Waking up to a sharp pain in the heel is not what many people would call an enjoyable morning. For some, the pain begins to subside as they walk for a few minutes each day, only to return when they sit or at the end of a hard working shift. When stretching and switching shoes have not helped, the question turns to what other options are available to provide relief. Shockwave therapy for heel spurs is one of the most common responses to that question. This article provides an overview of what it is, how it works, what a session entails and what the research and who should pose questions before beginning.
What Is Shockwave Therapy for Heel Spurs?
Shockwave therapy, officially known as extracorporeal shockwave therapy or ESWT, uses focused acoustic pulses delivered through the skin to an irritated area, without any needles or incisions. It is an outpatient treatment, typically offered in a podiatrist’s office.
A few words of clarification help. A heel spur is a bony growth on the underside of the heel bone. It is often seen in conjunction with plantar fasciitis, which is inflammation of the thick band of tissue running along the sole. A spur is commonly visible on an X ray in patients diagnosed with plantar fasciitis, but it is not considered the defining feature of the condition, and many people have spurs without pain, but the pain in many cases is from the irritated fascia where it attaches the heel.
Which is why shockwave therapy for plantar fasciitis and shockwave therapy for spurs are so closely linked. The treatment targets the painful tissue rather than the bump on the X ray.
How Does Shockwave Therapy Help With Heel Pain?
Shockwave therapy helps with heel pain by delivering pulses of energy into the painful tissue, which are thought to stimulate the body’s healing response and reduce pain signalling. The mechanism is not entirely settled, so it is best described as a leading theory rather than proven fact.
Podiatrists often describe it as restarting a stalled repair process. Chronic heel pain tends to linger because the tissue is stuck in an irritated state. The pulses are believed to encourage better local blood flow and cellular activity, which could help the area recover.
One thing that surprises many patients. The spur itself does not go away. In a study on 54 runners with plantar fasciitis and a heel spur, follow up X rays showed no significant change in the spur, even though many patients improved. The goal is relief, not removing the bone growth.
What Happens During a Shockwave Therapy Session?
A session is straightforward. The podiatrist looks at the heel, finds the most tender spot and applies gel to the skin. In a study, the ultrasound gel was applied to the heel and the treatment area was located with ultrasound guidance. A handheld applicator is then pressed against the heel, and the device delivers a series of pulses.
Patients usually feel a tapping or pulsing sensation, and some describe discomfort in the tender area that eases when the treatment is over. The pulse count and energy level are adjusted to what the patient can tolerate. There is no incision and no dressing, and most people walk out after the session and return to light activity, although the podiatrist might suggest they ease off high impact exercise for a short time.
One visit is rarely the whole plan. High energy protocols typically use a single session, while low energy protocols may use three to five sessions. A randomized trial used three weekly sessions of 2000 impulses. Improvement often builds up gradually.
What Does the Research Say?
The evidence is encouraging but mixed, which an honest article should address. A randomized, controlled multicenter study found a 69.2% reduction in heel pain with focused shockwave therapy compared with 34.5% for placebo. The runner study reported 71% good or excellent results, with improvement lasting up to 24 months.
Other findings are more modest. A small case series reported pain reductions of roughly 37 to 44% on several measures, with the pain relief maintained by approximately half of patients at six months. Older technology reviews also noted that the scientific evidence at the time did not allow a firm conclusion on effectiveness. Results vary by device, energy level, sessions and the patient. Shockwave therapy is a reasonable option for stubborn heel pain, but it is not a guaranteed fix.
Benefits Patients Often Value
The shockwave therapy for heel pain appeal is mostly practical. They are noninvasive, so there is no surgical recovery. They are done in the office, with short visits and little downtime. They do not involve medication or injections, and give patients with chronic pain an alternative to more stretching and new insoles. For some, they also delay or avoid the need to consider surgery.
Who Is a Good Candidate?
Most heel pain improves without it. About 85% to 90% of patients improve with conservative care such as stretching, supportive footwear, anti-inflammatory medication and orthotics. Shockwave therapy is generally considered for chronic cases. It has been used for pain that has not responded to at least six months of conservative treatment.
A correct diagnosis comes first, because nerve entrapment and other conditions can mimic plantar fasciitis. Several groups should raise it at the consultation. Some studies excluded people with diabetes, peripheral vascular disease or previous heel surgery. Pregnancy, bleeding disorders, blood thinners, active infection and implanted devices near the treatment area are also typical reasons for extra caution.
Side Effects and Costs
Side effects are usually mild and short lived. Temporary soreness, redness, swelling, bruising or tingling in the heel can follow a session. Severe or lasting pain should be reported to the podiatrist.
Insurance coverage varies by plan and diagnosis, and some patients pay out of pocket. Asking about per session fees, the likely number of visits and coverage before booking avoids surprises.
Heel Pain Habits for New Jersey Patients
Long days on hard retail or hospital floors, commuting on foot and running on boardwalks all load the heel. Worn out shoes make it worse, and so do flat winter boots. Calf and plantar fascia stretching, shoes with solid arch support and gradual increases in activity help, whatever treatment is chosen.
A practice like John M. Galant, D.P.M can examine the foot, confirm the cause of the pain and explain whether shockwave therapy for heel spurs or a different approach is the better fit.
FAQs:
How does shockwave therapy help with heel pain?
Shockwave therapy sends focused acoustic pulses into the painful area of the heel. The pulses are thought to stimulate healing, improve local blood flow and ease pain signals in irritated tissue. The mechanism is still debated, and results vary, so podiatrists usually consider it when pain persists despite conservative care.
What happens during a shockwave therapy session?
The podiatrist applies gel, locates the tender spot and moves a handheld applicator over it while delivering pulses. Most patients feel tapping or mild to moderate discomfort. The visit is brief, involves no incisions, and people usually leave walking normally. Several sessions are recommended, spaced about a week apart.
Does shockwave therapy remove a heel spur?
No. In a study of runners, follow up X rays showed no significant change in the spur after treatment, yet many patients improved. The goal is pain relief, not shrinking the spur.
How many shockwave therapy sessions are needed for heel pain?
Low energy protocols commonly use three to five sessions, often a week apart, while high energy protocols may use a single session. Improvement can take several weeks to show, and a podiatrist may suggest more sessions if the first round is not enough. Response varies from person to person.
