Plantar fasciitis is a chronic orthopedic condition of the foot and a leading cause of heel pain. While 90% of patients improve with nonsurgical treatment, sometimes the pain persists despite conservative measures. It is possible to treat plantar fasciitis with surgical treatment, but many orthopedic surgeons are reluctant to perform the procedures because they carry with them a risk of complications. Extracorporeal shock wave therapy (ESWT) for plantar fasciitis is a minimally-invasive alternative when conservative treatments have not been effective but you do not want to take the risks involved with surgery.
What Is Plantar Fasciitis?
The plantar fascia is a ligament that runs along the length of your foot on the bottom, connecting the heel and the toe. As you walk, the plantar fascia tightens like a bowstring, stiffening your foot for stability as you walk. It also supports the arch of your foot and prevents you from becoming flat-footed.
Plantar fasciitis occurs when small tears form due to repeated stress and tension on the ligament. Over time, the damage causes inflammation and irritation. It may not be possible to identify a single cause of plantar fasciitis. It often occurs in people who have jobs that require a lot of standing. Excess weight can put stress on the plantar fascia, but so can athletic activities such as ballet dancing or long-distance running that impact your heels. Abnormal foot mechanics, such as high arches or flat feet can increase stress on the plantar fascia by redistributing your weight as you stand. There may also be a degenerative aspect to plantar fasciitis because it tends to affect people over 40 most often.
Characteristic symptoms of plantar fasciitis include pain at the bottom of the heel or in the midfoot. It can be a sharp, stabbing pain, a dull ache, or a burning sensation that starts at the heel and extends outward. Unlike many musculoskeletal complaints, plantar fasciitis pain tends to be worse with rest and improves with activity. Patients often report pain when they first get up from sleeping and when resting after exercise. In addition to pain, stiffness of the heel is another common symptom of plantar fasciitis.
Treatment for plantar fasciitis usually involves nonsurgical treatments to control the pain, relieve the tension on the foot, and improve the flexibility of the heel. However, in about 10% of cases, the pain and symptoms do not respond to conservative measures such as physical therapy, anti-inflammatory medication, rest, or foot supports such as night splints or orthotics. Surgical treatments for chronic plantar fasciitis include releasing the plantar fascia or lengthening the calf muscle to increase ankle motion, but these can cause complications of nerve damage and may not relieve the pain completely. There is also a possibility of infections at the surgical site and problems with wound healing.
What Is Extracorporeal Shockwave Therapy?
Extracorporeal shock wave therapy for plantar fasciitis is a technique that involves creating high-energy shock waves with a special machine using either electromagnetic pulses (in the case of focused shock wave therapy) or pressurized air. A handheld probe connects to the machine to deliver the sound waves through the skin to the site of pain in the foot. “Extracorporeal” means “outside the body,” meaning that treatment with ESWT does not require any surgical cutting into the body with the attendant risks of complications.
ESWT shock wave treatment grew out of an earlier technique called lithotripsy which uses sound waves to break up kidney stones so that they can pass painlessly out of the body with urination. Urologists began noticing that patients who had lithotripsy showed new tissue growth and increased bone density, suggesting that shockwave therapy may have broader implications for treating a wide range of conditions. Since 2000, the Food and Drug Administration has approved extracorporeal shockwave therapy for the treatment of plantar fasciitis. In addition to plantar fasciitis, other orthopedic conditions treated with ESWT include Achilles tendonitis and medial epicondylitis, more commonly known as tennis elbow.
Because ESWT is a relatively new technology, it is not entirely clear why it works to relieve plantar fasciitis pain. Two possible theories are that it decreases pain sensation by overstimulating the nerves in the foot, disrupting the signals to the brain. Another theory is that microtrauma induced by the sound waves jumpstarts the body’s healing process, improving circulation and promoting new blood vessel formation to the affected area. As a result, the delivery of nutrients to the area used to heal the damage increases. Both of these factors may have a role to play in healing plantar fasciitis with ESWT.
