Shockwave therapy for foot and ankle pain: how it works and who it helps

What is shockwave therapy?

Shockwave therapy, also called extracorporeal shockwave therapy (ESWT), is a non-surgical treatment for long-lasting tendon and soft tissue pain. “Extracorporeal” just means the waves are made outside the body. A handheld applicator is pressed against the sore spot, with gel on the skin, and delivers a rapid series of strong pressure pulses into the tissue underneath.

In the foot and ankle, it’s mostly used for two problems:

• Plantar fasciitis: irritation and thickening of the plantar fascia, the thick band of tissue under your foot, where it attaches to the heel.
• Achilles tendinopathy: long-lasting pain and thickening in the Achilles tendon at the back of the ankle or heel.

It isn’t a first treatment. It’s for pain that has hung on for months despite simpler care. Some shockwave devices are FDA-approved for plantar fasciitis heel pain that hasn’t improved with at least 6 months of other treatment.

How does shockwave therapy work?

Nobody knows exactly. Researchers think the pulses may:

• trigger a fresh healing response in tissue that has stopped healing on its own
• increase blood flow and the growth of small blood vessels in the area
• calm the nerve endings that carry pain signals

What matters most for you is whether it helps, and that has been tested in clinical trials (see what the research shows).

Radial vs focused shockwave therapy

There are two main types. They produce and deliver the pulses differently.

Both types have been studied for plantar fasciitis, and research hasn’t clearly shown that one works better than the other. Getting the diagnosis right, the energy used and the skill of the person treating you probably matter more than the type of machine.

Evolve Health podiatrists offer radial shockwave therapy.

What foot and ankle problems can it treat?

If you have heel pain, our guide to heel pain when you wake up explains the common causes, and can plantar fasciitis go away on its own? covers how long it usually lasts. For the Achilles, see our guide to Achilles tendinitis.

How well does shockwave therapy work?

Here’s an honest summary of the research:

• For long-lasting plantar fasciitis, reviews that pool many trials have found that shockwave therapy reduces pain more than a sham (placebo) treatment. Not every trial agrees, and results depend on the device, the energy used and who was treated.
• For Achilles tendinopathy, trials suggest shockwave helps, and works best alongside calf-strengthening exercises rather than instead of them.
• Not everyone responds. Some people get a lot better, some a little, and some not at all. There’s no reliable way to know in advance.
• Plantar fasciitis often improves on its own over months with good home care, so shockwave is best saved for pain that clearly isn’t getting better.

Be wary of any success rate for shockwave therapy that doesn’t say where it comes from.

Who is a good candidate for shockwave therapy?

Shockwave therapy may be worth considering if:

• your heel or Achilles pain has lasted at least 3 to 6 months
• you’ve given simpler treatments a fair try, such as daily stretching, supportive shoes, arch supports or orthotics, a night splint and physical therapy
• a podiatrist has examined you and confirmed the cause of the pain
• you’d like to avoid or delay a steroid injection or surgery

Who should not have shockwave therapy

It isn’t used:

• during pregnancy
• over a tumor or cancer, or an infection or open wound, in the treatment area
• over the growth plates of children and teens whose bones are still growing

Tell your podiatrist first if you:

• take a blood thinner or have a bleeding disorder
• have a pacemaker or other implanted device, or metal implants near the area
• have numbness in your feet from neuropathy, because you may not be able to say if the treatment is too strong
• had a steroid injection in the same spot recently

What happens during a shockwave therapy session

1. Exam first. Your podiatrist confirms the diagnosis. An X-ray or ultrasound may be used to rule out a stress fracture or other cause.
2. Positioning. You lie or sit with your foot supported. Gel is put on the skin over the painful spot.
3. Treatment. The applicator is pressed against the area and delivers a few thousand rapid pulses. It feels like fast, strong tapping. The strength usually starts low and is turned up as you get used to it.
4. Speak up. Say if it’s too uncomfortable. The strength can be adjusted.
5. Done in minutes. The shockwave part usually takes about 5 to 10 minutes, and you walk out afterward.

Numbing medicine usually isn’t used, because it may make the treatment work less well. Radial shockwave is typically given once a week for 3 to 5 weeks.

After treatment: what to expect

The first few days

• Walk normally. You can go back to work and daily activities the same day.
• Skip high-impact exercise such as running and jumping for about 48 hours after each session.
• Expect some soreness, redness or small bruises for a day or two. Pain can briefly feel a little worse before it gets better.
• Ask about pain relievers and ice. Some clinics suggest avoiding anti-inflammatory pain relievers such as ibuprofen (Advil, Motrin) or naproxen (Aleve), and ice, around each session, because in theory they could dampen the healing response. Ask your podiatrist what to use.
• Keep up your home program. Stretching, supportive shoes and inserts still matter.

When will I feel better?

Side effects and risks

Shockwave therapy is generally safe when it’s used for the right problem. Common, short-lived side effects are:

• soreness or aching for a day or two
• redness and mild swelling
• small bruises or tiny red spots on the skin
• brief tingling or numbness

Serious problems are rare. Call your podiatrist if pain gets much worse and stays worse for more than a few days, or if numbness doesn’t go away.

Shockwave therapy vs other treatments for stubborn heel pain

If heel pain from plantar fasciitis hasn’t improved after a few months of home care, these are the main next steps. Your podiatrist will help you weigh them.

Shockwave therapy is meant to be combined with physical therapy, stretching and orthotics, not to replace them.

Cost and insurance

• Coverage is limited. Many insurance plans, and Medicare in most cases, don’t cover shockwave therapy for foot and ankle pain, so you may pay for it yourself.
• Ask for the full cost up front, for the whole course of sessions, not just one visit.
• Check your plan before you start. See which insurance plans we accept for office visits.

When to see a podiatrist

Get seen the same day if:

• you felt a pop or a kick at the back of your ankle and now can’t push off or stand on tiptoe (a possible Achilles tendon tear)
• you can’t put weight on your foot
• your heel or ankle is red, hot and swollen, or you have a fever

Book a visit if:

• heel or Achilles pain lasts more than 2 to 3 weeks despite rest, stretching and good shoes
• the pain keeps coming back, or is changing the way you walk
• you’ve had heel or tendon pain for months and want to know whether shockwave therapy or another treatment is a good fit
• you have diabetes, numbness or poor circulation in your feet

Shockwave therapy at Evolve Health

At Evolve Health, radial shockwave therapy is part of how our podiatrists treat plantar fasciitis and heel pain. Our podiatrists are board-certified or board-qualified. They examine your foot and, with digital X-ray on site, can check for a stress fracture or other cause before deciding whether shockwave is a good fit.

Shockwave therapy isn’t offered at every office, so call ahead to check which one near you provides it. Bring a list of the treatments you’ve already tried and any past X-ray or MRI reports. You can find a podiatrist near you and book online.