- 1 Summary of the Content:
- 2 Understanding Plantar Fasciitis
- 3 What is Shockwave Therapy?
- 4 The Clinical Evidence for Shockwave Therapy and Plantar Fasciitis
- 5 Who is a Good Candidate for Shockwave Therapy?
- 6 What to Expect from Shockwave Therapy Treatment
- 7 Comparing Shockwave Therapy to Other Treatments for Plantar Fasciitis
- 8 Final Thoughts
May 23, 2024
By Nick Lorem
Does Shockwave Therapy Really Work for Plantar Fasciitis?
That first step out of bed shouldn’t be excruciating. Yet morning pain is just the beginning of daily limitations for millions suffering from plantar fasciitis—inflammation of the thick band of tissue connecting your heel to your toes. Plantar fasciitis can make walking and standing uncomfortable.
Some people find relief with rest, ice, stretching, or shoe inserts. But for others, the pain continues—sometimes for months or even longer.
When standard treatments don’t help, you might start looking into other alternative options. One treatment you may come across is shockwave therapy. In this article, we’ll explore this question: does shockwave therapy really work for plantar fasciitis?
Using simple language, we’ll explain what the treatment involves, how it works, and what the research says. Our goal is to give you the information you need to decide if it’s right for you.
Summary of the Content:
- Plantar fasciitis is a common cause of heel pain, especially first thing in the morning or after rest, and is often linked to overuse or poor foot support.
- Conservative treatments like stretching, footwear changes, and orthotics are often helpful but may not work for everyone.
- Shockwave therapy is a non-invasive option that uses sound waves to stimulate healing in the plantar fascia.
- Research shows that shockwave therapy may improve pain and function, particularly in people with long-term symptoms.
- Clinical studies report significant pain reduction and low rates of side effects, though results can vary between individuals.
- Shockwave therapy is usually considered after 6 to 12 weeks of unsuccessful conservative care.
- This treatment may offer longer-lasting relief than cortisone injections and may help avoid surgery.
- Always consult a qualified health professional to determine if shockwave therapy is appropriate for your condition.
Understanding Plantar Fasciitis
Plantar fasciitis is a common foot condition that causes heel pain, especially during your first steps in the morning or after periods of rest. Pain is usually most intense when getting out of bed or after sitting for long periods. It often improves with movement but can return after rest.
This condition affects the plantar fascia, a strong band of tissue that connects your heel bone to the base of your toes. When this tissue becomes irritated or inflamed, it can lead to discomfort and limited mobility.
Overuse, tight calf muscles, poor foot alignment, or prolonged standing often cause plantar fasciitis. It is more common in people who are overweight, aged between 40 and 60, or who wear unsupportive footwear.
When symptoms last for more than a few months, the condition is sometimes called chronic plantar fasciitis, chronic proximal plantar fasciitis, or chronic recalcitrant plantar fasciitis. In these cases, the pain may interfere with work, exercise, and daily activities.
Common First-Line Treatments
Most patients start with conservative plantar fasciitis treatment options. These are usually recommended before considering more advanced therapies.
- Patients are often advised to reduce activities that worsen their plantar heel pain, such as running or standing for long periods.
- Stretching exercises targeting the foot and Achilles tendon are commonly recommended to relieve tension in the affected area.
- Supportive shoes or custom orthotic inserts are used to help distribute pressure and reduce strain on the plantar fascia.
- Wearing a night splint may keep the foot gently stretched during sleep and prevent morning stiffness.
- Many patients benefit from physical therapy, which can include hands-on treatment and guided exercise plans.
- Some people take nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, although these do not manage the underlying condition.
While these options can help many people, some continue to experience chronic plantar heel pain despite consistent effort. This leads some to explore other treatment modalities, including extracorporeal shock wave therapy (ESWT) or radial shock wave treatment.
What is Shockwave Therapy?
Shockwave therapy is a non-invasive option sometimes used when plantar fasciitis becomes long-lasting and painful.
It involves using sound waves to target areas of the foot that have become irritated over time. This approach is often explored when other care strategies—like physical therapy, footwear changes, or rest—have not brought lasting comfort.
The method known as extracorporeal shockwave therapy (ESWT) may be considered for people experiencing chronic plantar fasciitis or plantar heel pain that continues despite earlier efforts.
How Shockwave Therapy Works
During shock wave therapy for plantar fasciitis, a device sends acoustic energy into the part of the foot that is painful or inflamed.
Here’s how that may help:
- The energy can improve blood flow, which may support the body’s natural healing process.
- It may interrupt pain messages sent through nerves, helping to reduce the feeling of pain over time.
- The waves can also help stimulate new blood vessels in the area, which may help the tissue recover from chronic inflammation.
