Last week I summarized an evidence based review article on the treatment of plantar fasciitis and that article stated that a randomized double-blinded trial that added 1 application of high energy extracorporeal shock wave therapy to standard therapies showed a statistically significant improvement in symptoms at 3 months compared to standard therapies without ESWT.
So, I decided to look into electrical shock wave therapy a bit. The shockwaves are abrupt, high amplitude pulses of mechanical energy, similar to soundwaves, generated by an electromagnetic coil or a spark in water. Similar technology using focused higher energies is used to break up kidney and gallstones, and is termed lithotripsy. “Extracorporeal” means that the shockwaves are generated externally to the body and transmitted from a pad through the skin.
In different site discussing ESWT it is discussed as being used to treat many different areas of tendonitis: epicondylitis, Achilles tendonitis, plantar fasciitis, etc…. as well as shoulder rotator cuff pain and knee pain. Besides this it is discussed as being used for non-healing fractures and diabetic foot ulcers.
The exact physiological mechanism is not understood, but it is thought that the shockwaves stimulate angiogenesis and neurogenesis and the cells undergo microtrauma which promotes inflammatory and catabolic processes that are associated with removing damaged matrix constituents and stimulates wound healing mechanisms. This mechanical stimuli to an inflammatory response that is focal to a tendon sounds similar to prolotherapy, but without the trauma of the needle.
Listed contraindications for this procedure include: neurological and vascular disease of the foot; history of rupture of the plantar fascial ligament; open bone growth plates; pregnancy, implanted metal in the area (bone screws and pins); and people on medication that interferes with blood clotting such as Coumadin and prophylactic aspirin.
ESWT is approved in the US by the Food and Drug Administration (FDA) for treatment of only plantar fasciitis and tennis elbow. It was stated that there is an FDA study that is looking at using it to treat recalcitrant diabetic wounds.
Have a nice Thanksgiving Everyone!