Extracorporeal shockwave therapy (ESWT) may work on plantar fasciitis as part of a conservative treatment plan. It uses sound waves or ultrasound energy to heal the inflamed plantar fascia by increasing the blood flow to the affected area. Physiotherapists may recommend shockwave therapy for plantar fasciitis when symptoms have not improved with other conservative care. But how effective is the treatment for plantar fasciitis? Is it suitable for every patient? This article discusses what plantar fasciitis is, how shockwave therapy works on it, and who may benefit from the treatment.
What is Plantar Fasciitis?
Plantar fasciitis is a foot condition that causes sharp pain in the heel or arch of the foot. It occurs when the plantar fascia is overused or overstretched, leading to its inflammation. This inflamed plantar fascia makes it difficult for the patient to step on the ground and move. Plantar fascia is a thick band of connective tissue that stretches along the bottom of the foot, connecting the heel to the toes. This keeps the bones in your foot together, helps you move and forms the arch at the bottom of your foot. So, when it’s inflamed, you may feel heel pain, swelling around your heel or sharp pain in the arch of your foot. The symptoms may differ for every individual. However, in most cases, the pain feels worse when you take the first steps after waking up in the morning.
What Causes Plantar Fasciitis?
The common causes include:
- Playing sports
- Working on a hard, uneven surface
- Standing on your feet all day for work
- Sudden exercise without stretching
- Wearing improper shoes that strain the tissue
- Staying barefoot at home
- Repetitive stressful movements involving the plantar fascia
- Improper calf or ankle mobility
- Excessive body weight putting pressure on the plantar fascia
Overuse of the plantar fascia is one of the most common causes of plantar fasciitis. However, it is usually caused by a combination of several factors, rather than one sole reason.
What is Extracorporeal Shockwave Therapy?
Shockwave therapy is a non-invasive treatment that uses mechanical sound waves to target inflammation and injuries and trigger the healing response. A professional therapist uses an applicator to apply the sound waves from a device to the inflammation or injury on the skin. As the sound waves penetrate the skin, they may trigger the natural healing process, improve blood circulation, and reduce pain or inflammation.
How Does Shockwave Treatment Work for Plantar Fasciitis?
Shockwave therapy sends mechanical sound waves to the inflamed and painful plantar fascia. As the waves penetrate and interact with the affected tissue, it may trigger blood circulation, a healing response and tissue remodelling in that area. These biological responses may help the tissue heal by reducing the inflammation and pain and supplying nutrient-rich blood to the plantar fascia.
Here’s a detailed breakdown of how shockwave works on plantar fasciitis.
1. Creating mechanical stimulus on the affected tissue (H3)
First, the healthcare practitioner applies the sound waves to the affected plantar fascia. As the mechanical acoustic energy penetrates the skin and reaches the inflamed plantar fascia, it creates a mechanical stimulus on the tissue. This mechanical stimulus can influence how the cells in the plantar fascia convert the stress into biochemical signals and tissue remodelling. This initiates the healing process.
2. Triggering a natural healing response
As mentioned earlier, the mechanical stimulus can trigger the cells’ natural biological healing response. It may trigger a series of biochemical reactions that ultimately help the inflamed plantar fascia tissue heal.
The biochemical reactions may look something like this:
- Better blood circulation may begin in the area so the affected plantar fascia receives oxygen and nutrient-rich blood.
- Strong stimulation of nerve endings in the affected area, leading to pain reduction.
- May temporarily influence cell membrane permeability, which can potentially support the biological processes involved in tissue repair & remodelling.
3. Supporting tissue remodelling
Chronic plantar fasciitis can alter the structure and organization of the plantar fascia. The connective tissue may thicken, or it may change the way it responds to mechanical stress if left untreated for a long period of time. Shockwave therapy can trigger the natural biological responses in the affected area, which in turn may help restore the optimal structure and function of the plantar fascia.
Why is Shockwave Therapy Used for Plantar Fasciitis?
Shockwave therapy is used for chronic plantar fasciitis as part of a bigger conservative treatment program. Physiotherapists or doctors may recommend it if the condition doesn’t seem to improve despite using other non-invasive treatments. If the symptoms persist despite guided exercises and conservative care, shockwave treatment may be recommended.
Note: A trained therapist assesses your symptoms, medical history and lifestyle to determine if shockwave would help reduce your plantar fasciitis.
Does Shockwave Therapy Work for Plantar Fasciitis?
