.
If you have diabetes, poor circulation or neuropathy, have new foot pain checked promptly, since reduced sensation can hide a more serious problem. This article is educational and cannot diagnose the cause of an individual patient's heel pain.
Westchester Podiatric Medicine offers shockwave therapy in Scarsdale, New York, as one option within a broader plan for heel pain. Learn more about our shockwave therapy and plantar fasciitis treatment, or request an appointment if your heel pain has not improved.