- Some cells in the area may respond by increasing collagen production, which is important for flexibility and support.
- In some cases, the wave pulses may help loosen tight or stiff areas in the foot.
This approach is often considered for people with chronic plantar fasciitis, chronic plantar heel pain, or plantar fasciopathy. The question, “Does shockwave therapy really work for plantar fasciitis?” is a valid one—especially for those who have been managing heel pain for months without lasting relief.
Types of Shockwave Therapy (Focused vs. Radial)
There are two main ways acoustic wave energy is delivered:
- Focused shockwave therapy
reaches deeper into the tissue. It may be used when discomfort is located below the surface. - Radial shock wave therapy
spreads energy over a broader area and stays closer to the surface of the foot.
These forms use different machines, including electromagnetic shock wave devices. The choice depends on your symptoms and how the pain presents during your appointment.
Both approaches are considered non-invasive and part of broader physical medicine options used in clinical practice.
The Treatment Process and Experience
A typical shockwave therapy session is quick and does not require surgery or needles.
Before starting, your provider will examine your foot and talk with you about your symptoms. If the pain is linked to chronic plantar fasciitis and other care options have not helped, this method may be offered.
During the session:
- You’ll either sit or lie down, depending on what’s most comfortable for the session.
- A small amount of gel is placed on the sore area of your foot. This helps the waves move through your skin.
- A device is used to send sound waves (shockwaves) into the painful spot using a handheld probe.
- These waves feel like a tapping or pulsing sensation. Some people feel mild discomfort, but most say it is manageable.
The first session may involve about 1,500 to 2,500 pulses (or “shocks”) at a higher frequency and pressure. The settings are often 21 Hz and 1.6–1.8 bar pressure in the beginning. Later sessions use slightly lower levels.
Most people receive three to four sessions, usually one per week. Each session lasts around 10 to 20 minutes. You can usually walk out straight after the session and return to normal movement, though heavy activity may be limited for a short time.
No anaesthetic is usually needed. The treatment is non-invasive, meaning there is no cutting, stitches, or recovery time like with surgery.
The Clinical Evidence for Shockwave Therapy and Plantar Fasciitis
Summary of Research Findings
Research on shockwave therapy for plantar fasciitis shows mostly positive results, though outcomes can vary.
- Long-term relief:
A 2016 study by Malliaropoulos et al. found that 98% of patients had at least a 60% drop in pain after one year. - Better function and mobility:
Dedes et al. (2018) reported significant improvement in pain and daily movement after 3–4 sessions, compared to standard care. - Compared to physiotherapy:
A 2013 study by Grecco et al. found that shockwave therapy offered longer-lasting pain relief than conventional physiotherapy. - Generally safe:
A 2017 review by Roerdink et al. found most side effects were mild and short-lived, like temporary discomfort or redness.
While shockwave therapy often helps, differences in treatment methods and definitions of “success” mean results can vary between clinics and patients.
Success Rates in Clinical Studies
A 2016 retrospective study titled Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy followed patients for one year after treatment. At three months, 70% of patients reported at least a 60% reduction in pain. This increased to 98% by the 12-month follow-up, suggesting that many patients experienced lasting relief.
In a large study on tendinopathies, Dedes et al. (2018) found that 80% of plantar fasciitis patients responded well after three shockwave sessions, and 17% required a fourth. Compared to those who received conservative care like massage and heat therapy, patients in the shockwave group showed more significant improvements in pain levels, mobility, and overall quality of life.
Another study, published by Grecco et al. (2013), compared radial shockwave therapy to conventional physiotherapy. While both groups improved, the shockwave group experienced better and longer-lasting pain relief—benefits that continued even one year after treatment.
Limitations of Current Research
Research on shockwave therapy does have its challenges. A 2017 systematic review by Roerdink and colleagues highlighted that different studies use very different treatment protocols—varying the number of sessions, energy settings, and even the type of device. This makes it difficult to compare results directly or draw universal conclusions.
There’s also no single definition of “treatment success.” Some studies, like the one by Malliaropoulos et al. (2016), define success as a 60% or greater drop in pain. Others include factors like improved function or ultrasound imaging results. This lack of consistency makes it harder for patients and practitioners to know what to expect.
Lastly, most studies track outcomes for only 6 to 12 months. Roerdink et al. (2017) noted that more long-term research is needed to understand better how often symptoms return and how well the results are maintained over time.
What Medical Guidelines Say About Shockwave Therapy
In Australia, shockwave therapy is usually considered when other options haven’t worked. These may include rest, stretching, ice, footwear changes, or pain relief.
