Shock Wave Therapy for Tendonitis and Plantar Fasciitis

Can Shock Waves Be An Effective Treatment for Pain?

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Extracorporeal shock wave therapy, or ESWT, has emerged as a possible treatment option for patients with chronic tendon problems. ESWT delivers focused shock waves to the body, and has been used for treatment of a variety of conditions including:

There is both a high-energy and low-energy form of shock wave treatment, and both forms of therapy can be used in the treatment of these conditions.

Low-energy shock wave treatments are given as a series of three or more treatments. The low-energy shock waves are not painful, or mildly painful. On the other hand, the high-energy shock wave treatments are given at one session. High-energy shock wave treatments are quite painful, and often some type of anesthesia is needed. Either a regional block or general anesthesia can be administered for the high-energy treatments.

Shock wave therapy is thought to work by inducing microtrauma to the tissue that is affected by these problems. This microtrauma initiates a healing response by the body. The healing response causes blood vessel formation and increased delivery of nutrients to the affected area. The microtrauma is thought to stimulate a repair process and relieve the symptoms of pain.


First reported in 1996, several investigators have published successful results when using shock waves to treat these conditions.

  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 these problems.

There are many reports about the effectiveness of treatment of these different conditions.  Some studies demonstrate good results for the treatment, particularly with calcific tendonitis and plantar fasciitis.

  However, there are also numerous reports that have not been as successful and show no significant difference when shock wave treatment is compared to more standard treatments of these problems.


The most attractive aspect of shock wave treatment is that it is a noninvasive option for problems that are sometimes challenging to treat. Because of these challenges, doctors are always seeking more effective treatment for patients who do not seem to improve with simpler treatments.

Furthermore, one of the most concerning aspects of surgical treatment of conditions such as 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 are cured of their symptoms.


Shock wave therapy is quite expensive, and whether or not it is an effective treatment is controversial.

Each individual treatment can cost a lot of money, and insurance companies may not necessarily cover the expense. Therefore, patients who wish to have these treatments may end up paying for them out of pocket.​

Finally, the effectiveness of treatments is questioned. If the shock wave treatments are helpful, the difference is small. The reports in the literature are quite variable, but even in studies that show a good effect of ESWT, it probably helps only a fraction of patients.  Therefore, a significant number of patients will still have pain after shock wave treatments.

Where It Stands

The jury is still out on whether or not shock wave therapy is an effective treatment for these orthopedic conditions. Current recommendations for this treatment are that it is a safe treatment for patients who have failed conservative measures and may require more invasive treatment.

It is important that patients try more traditional treatments for a period of at least 6 months to a year before considering shock wave therapy. For patients with plantar fasciitis, conservative treatment measures consisting of medications, ice application, exercises and stretches, and shoe inserts are often effective treatments. Furthermore, it is also known that a period of time of 6 months to one year is required to effectively treat these problems.

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 six month trial of standard treatments, shock wave therapy is a safe treatment alternative to surgery.


Rompe, JD, et al. "Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis." Jour Bone Joint Surg. 2002;84:335-41.

Sems A1, Dimeff R, Iannotti JP. "Extracorporeal shock wave therapy in the treatment of chronic tendinopathies" J Am Acad Orthop Surg. 2006 Apr;14(4):195-204.

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