Shockwave Therapy for Heel Pain - Does It Actually Work?

If you've had heel pain for more than 3 months and tried the usual things - stretching, orthotics, rest, better shoes - and it's still not getting better, shockwave therapy is probably the most important conversation you haven't had yet.

Despite being one of the most evidence-supported treatments in musculoskeletal podiatry, shockwave therapy remains underutilised simply because many patients and even some clinicians aren't aware of how strong the evidence is. This article covers what it is, what the research shows and what to expect from a course of treatment.

What Is Shockwave Therapy?

Extracorporeal shockwave therapy (ESWT) delivers high-energy acoustic pressure waves to damaged or degenerated soft tissue. A handheld applicator is pressed against the skin at the target site and generates pressure pulses that travel into the tissue.

These pressure waves have several biological effects:

• Neovascularisation: Stimulates the formation of new blood vessels at the treatment site, improving the local blood supply needed for tissue repair
• Micro-inflammatory response: Triggers a controlled inflammatory reaction that "restarts" a stalled healing process in chronically degenerated tissue
• Collagen synthesis: Stimulates fibroblast activity and collagen production, supporting structural repair of the damaged fascia
• Calcium breakdown: Fragments and disperses calcific deposits that sometimes form within chronically degenerated tendon or fascial tissue
• Neurological desensitisation: Reduces the density of substance P (a pain-mediating neuropeptide) in the local tissue, reducing pain sensitivity

Critically, shockwave doesn't just mask pain. It promotes the biological processes that achieve actual tissue healing. This is why the effects are sustained after treatment ends, rather than returning when a pain-masking drug wears off.

What Does the Evidence Say?

The evidence base for shockwave therapy in plantar fasciitis is extensive and strong. Key findings from the clinical literature:

• A landmark Cochrane review of ESWT for plantar fasciitis found significant reductions in pain and improved function compared to placebo at both short and medium-term follow-up.
• A 2018 meta-analysis published in the Journal of Orthopaedic Surgery and Research pooling data from 12 randomised controlled trials found ESWT significantly superior to placebo and comparable to or better than cortisone injection at 12-week follow-up, with durable effects at 12 months.
• Multiple studies demonstrate response rates of 70-80% in patients with chronic plantar fasciitis that has failed conservative treatment.
• ESWT consistently outperforms cortisone injection at longer follow-up periods. While cortisone provides faster initial pain relief, ESWT produces better outcomes at 3 and 12 months.

The American Podiatric Medical Association and the Podiatry Australia both include ESWT as a recommended treatment modality for chronic plantar fasciitis.

Is Shockwave Just for Plantar Fasciitis?

Plantar fasciitis is the most common indication for shockwave in podiatric practice, but it's not the only one. Evidence also supports its use for:

• Achilles tendinopathy: Both insertional (at the heel bone attachment) and mid-portion Achilles tendinopathy have demonstrated good response to ESWT in clinical trials.
• Calcific tendinopathy: Calcium deposits within tendons respond particularly well to shockwave, which physically fragments and disperses the calcific material.
• Tibialis posterior tendinopathy: The tendon most associated with acquired flat foot deformity responds well to shockwave when conservative loading protocols haven't resolved symptoms.

What Does a Shockwave Session Involve at Bexley Podiatry?

Your first appointment includes a clinical assessment to confirm the diagnosis and determine whether ESWT is the appropriate next step for your presentation. Not everyone is a candidate - shockwave is contraindicated in pregnancy, over growth plates in skeletally immature patients, and in people with certain blood clotting disorders or local malignancy.

Each treatment session typically takes 15-20 minutes. The podiatrist applies coupling gel (similar to ultrasound gel) to the treatment site and uses the applicator over the affected area - for plantar fasciitis, this is the heel and the length of the plantar fascia. Most patients describe the sensation as a rapid tapping or deep pressure - uncomfortable over the most sensitive areas but generally tolerable. Intensity is adjusted throughout based on your feedback.

There's no downtime. You can walk out and return to normal daily activities immediately after each session. High-impact sport should be modified for 24-48 hours post-treatment.

How Many Sessions Do You Need?

Most plantar fasciitis protocols involve 3-6 sessions, spaced approximately one week apart. Clinical trial protocols most commonly use 3 sessions for radial shockwave and 3-6 for focused shockwave. The majority of patients begin to notice meaningful improvement after sessions 2-3. The full therapeutic effect typically becomes apparent 6-8 weeks after completing the course, as the biological tissue repair processes continue after treatment ends.

For Achilles tendinopathy, protocols typically involve 4-6 sessions. For calcific conditions, 3-6 sessions with imaging review to confirm calcium fragmentation.

Who Is Not a Candidate for Shockwave?

Absolute contraindications include:

• Pregnancy
• Active malignancy at the treatment site
• Blood clotting disorders or anticoagulant therapy (relative contraindication - discuss with your treating podiatrist)
• Open wounds or active skin infections at the treatment site
• Pacemaker or implanted electronic device near the treatment site

Shockwave is also not applied directly over growth plates in children and adolescents who are still skeletally immature.

Heel pain that hasn't resolved after months of trying the usual approaches deserves a different strategy. Shockwave therapy may be exactly what's needed to finally break the cycle. Book a shockwave consultation.