Extra-Corporeal Shockwave Therapy
(ESWT) – For the treatment of:
- Plantar Fasciitis / Fasciosis
- Achilles Tendinopathy
- Non-unions of bone
Extracorporeal Shockwave Therapy (ESWT) is used for the treatment of chronic plantar fasciitis. The most advanced ESWT Equipment available is, The FDA approved the Epos Ultra® by Dornier, Inc., a high-energy device that utilizes a single treatment protocol and results in successful patient outcomes.
Extracorporeal shock wave therapy, or ESWT, has emerged as a treatment option for patients with chronic plantar fasciitis/ fasciosis. ESWT delivers focused shock waves to the body. There is both a high-energy and low-energy form of ESWT; and both forms of shock wave therapy can be used in the treatment of plantar fasciitis.
Low-energy shock wave treatments are given as a series of three or more treatments. The high-energy shock wave treatments are given at one session. High-energy shock wave treatments are mildly uncomfortable and local anesthesia is needed.
Shock wave therapy works by inducing micro trauma to the tissue that is affected by plantar fasciitis. This micro trauma initiates a healing response by the body. This healing response causes blood vessel formation and increased delivery of nutrients to the affected area. The micro trauma stimulates the repair process and relieves the symptoms of plantar fasciitis.
First reported in 1996, several investigators have published successful results when using shock waves to treat plantar fasciitis. (1) The FDA subsequently approved the use of shock waves for the treatment of plantar fasciitis in 2000. Since that time, numerous studies have investigated the use of shock wave treatments for plantar fasciitis.
One often cited report investigated the use of low-energy ESWT and found good results in patients treated with three sessions of ESWT (2) This study was a well-designed, randomized trial that showed good results in patients who did not improve with more traditional treatments.
The most attractive aspect of shock wave treatment for plantar fasciitis is that surgical treatment of chronic plantar fasciitis is not terribly effective because of this surgeons are seeking more effective treatment for these patients who do not seem to improve with more standard treatments. The standard treatment for plantar fasciitis that does not improve with conservative measures is surgery. Many patients wish to avoid surgery if at all possible.
Furthermore, one of the most concerning aspects of surgical treatment of plantar fasciitis is that there are potentially serious complications. Few complications have been reported with the use of shock wave therapy. Patients who have surgery are at risk for continued pain, wound problems, and infections. The primary problem with ESWT is that not all patients arc cured of their symptoms.
It is important that patients try more traditional treatments for a period of at least 3 months to 6months before considering shock wave therapy. It is known that conservative measures, consisting of medications, exercises, stretches and shoe inserts are effective treatments for plantar fasciitis. Furthermore, it is also known that a period of 3 months is required to effectively treat plantar fasciitis. More than 90% of patients with plantar fasciitis should be effectively treated by this standard treatment plan.
Patients who have no success with these traditional treatments may benefit from shock wave therapy. It is a reasonable option to consider ESWT prior to surgical intervention. Potential side-effects of ESWT are minimal. Therefore, in patients who have chronic plantar fasciitis, and who have failed a minimum 3 month trial of standard treatments, shock wave therapy is a safe treatment alternative to surgery.
The cost for High energy ESWT treatment is $600 and only one treatment is necessary for most patients.
High energy ESWT augmented with Platelet Rich Plasma (PRP) is $900.
Low energy ESWT is $300 and requires 3 treatments.
Our facility does not accept insurance for this procedure; most health insurance companies do not cover ESWT therapy for foot and ankle conditions.
Rompc.JD.et al. “Low-energy extracorporeal shockwave Therapy for painful heel: a prospective controlled single-blind study.– Anh Orthop Trauma Surg. 1998; 115:75-9.