Chronic heel pain — when conservative care isn't moving things
Plantar fasciitis, Achilles tendinopathy and other heel-pain conditions usually respond to a combination of activity modification, stretching, strengthening, footwear and (sometimes) orthoses. But a smaller group of people have symptoms that persist past 6–12 months despite doing the right things. For this group, shockwave therapy is one of the options that may be discussed.
What shockwave therapy actually is
Shockwave therapy (formally, Extracorporeal Shockwave Therapy or ESWT) delivers acoustic pressure waves to a localised area of tissue. There are two broad types: radial (the more common form in clinics) and focused. The treatment is applied through a handheld device, usually with gel, in short sessions over a number of weeks. It's not painful for most people, though it can be uncomfortable.
What conditions might it be used for?
- Chronic plantar fasciitis (often more than 6 months)
- Insertional and mid-portion Achilles tendinopathy
- Some other chronic tendinopathies (e.g. patellar, lateral hip)
- Heel spurs (where symptomatic)
What the evidence says — in plain language
For chronic plantar fasciitis and certain tendinopathies, there is moderate-quality evidence that shockwave can help reduce pain and improve function, particularly when conservative treatment has plateaued. It's not a quick fix, and it's not for everyone. Outcomes vary between individuals — some respond well, others see little change. Your practitioner should walk you through current evidence honestly so you can make an informed decision.
What a treatment course usually looks like
A typical course is 3–6 sessions, spaced about a week apart. Each session takes around 10–15 minutes for the shockwave application itself, on top of assessment and exercise work. Some soreness in the 24–48 hours after treatment is common. Most clinicians combine shockwave with continued exercise — it's not a substitute for the rehab side.
When shockwave isn't appropriate
Shockwave is generally avoided in pregnancy, over open growth plates in children, near major blood vessels or nerves, in some clotting conditions, and over malignancy. A full history is taken before treatment to identify any contraindications.
Realistic expectations
Shockwave is best thought of as one tool in a broader plan, not as a standalone solution. It may help break through a plateau for chronic heel pain — but the load management, footwear and strengthening work usually still need to happen alongside it. Your physiotherapist or podiatrist will discuss whether shockwave is likely to add value in your specific situation, and what success would realistically look like.
At 101 Physio & Allied Health
We offer shockwave therapy at select clinics where it's clinically appropriate. Suitability depends on your history, examination findings and how your condition has responded to other treatment. If you're considering it, an assessment is the first step — your practitioner will explain options, expected timeframes, costs and what to expect during treatment.
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