Plantar fasciitis is a painful inflammatory condition of the plantar fascia, a band of fibrous tissue on the bottom of the foot that connects the heel bone to the toes. Plantar Fasciitis is the most common cause of heel pain. It is estimated to occur in 10% of the general population, particularly in active working adults. Plantar Fasciitis can usually be managed successfully with conservative treatments such as rest, stretching, massage, and pain medication, or with the use of improved footwear and orthotics.

However, there are cases for which these approaches are not sufficient. If conservative measures are unsuccessful at relieving Plantar Fasciitis pain, other treatment options can be considered.

Extracorporeal Shockwave Therapy can be a simple and excellent option. Extracorporeal Shockwave Therapy has become one of the most successful and used therapies for musculoskeletal conditions. Its effects have been demonstrated in multiple clinical trials and its use has been approved and recommended by orthopedic medicine associations throughout the world.

What is Extracorporeal Shockwave Therapy?

Extracorporeal Shockwave Therapy (ESWT)

Extracorporeal Shockwave Therapy (ESWT)

Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment technology that uses shock waves to promote tissue healing and treat injuries, inflammation, and pain. This therapeutic procedure is carried out by applying sound waves to the injured area, directing them at the most tender part of the heel.

There is a specific type of ESWT that has been shown to be very effective in treating early Plantar Fasciitis. It is called Extracorporeal Pulse Activation Technology or EPAT®. EPAT uses high frequency sound waves to promote healing. In most cases, when performed by an expert, EPAT allows for a fast recovery with good tolerability and minimal discomfort.

The exact process by which ESWT and EPAT promote healing is not fully understood, even though it has been extensively studied. It is believed that the repeated incidence of the sound waves induces microtraumas to the affected area, which stimulates the healing process by attracting new blood vessels and chemical mediators that promote the repair of injured tissues. It is also believed that sound waves may act on neurons in the injured area and inhibit pain receptors, thereby having an analgesic effect.

Is Extracorporeal Shock Wave Therapy effective?

The efficacy of Extracorporeal Shock Wave Therapy for Plantar Fasciitis treatment has been studied in several clinical trials. The vast majority of those trials reported beneficial effects, with success rates being as high as 88% in some studies. Significant pain relief and improvement in function has been reported, with most patients remaining complaint free at one-year follow-up.

A study comparing the effect of Extracorporeal Shock Wave Therapy with surgery (plantar fasciotomy) in the treatment of Plantar Fasciitis showed that, although the functional outcomes were comparable, ESWT had the significant advantage of avoiding the risks and adverse effects of surgery, including post-surgical pain.

Another study compared the effect of Extracorporeal Shock Wave Therapy with local corticosteroid injections in the treatment of chronic Plantar Fasciitis and showed that ESWT had better efficacy in promoting the regeneration of the plantar fascia, in improving functional outcomes, and in reducing pain.

Extracorporeal Shock Wave Therapy has been shown to be effective in cases of Plantar Fasciitis that did not respond to other more traditional treatments. Recent studies have shown that patients with heel spurs, edema or high pain scores respond better to Extracorporeal Pulse Activation Technology.

What is the procedure for Extracorporeal Shockwave Therapy?

Extracorporeal Shock Wave Therapy in the form of Extracorporeal Pulse Activation Technology is a simple and quick procedure. Treatment is performed using a sound wave applicator moved over the affected area in a circular motion. Before the procedure, a gel is applied to the zone being treated to enhance the effectiveness of the shock waves. Treatment sessions usually take approximately 5-10 minutes.

ESWT plantar fasciitis treatment

ESWT plantar fasciitis treatment

The procedure causes minimal discomfort and is generally well tolerated when performed by trained technicians. EPAT offers fast recovery without the necessity of immobilization or reduced weight bearing. Since there is no recovery period after the treatment, patients can resume their daily routine immediately.

Many patients feel immediate relief from pain, even after a single session. However, EPAT has a cumulative effect and repeating the procedure can be beneficial. The most common protocol is to administer EPAT in a course of three treatments, each two weeks apart. It may take up to 6 weeks after the last treatment to feel the full effect of the three treatments.

Is Extracorporeal Shockwave Therapy safe? Are there any side effects?

Extracorporeal Shock Wave Therapy and Extracorporeal Pulse Activation Technology are approved by the Food and Drug Administration (FDA) and recognized as safe.

The use of ESWT or EPAT in the treatment of Plantar Fasciitis has a very low occurrence of side effects and complications, especially when the procedure is performed by an expert physician. When they do occur, they are mild and usually resolve spontaneously. The most common side effects are local skin redness or bruising; local inflammation and swelling, pain, numbness, discomfort, tenderness or tingling may also occur, but all can easily be managed and do not pose any serious risks.

Contraindications to extracorporeal shockwave therapy include: a positive history of hemophilia or other coagulopathies; malignancy; and open bone growth plates.

Why should I try Extracorporeal Shockwave Therapy?

Plantar Fasciitis pain can disrupt your normal daily routines and interfere with your regular physical activities. Conservative treatments of plantar fasciitis such as rest, ice, massage, and stretching are often successful in treating Plantar Fasciitis and relieving pain, but sometimes, they are insufficient. In those cases, you should consider alternative treatment options such as Extracorporeal Shockwave Therapy to avoid the progression of Plantar Fasciitis.

If you stop treating Plantar Fasciitis, you may make it worse. As you carry on with your regular routines, you will continue to stress the plantar fascia and further affect its strength and stability, making it more vulnerable to further damage, degeneration and persistent inflammation. As you continue to overload the ligament, you may aggravate the injury to an extent that may require surgical treatment.

Plantar Fasciitis surgery — Plantar Fascia Release —should be avoided whenever it’s possible and always be the last option. If you have treatment options that allow you to avoid surgery and that may even be more effective than surgery, you should consider them. That is the case with Plantar Fasciitis — around 95% of patients recover with non-invasive treatments in just a few months. Surgeries are invasive procedures that always have risks: there is always a small risk of infection, and there is always a risk of nerve damage to the nerves surrounding the plantar fascia during the procedure, which may cause numbness or tingling in your foot. There are also specific risks associated with plantar fascia surgeries: excessive release of the plantar fascia may reduce the height of the foot arch and increase the likelihood of further foot injuries. Furthermore, in some cases, the surgery may not be successful and the symptoms may remain unresolved.

Extracorporeal Shockwave Therapy in the form of Extracorporeal Pulse Activation Technology is a safe, simple, quick, and well-tolerated procedure. It is non-invasive, it has no risk of infections or nerve damage, and it allows a fast recovery. Is the most advanced, cutting-edge option for the Plantar Fasciitis treatment. Most importantly, it is highly effective in promoting healing and relieving pain.

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Janet Pearl MD

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