There are two different types of shockwave treatment available for plantar fasciitis. Radial shock wave therapy, or low energy shockwave therapy, uses a slow impulse and low energy density to treat superficial symptoms over a larger treatment area. Focused shockwaves use a faster impulse at high energy density to reach up to 12 cm deep to accurately target the symptomatic area. A meta-analysis of studies on the effectiveness of shockwave therapy for plantar fasciitis showed that focused shockwave therapy had a higher success rate than sham therapy used as a control as part of a clinical study. Radial shockwave therapy is a newer technology and there are fewer studies demonstrating its effectiveness relative to focused shockwave therapy.
When Can You Have Extracorporeal Shockwave Treatment for Plantar Fasciitis?
ESWT is a relatively new technology and studies into its effectiveness are still ongoing. For this reason, it is usually not the first treatment recommended for plantar fasciitis. Patients typically try multiple conservative treatment measures for plantar fasciitis for six months to a year. If there is no improvement in your chronic pain after you have tried at least three conservative treatment options, you may be a candidate for extracorporeal shockwave therapy for your plantar fasciitis symptoms.
What Are the Potential Benefits of Shockwave Therapy for Plantar Fasciitis?
Research is still ongoing to determine the effectiveness of shockwave therapy, but the Food and Drug Administration (FDA) does consider it to be safe. Side effects, when they occur, are generally mild. Because ESWT is noninvasive, it eliminates many of the risks involved with surgery. There is no surgical incision, so there is no chance of incision site infection or complications with wound healing. Serious adverse effects of ESWT, such as nerve damage, hematoma, or Achilles tendon rupture, are very rare.
Even with uncomplicated surgical treatment for plantar fasciitis, your body still needs time to recover. During this time, you need to modify your usual activities to facilitate healing. Depending on the type of surgery, recovery time may be from six weeks up to three months, during which time you need to avoid strenuous physical activity and use an assistive device when walking. With ESWT, the recovery time is minimal. You can walk out of the office following treatment with no assistive devices and wearing your regular shoes. You may have to avoid any particularly strenuous or high-impact exercise for 48 hours following the treatment, but otherwise, you can typically resume your normal activities, including returning to work, right away.
What Does ESWT Treatment Involve?
The type of shockwave therapy for plantar fasciitis you receive determines what happens during the procedure. The low-energy radial shockwave therapy is mildly painful at most. The high-energy focused radial shockwave therapy may be more painful, in which case, you may receive an anesthetic prior to the procedure. In either case, your foot rests on the machine while you lie back comfortably. The technician identifies the area of damage with an ultrasound scan and then uses the probe to deliver the shockwaves to the area. Despite using sound waves, the treatment is not excessively noisy; all you hear is a repetitive clicking sound. The procedure usually takes less than an hour, typically between 10 and 20 minutes.
While you may start experiencing significant pain relief after one or two sessions, we usually recommend three to six on average. These take place on a weekly basis.
What Else Should You Know About Shockwave Therapy for Plantar Fasciitis?
You may experience mild side effects after ESWT for plantar fasciitis. These usually resolve in a day or two, up to a week at most. For example, you may experience bruising caused by minor bleeding from small blood vessels in the heel. Other possible side effects include calf numbness, heel swelling, skin reddening, and discomfort during the procedure that persists for up to 24 hours after it is complete.
Having FDA approval to treat plantar fasciitis for only a couple of decades, ESWT is still a new treatment. Research into its effectiveness, both short-term and long-term, is still ongoing. Insurance companies are often reluctant to cover emerging treatments with uncertain results, so if you decide to receive shockwave therapy for plantar fasciitis, you may have to pay for it out of your own pocket.
Why Should You Choose Metro Healthcare Partners To Perform Shockwave Therapy for Plantar Fasciitis?
A pain management doctor in Brooklyn can perform shockwave therapy for plantar fasciitis. Our experienced providers have committed to offering patients non-invasive treatments whenever possible as alternatives to surgery that offer less chance of complications. If you experience heel pain that interferes with your quality of life, contact Metro Healthcare Partners to make an appointment in our pain management department.