Baxter's neuritis, a common cause of heel pain
Heel pain in youth - calcaneal apophysitis or Sever's disease

ESWT or extracorporeal shockwave therapy for the treatment of heel pain


ESWT is a treatment modality derived from renal lithotripsy in which high energy shock waves are used to break up kidney stones. The best way to understand the nature of a shock wave is to consider what happens when a tire blows out and the windows rattle afterwards. A acoustic wave or pressure wave is generated. The pressure waves that are used in lithotripsy or ESWT involve a very rapid increase in pressure followed by a rapid decrease in pressure.

Studies performed on kidney tissue via biopsies after renal lithotripsy noted a surprising finding, that the kidney tissue in the path of the shockwave became much healthier than surrounding tissue. That led to research as to how shockwaves applied with the right intensity and frequency can cause damaged tissue to repair itself. This technology led to a new industry, ESWT, which involves the use of controlled shockwave energy applied to damaged tissue to effect a repair.

Initially, studies led to somewhat variable results as the type of human tissue which ESWT has a beneficial effect on was not known. The key issue is to differentiate tissue that is inflamed from tissue which is degenerated. The term “fasciitis” means inflammation of the fascia and “tendinitis,” inflammation of a tendon. Our bodies appear to handle acute inflammation fairly well but have difficulty with chronic inflammation. Arteries which are chronically inflamed form plaque and clog; tendons which are chronically inflamed become thickened, filled with thick inflexible scar tissue which tends to crowd out the good tissue and reduce the blood supply to the tendon. That is true for fascia too. Fascia is connective tissue that surround muscle, giving it support. The blood supply (nutrition) to fascia generally comes from adjacent muscle tissue. When fascia becomes too thick or scarred, there is reduced circulation to it and it becomes diseased. We call that process, “fasciosis” if it involves the fascia or “tendinosis” if it involves tendon.

Dr. Harvey Lemont, a professor at the Temple University College of Podiatric Medicine, the school I graduated from, did a fascinating study which he published in 2003. He examined tissue samples taken from 50 patients undergoing surgery on the plantar fascia. Why were those patients being treated surgically? Because they had what was known to that point as “intractable plantar fasciitis,” in other words, heel pain caused by plantar fasciitis which did not respond to conventional conservative treatments. He found that the plantar fascia in those patients showed no signs of inflammation but degeneration instead, ie. Plantar fasciosis.  With the advent of ESWT, surgical treatment of plantar fasciosis is rarely required.

ESWT is a treatment for plantar fasciosis, not plantar fasciitis.

ESWT is a treatment for Achilles tendinosis., not tendinitis.

How does one know if plantar fasciosis or Achilles tendinosis is the cause of heel pain? The best way to know for sure is to perform imaging, either MRI or diagnostic ultrasound (sonography). We generally perform diagnostic ultrasound as it is relatively quick and inexpensive.

There are different technologies to provide ESWT which I will cover in a later post.   We use the Swiss Dolorclast made by EMS, the Storz/Curamedix  Orthopulse  and the Storz/Curamedix Intellect FS-W focused ESWT units in our office.  

Dr. Ed Davis – “heel pain doctor” in San Antonio    heel pain doctor


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Sean Valjean

How interesting that heel pain can be treated with eswt. I had heard of it being used to break up kidney stones but I never considered that it might be used to help relieve pain in the feet. This sounds really great.

Suzy Frame

This is super interesting! My mom has been having heel pain and I have been looking into different treatments available for her! I think this blog with help me find some of those! Can you tell me where to find more like this? Thanks!


I recently heard about eswt treatments from a podiatrist in Lake in the Hills, and it sounded really interesting. This article did a good job breaking it down, and I have to say, the pros are really compelling. Here's hoping for more advancements like this.

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