- Shockwave is a non-invasive treatment, which means that no surgery is required.
- Pain reduction occurs by inhibiting nociceptors, which are the nerves that detect pain and transmit painful impulses.
- Collagen production is stimulated, helping muscles, tendons and soft tissue structures to heal and repair.
- New blood vessel formation occurs in the area because the shock waves promote a process called angiogenesis. This means that more oxygen and nutrients can help repair injuries.
What is Plantar Fasciitis?
Plantar fasciitis is a painful condition of the foot caused by repetitive stress straining the plantar fascia. This is a fibrous band of soft tissue that connects the heel bone to the toes. It helps reinforce the arch of the foot and acts as a ‘bowstring’ to stiffen the foot when you walk.
Plantar fasciitis is believed to be the result of excessive tension across the plantar fascia, which causes pain in the underside of the heel, pad or sole of the foot, particularly when lifting.
The pain is usually worse in the morning or after standing or walking for a long time.
The exact cause of plantar fasciitis is not known.
Initial treatment
Treatment of plantar fasciitis is aimed at reducing pain and restoring function.
The most common treatment options are conservative, such as ice, stretching, anti-inflammatories, orthoses, physical therapy and exercises.
These conservative treatments can help relieve symptoms in most patients after several months.
However, some patients may not respond well to conservative treatments or may experience recurrent symptoms. In such cases, alternative treatments may be considered, such as extracorporeal shock wave treatment (ESWT) or surgery.
Shockwaves for Plantar Fasciitis
Shockwave treatment is indicated when other conservative treatment methods, such as rest, medication, physical therapy, night splints, supportive shoes, and orthoses, do not improve even when used for a period of 6 months.
| Description | Technical details |
|---|---|
| Shockwave therapy is a minimally invasive procedure used to treat musculoskeletal and soft tissue pain. | Shockwave therapy applies acoustic waves to the affected area, causing microtrauma and a body response to heal the area. |
| The therapeutic effect of shockwave therapy is based on the body’s natural healing process. | The acoustic waves cause an increase in local blood circulation and metabolic rate, which stimulates the body’s natural healing process and helps to reduce pain. |
| Shockwave therapy can be used to treat a variety of conditions, including tendinitis, bursitis, and myofascial pain. | The acoustic waves are delivered at low to moderate pressures, which allows the shock waves to reach deeper tissues without causing any damage. |
Shock wave treatment is used as an alternative treatment modality to surgery. Most patients undergoing shockwave therapy experience significant pain reduction and improved movement compared to other conservative treatment options.
What is Shockwave Treatment like?
| Stage | Description |
|---|---|
| 1 | The shock wave is generated by the device, producing acoustic waves that travel through the skin. |
| 2 | Acoustic waves penetrate the tissues of the affected area. |
| 3 | The shock waves interact with tissues, causing microscopic bubbles to form. |
| 4 | The pressure from the shock wave causes these bubbles to implode, releasing energy. |
| 5 | This energy stimulates the body’s cells to produce new blood vessels, which increases the supply of oxygen and nutrients to the area. |
| 6 | Increased blood flow helps reduce inflammation and pain. |
Learn more about Shockwaves in this comprehensive guide.
evidence
A recent study published in The American Journal of Sports Medicine evaluated the long-term results of shockwave therapy for plantar fasciitis. The study involved 149 patients with chronic plantar fasciitis who were randomly assigned to receive either shock wave treatment or conservative treatment. Patients were followed for 5 to 6 years and assessed for pain and function using a 100-point scoring system.
The study found that shock wave treatment was significantly more effective than conservative treatment in improving pain scores and function. Overall results were 69.1% excellent, 13.6% good, 6.2% fair, and 11.1% poor for the shock wave group; and 0% excellent, 55% good, 36% fair, and 9% poor for the conservative treatment group.
The rate of injury and pain recurrence was also lower for the shock wave group (11%) than for the conservative treatment group (55%). There were no serious complications or adverse effects from the treatment.
The study concluded that shockwave treatment is safe and effective for plantar fasciitis, with good long-term results, and may be a viable option for patients who do not respond to conservative treatments or who wish to avoid surgery.
Systematic Reviews
A systematic review and meta-analysis of 13 studies (with nearly 1200 patients in total) published in 2020 compared the efficacy and safety of shockwave treatment with other therapies for chronic plantar fasciitis.
The other therapies included non-steroidal anti-inflammatory drugs, heel pads, orthoses, physiotherapy, stretching exercises and corticosteroid injections.
The meta-analysis found that patients who received shockwaves had better outcomes than those who received other therapies in terms of success or rates of improvement, pain reduction, functional improvement, return to work, and complication rates.
According to the authors, shockwave therapy for chronic plantar fasciitis may be more effective than other treatments and offer a safe alternative to treat chronic plantar fasciitis.
Other Comparative Studies
A recent systematic review evaluated 236 studies (with more than 15,000 patients) and investigated the use of different pain treatments and, mainly, their effectiveness in the short, medium and long term.
Treatments investigated included botulinum toxin, dry needling, low-dye taping, low-level laser therapy, myofascial releases, platelet-rich plasma, radiofrequency, and stretching.
Results of the systematic review suggest that these treatments resulted in effective pain treatments when compared to short-term control.
In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain from plantar fasciitis when compared to control.
Risks and complications
Shock wave therapy is a relatively safe procedure; however, as with any procedure, there are risks and complications that can occur in the heel region, such as:
- Dor – mild pain for 24-48 hours after the procedure
- Swelling – minimal local swelling, skin sensitivity after stimulation
- skin redness – light and transient
- Hematomas – down
- numbness – local, light touch sensitivity
Source: blogdasaude.com.br