The Royal Australian College of General Practitioners (RACGP) does not give a strong recommendation for or against shockwave therapy. However, it does mention it as a possible option for ongoing heel pain. A 2024 RACGP article notes that extracorporeal shockwave therapy may help some people. It also says results can vary, and this method is usually tried only after simpler steps haven’t helped.
The Australian Podiatry Association does not have official national guidelines for shockwave therapy. However, many podiatrists use it based on clinical experience and research. It is often offered when pain has lasted for weeks or months and is not improving.
Who is a Good Candidate for Shockwave Therapy?
Shockwave therapy is usually considered when heel pain hasn’t improved with other care.
When is Shockwave Therapy Typically Recommended?
Shockwave therapy is often suggested for plantar fasciitis when other non-invasive treatments have not helped. This usually means trying care such as rest, stretching, orthotics, ice, and footwear changes for at least 6 to 12 weeks without much improvement.
To decide if this therapy is suitable, your podiatrist or physiotherapist will consider the following:
- Pain duration:
If your heel pain has lasted for several weeks or months without relief, shockwave therapy may be considered. - Previous treatments:
If you have already tried conservative treatments like stretching, physical therapy, or footwear changes with little improvement, you may be a candidate. - Location of pain:
Shockwave therapy is commonly used for pain at the bottom of the heel, which is a typical spot for plantar fasciitis. - Response to other treatments:
if other treatments have not helped and pain still affects your daily activities, shockwave may be a suitable next step. - Overall health and history:
A health professional will review your medical history to check for any conditions that may affect treatment safety.
Contraindications and Risk Factors
Shockwave therapy is not suitable for everyone. There are some cases where this treatment may be unsafe or not recommended:
- Pregnancy:
This treatment is not used during pregnancy due to limited safety data. - Use of blood thinners or bleeding conditions:
People who take medications like warfarin or have clotting problems may have a higher risk of bruising or bleeding. - Bone infection or tumours:
If there is an active infection or a tumour in the area, shockwave therapy should be avoided. - Reduced feeling in the feet:
People with nerve damage or conditions like advanced diabetes may not respond safely or effectively. - Open wounds or skin infections:
The treatment should not be applied to areas with broken skin or visible infection. - Poor blood flow or severe nerve issues:
People with serious circulation or nerve problems in the legs or feet may not be good candidates. - Young children or teens:
This therapy is not usually recommended for growing children, as their bones are still developing.
Important Considerations Before Treatment
Before starting shockwave therapy, it’s useful to think about the following:
- Cost:
Shockwave therapy isn’t covered by Medicare. Some health funds may help with the cost, depending on your level of cover and the provider. It’s a good idea to check with your fund in advance. - Time commitment:
Most people have one session per week for three to six weeks. Each visit lasts around 15–20 minutes. A follow-up appointment may be needed to review your progress. - Other therapies may be included:
Your provider might also suggest stretching, changes to footwear, or custom orthotics to support recovery and help prevent the pain from coming back. - Expected results:
Relief can take time. Some people feel better after a few sessions, while others may take longer. Results often depend on how long you’ve had symptoms and your overall foot health.
Your healthcare provider will check your medical history and any health conditions before starting therapy. This helps reduce risks and supports the safest possible approach.
What to Expect from Shockwave Therapy Treatment
Typical Treatment Protocols
Most shockwave therapy plans involve several short sessions over a few weeks. The number of sessions and intensity may vary based on your symptoms and how your body responds.
Key details:
- Session count:
Most people receive three to six sessions in total. Your healthcare provider may adjust the number depending on how long you’ve had heel pain, how severe it is, and how you respond after the first few sessions. - Timing:
Sessions are usually spaced about one week apart. This gives the tissue time to respond between appointments and helps track your progress. - Session length:
Each session lasts around 15 to 20 minutes. Most of this time is spent applying a handheld device to the area of pain using a gel to help the sound waves travel through the skin. - Adjustments:
The intensity of the pulses may be adjusted depending on your comfort. For example, a higher level might be used as pain decreases, or lower settings may be applied if your foot is still sensitive. - No anaesthetic needed:
You stay fully awake during treatment. Most people find the sensation tolerable—often described as a pulsing, tapping, or vibrating feeling over the sore area.
Timeframe for Seeing Results
- Early improvement: Some patients notice less pain after the second or third session. This may feel like a decrease in morning pain or less soreness after walking.
- Gradual relief: The most noticeable changes often happen 3 to 12 weeks after completing the full set of treatments. This is when tissue healing and reduced inflammation are more likely to occur.
- Duration of symptoms: Long-term plantar fasciitis may take longer to improve.
- Footwear and activity habits: Supportive shoes and modified movement can affect outcomes.
- Overall health: Conditions like diabetes or circulation problems may influence healing time.