As per a 2021 study, shockwave therapy may be an effective treatment for plantar fasciitis. Approximately four sessions were found to reduce symptoms such as inflammation of the plantar fascia. Research suggests that shockwave could reduce pain, inflammation and improve foot function in people with plantar fasciitis. However, it might not be equally effective for everyone with similar symptoms, because every individual is unique and has different recovery needs.
What does research say?
As per the results of a randomized controlled trial, shockwave therapy could be an effective pain-relieving treatment for plantar fasciitis. A meta-analysis suggests that shockwave therapy can help relieve pain in chronic plantar fasciitis. The study suggests that people with plantar fasciitis may consider shockwave as an alternative treatment option.
Research also suggests that pain reduction may be accompanied by improvements in foot function and mobility. Shockwave may lead to longer-term outcomes. For example, a 2024 review comparing shockwave treatment with corticosteroid injections found the former to be more effective in improving foot function at six months.
What Happens During Shockwave Therapy Sessions for Plantar Fasciitis?
Here’s what to expect during shockwave therapy for plantar fasciitis treatment.
Assessment
A healthcare practitioner assesses your condition to confirm whether it’s plantar fasciitis or some other condition affecting the foot. They are most likely to check your foot, look for inflammation in the bottom of the foot and examine your movement patterns. They may want to know more about your symptoms and lifestyle to understand if shockwave would be the right treatment for you or not.
Treatment Positioning
You may have to remove your socks and shoes before the session begins. The therapist may ask you to lie down on a cushioned table on your stomach.
Application of Shockwaves
Once you are comfortable, the practitioner begins the treatment. They may apply a gel on your affected heels. Then they use a specialized probe to target shockwaves on the inflamed region.
Treatment Duration
Generally, the treatment takes about 20 minutes per foot. You may feel slight discomfort in the heel as the sound energy is transmitted. The therapist may recommend further sessions depending on the severity of your condition.
Post-Treatment Care
Your therapist may ask you to reduce high-impact activities like jumping or running for the first 2 days after the treatment. They may recommend specific gentle exercises to improve the plantar fascia and your foot’s ability to tolerate load.
Does Shockwave Therapy for Plantar Fasciitis Hurt?
You may feel a slight discomfort during shockwave therapy as the mechanical sound waves travel through your skin and touch the underlying inflamed tissue. It isn’t, however, extremely painful since it is a non-invasive procedure and relies solely on acoustic sound waves. The sensation may vary between individuals. Your therapist may adjust the intensity of the waves based on the clinical protocol. You may feel mild soreness in the area after the treatment.
How Many Shockwave Therapy Sessions Are Needed?
The number of sessions you need depends on your unique recovery needs, lifestyle and severity of symptoms. Your physiotherapist may recommend an approximate number of sessions after evaluating your condition. Generally, in mild cases, one session might provide temporary relief. However, it may also require up to 3 to 4 sessions depending on what you need.
How Long Does Shockwave Therapy Take to Work on Plantar Fasciitis?
Shockwave therapy may provide temporary pain relief, but it isn’t necessarily an instant pain-relief treatment. In most cases, it is recommended when other conservative treatments haven’t produced enough results. Physiotherapists often include shockwave in their comprehensive treatment plan alongside physiotherapy, chiropractic or massage therapy. You may notice gradual improvement, while some may feel some relief after the first session. It depends on the severity of your condition.
When Should You See a Physiotherapist for Heel Pain?
Here are signs you should consult with a physiotherapist:
- Persistent heel pain despite rest
- Pain in the bottom of the foot while walking
- Foot discomfort affecting sports or exercises
- Recurrent symptoms
- Discomfort especially in the morning after waking up
If you are experiencing heel pain and are uncertain if it is actually plantar fasciitis, get in touch with us. Physiotherapy First can evaluate your symptoms, diagnose the condition and prescribe an effective treatment plan tailor-made for your recovery.
Key Takeaway
Shockwave therapy may help reduce plantar fasciitis inflammation and pain, thereby allowing you to move comfortably. However, it is generally recommended as an alternative option when other conservative care hasn’t yielded effective results. The sound waves travel through the skin to the affected tissue in your foot and trigger the natural healing process in that area. Blood circulation may improve, helping the plantar fascia receive healthy blood and heal gradually. A physiotherapy assessment can help determine if the pain in your foot is actually plantar fasciitis and if shockwave therapy would be suitable for your symptoms. Book an appointment with our team for a quick yet thorough assessment.
