Extracorporeal shockwave therapy to treat ankle, heel and foot pain


People who suffer from pain in their feet, ankles and heels may have reduced abilities to participate in activities that they enjoy and poorer qualities of life.

A good treatment option for people who experience chronic pain in these areas may be extracorporeal shockwave therapy. This type of therapy may be the best choice to help alleviate the pain.

Extracorporeal shockwave therapy benefits

Extracorporeal shockwave therapy offers several potential benefits to patients, including the following:

  • It is a painless procedure
  • It can be performed during an in-office appointment
  • It is non-invasive
  • It requires no anesthesia; and
  • It provides relief from the pain

Since the therapy does not require anesthesia, people who receive it are able to avoid the associated risks. Many people report feeling an almost immediate improvement in their symptoms after they receive the treatment. They may then be able to participate in activities that they enjoy with greater ease.

Conditions that may be treated with extracorporeal shockwave therapy

There are numerous conditions that may respond well to extracorporeal shockwave therapy. It is particularly useful to treat injuries that have happened to the ligaments, tendons and the fibrous parts of the feet, ankles and lower legs.
It may also be useful in treating patellar tip syndrome, which involves inflammation where the ligament attaches to the kneecap. It may also be good to treat shin splints and generalized Achilles’ tendon pain. Extracorporeal shockwave therapy is typically used to treat plantar fasciitis and may be a good choice for treating pain that occurs where the tendons attach.

How it works

Extracorporeal shockwave therapy is an effective treatment because it impacts the body’s ability to heal itself. When the shockwave therapy is applied, the currents cause the body to react by releasing chemicals that encourage pain relief and promote growth. The therapy also promotes the body to dilate the blood vessels, which helps to increase circulation. Finally, the body reacts to the therapy by improving its ability to exchange oxygen and nutrients that are needed for healing.

Shockwaves inhibit the body’s production of a substance called COX II, which causes inflammation. The treatment stimulates cellular defenses against disease, and it promotes the body’s release of free radicals. By overstimulating the nerve fibers, shockwaves help the body to produce its own analgesic effect against painful stimuli.

While extracorporeal shockwave therapy will not be the best treatment option for all conditions and all people, it may be a good choice for those who suffer from chronic pain conditions in their feet, heels and ankles. People who suffer from these types of pain may be greatly limited in their ability to enjoy the activities of daily life. If they are able to receive treatment that relieves their symptoms, they may then be able to participate in the activities that they previously enjoyed. Extracorporeal shockwave therapy may be a non-invasive therapeutic option to help people to literally get back on their feet again.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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