Extra-corporeal shock wave therapy (ECSWT) is now an established treatment alternative for many bone and soft tissue disorders in the foot and ankle. It is probably best known for its use in the foot and ankle in treating chronic Achilles pain, a condition known as Achilles Tendinopathy.
Extra-corporeal means “outside the body”, shock wave therapy refers to the exact nature of the treatment. The shock wave that is used to treat the painful area is generated from a probe that rests on the skin. Inside the probe that the surgeon holds in his hand, the impulse is generated as a pressured energy wave, that is passed through the end of the probe and very rapidly through the skin and into the painful area, such as the Achilles tendon. “Shock wave” has been used for many, many years in other surgical specialties such as renal surgery to break up kidney stones.
The generation of the shock wave is through a very focused impulse that targets the painful area. On a cellular level shock wave therapy has been shown in studies to reduce the quantity of nerve fibres that transmit painful impulses causing a reduction in pain sensation. It can also lead to an increase in tissue healing factors such as “growth factor” and increase the formation of new blood vessels which may contribute to promote healing in the degenerate tissues. The mechanism of shock wave therapy and how it works is being continually understood.
The main conditions that are treated with shock wave therapy in foot and ankle surgery include Achilles pain or tendinopathy and heel pain or plantar fasciitis. Other applications of this therapy that are being used with promising results include treatment of fractures that have failed to unite successfully, called a “non-union” or stress fractures for example of the metatarsal bones.
The therapy is administered very easily in the out-patient clinic. No anaesthetic is required because the shock wave impulses that are delivered are usually quite low-energy. The area of the pain is exposed whilst the patient is lying on a treatment bed and a small amount of gel is applied to the skin. This gel helps transmit the impulses to the painful area deep to the skin. The machine is then switched on and the “shock wave gun” is pressed lightly onto the skin to deliver the rapid impulses.
In the majority of cases the patient feels it to be uncomfortable rather than painful. There is no doubt that some discomfort will be experienced because the area being treated has been chronically painful. To ease any symptoms, pain-killers can be taken just before you treatment if necessary.
Each treatment session typically lasts between 5-15 minutes. The number of sessions for each patient does vary however the majority of conditions will have around 3 sessions repeated at weekly intervals. It is possible to administer even up to 6 sessions depending on the clinical response to the first few sessions.
The evidence to support its use is growing in the medical literature, especially in Achilles tendinopathy. Large studies have definitely shown its benefit in potentially completely resolving the symptoms from for example Achilles tendinopathy.
The huge advantage of this treatment is that it is non-invasive in comparison to surgery. There is no risk of infection from wound complications. Because the shock wave gun is pressing on the skin, the area can be a little red and uncomfortable after the treatment, but that is usually it!
It is worth trying, if your surgeon recommends it because it has such a small risk associated with it, and a potentially huge benefit with complete resolution of the problem.
Most surgeons will use shock wave therapy after more routine treatment has been tried such as physiotherapy. If the routine non-operative treatment has not worked and then shock wave therapy has not worked then the next step in treatment would potentially be surgery. This can be discussed with your surgeon.