Extracorporeal shock wave therapy, or ESWT with its abbreviated name, is a method that was first used in the field of urology in the 1980s for the treatment of kidney stones. It has been successful in treating kidney stones by breaking them up. Scientific research has also revealed other benefits of ESWT. Today, it is a tool widely used in physical therapy, especially in chronic tendon problems and heel spur pain.

What Problems Is ESWT Used For?

Heel spur (calcaneal spur), sole of the foot (plantar fasciitis), tendon calcification ( calcific tendinitis ), Achilles tendonitis, tennis elbow (lateral epicondylitis), medial tibial stress syndrome, patellar tendinopathy are the main problems in which ESWT method is used.

What is ESWT?

Shock waves are sound waves with certain physical properties. The main characteristic features of the waves are non-linearity, low stress amplitude after high peak pressure, short rise time and short duration (10 ms). They have a single pulse, wide frequency range (0-20 MHz) and high pressure amplitude (0-120 MPa). These features give the shock wave a positive and negative phase. While there is a direct mechanical effect in the positive phase, cavitation (gas bubbles) occurs in the negative phase. These bubbles burst rapidly as they form and create a secondary wave effect. Compared to the ultrasound wave, the peak pressure of the shock waves is about 1000 times greater. Waves give their energy at the border of two tissues with different sound permeability, for example, when they pass from soft tissue to bone.

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How Does ESWT Work?

Shock wave therapy can be applied in low-energy or high-energy forms. Low-energy shock wave therapy is usually applied in 3 or 5 sessions. During the procedure, the patient does not feel pain or may feel very little pain. High-energy shock therapy is performed in a single session. It can be very painful for the patient. Regional or general anesthesia may be required.

Shock wave therapy creates microtrauma in the tissue with a pneumatic (compressed air) effect. Microtraumas stimulate the healing response in tissue. With the formation of new vessels, the nutrients and oxygen reaching the damaged part increase and waste products are removed. With the increase of growth factors and protein synthesis, collagen production and tissue healing are stimulated. With ESWT application, tissue blood flow increases in a short time, this is achieved by increasing nitric oxide levels in the vessel wall.


ESWT treatment can be applied for varying durations depending on the energy density. During the treatment session, the patient is usually placed in a position where he or she is comfortable. The area to be treated can be determined by examination or ultrasound. In order to transmit the shock wave energy, gel is applied on the skin. The session can last for 3-4 minutes, during which 2500 shock wave pulses occur on average. During the treatment, knock-knock-knock sounds are made from the machine. It can be applied once a week for 3-5 weeks. The patient may feel some pain during the sessions and may continue for a short time after the session. Usually this feeling of discomfort does not last longer than a day.

Treatment Options

The US Department of Health FDA approved shock wave therapy for the treatment of plantar fasciitis in 2000. The main advantage of ESWT is that it is a non-surgical option for chronic tendon problems that are not easy to treat with other methods. Surgical treatment for heel spurs or plantar fasciitis may have undesirable consequences such as infection, wound problems, and failure to resolve complaints. For this reason, priority is given to non-surgical treatments whenever possible. ESWT’s lack of risk makes it advantageous in this sense.

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Possible disadvantages of ESWT include the lack of scientific data proving its effectiveness for some diagnoses and its relatively expensive method. ESWT may not work in every patient; Where it does work, the benefit may be small. As a result, the complaints of some patients may continue after ESWT. When the average of many scientific studies is taken, the success of ESWT in the treatment of plantar fasciitis is between 50-90%.

When is Shock Wave Therapy Preferred for Heel Spurs?

In the treatment of heel spurs or plantar fasciitis, methods such as cold application, exercise, use of insoles or heel pads used in shoes are recommended. Pain medications may be prescribed for short periods of time. It may take as long as 6 months for problems related to heel spur to improve. If there is no improvement after 6 months despite these treatments, EWST can be tried.

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