Potential Side Effects
Shockwave therapy has been shown to be safe for most people. However, like any medical treatment, it can cause some mild side effects. These are generally short-lived and eventually go away.
- Soreness or tenderness:
You may feel some discomfort in the treatment area during or after the session. This usually settles within 24–48 hours. - Swelling or redness:
The skin over the heel may become slightly red or swollen. This is a normal part of the body’s response to the sound waves. - Bruising or dull ache:
In some cases, mild bruising or a deep ache may develop. These effects are temporary and don’t usually require any special care. - Very rare risks:
Serious side effects like nerve damage or prolonged pain are rare. Your provider will ask about your medical history to reduce risks before starting.
Recovery Process
One of the main advantages of shockwave therapy is that it does not require rest time or hospital visits. However, a few short-term changes may help you heal more effectively.
Recovery support may include:
- Avoiding high-impact activity:
Your provider may advise skipping running, jumping, or prolonged standing for a few days after each session. This helps reduce stress on the healing tissue. - Continuing stretching exercises:
Gentle stretches for the foot and calf can support recovery. These are often guided by a physiotherapist or podiatrist and tailored to your movement. - Changing footwear:
Wearing cushioned, supportive shoes can help reduce strain on the plantar fascia. Your provider may recommend specific types or brands. - Using orthotics or inserts:
Custom or over-the-counter shoe inserts may be suggested to help improve foot position or reduce pressure on the heel. - Monitoring progress:
Some clinics schedule a follow-up appointment a few weeks after treatment ends. This helps assess your progress and decide if additional support is needed.
Comparing Shockwave Therapy to Other Treatments for Plantar Fasciitis
Conservative Treatments vs. Shockwave Therapy
Many people begin with non-invasive options that can often manage mild to moderate plantar fasciitis. These approaches are usually tried for at least 6 to 12 weeks before considering more advanced options.
Common conservative treatments:
- Rest and modifying activity:
Reducing time spent on your feet or adjusting exercise routines may help reduce pressure on the plantar fascia. - Stretching exercises:
Regular stretches for the calf muscles and plantar fascia can relieve tightness and improve flexibility. - Supportive footwear and orthotics:
Wearing well-cushioned shoes or using inserts can help absorb shock and reduce stress on the heel. - Ice application:
Applying ice to the heel for short periods can help ease pain and reduce inflammation. - Over-the-counter pain relief:
Medications like paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) may temporarily reduce discomfort, although they do not address the underlying problem.
Compared to shockwave therapy:
- Conservative care is easier to access and more affordable, especially early in treatment.
- Shockwave therapy may offer longer-term relief in chronic cases that do not respond to initial care.
- Unlike home-based methods, shockwave therapy requires weekly clinic visits and more upfront costs.
Shockwave Therapy vs. Cortisone Injections
Cortisone injections are sometimes offered to reduce heel pain, especially when symptoms are severe or limit daily function.
What to know about cortisone injections:
- Cortisone can reduce inflammation and provide fast relief, sometimes within a few days.
- The benefits often last for a few weeks or months but are not long-term in most cases.
- Repeated injections may weaken the tissue in the heel, increasing the risk of plantar fascia rupture or fat pad thinning.
Compared to shockwave therapy:
- Shockwave does not involve any injections and has fewer long-term tissue risks.
- Pain relief from shockwave builds more slowly but may last longer.
- Some people may use both treatments at different points, depending on their symptoms and goals.
Shockwave Therapy vs. Surgery
Surgery is usually the last step, only considered when symptoms continue for more than 6 to 12 months despite other efforts.
What to know about surgery for plantar fasciitis:
- Procedures may include partially releasing the plantar fascia or removing damaged tissue.
- Recovery from surgery can take weeks to months and may involve time off from work or sports.
- Like all operations, there are risks such as infection, scarring, nerve damage, or ongoing pain.
Compared to shockwave therapy:
- Shockwave therapy does not require any cutting or stitches, and there is no recovery downtime.
- It may help reduce symptoms enough to delay or avoid the need for surgery.
- For many people, it offers a middle-ground option between conservative care and more invasive procedures.
Final Thoughts
So, does shockwave therapy really work for plantar fasciitis? Some research suggests that shockwave therapy may help reduce pain and improve foot movement, especially in people with longer-lasting symptoms. Studies have shown positive outcomes, especially in long-term cases where other care hasn’t provided enough relief.
However, results can vary. Your experience may depend on how long you’ve had symptoms, your general health, and the specific approach used during treatment.
It’s important to talk to a podiatrist or physiotherapist. They can assess your condition, explain the options, and guide you on whether shockwave therapy suits your needs.
You can speak with clinics such as Impact Shockwave and Technology Centre to learn more about how this therapy is used in practice and whether it may be appropriate for your needs.
