Focused Shockwave Therapy

What is Focused Shockwave Therapy?

Focused Shockwave Therapy uses high-energy acoustic pressure waves rather than electrical shocks.

At The Podiatry Clinic, we use the EMS DolorClast Focused Shockwave system.

Unlike radial shockwave, where energy is concentrated closer to the surface and spreads through the tissues, focused shockwave can be directed to a more specific area and at a selected depth.

This allows your podiatrist to target the area identified during your clinical assessment and, where appropriate, ultrasound examination.

How does focused shockwave work?

Shockwave therapy creates controlled mechanical stimulation within the targeted tissue.

This is thought to trigger a number of biological responses involved in pain reduction, tissue repair and remodelling.

Depending on the condition being treated, these effects may include:

• stimulation of local cellular activity
• changes in blood flow and tissue metabolism
• stimulation of processes involved in tissue repair and remodelling
• effects on pain-sensitive nerve endings and pain signalling; and
• mechanical effects on certain calcific deposits where present.

The aim is not simply to temporarily mask pain. Treatment is intended to stimulate processes that may support recovery over the following weeks and months.

Why has focused shockwave been recommended?

Focused shockwave may be considered for persistent foot and ankle conditions including:

• plantar fasciopathy / persistent heel pain
• Achilles tendinopathy
• other selected foot and ankle tendinopathies
• some calcific tendon conditions
• selected bone-related conditions; and
• other persistent musculoskeletal problems where shockwave is considered clinically appropriate.

Your podiatrist will have considered your diagnosis, how long you have had the problem, previous treatment, clinical findings and individual circumstances before recommending focused shockwave.

What happens during treatment?

Your podiatrist will identify the area requiring treatment.

Depending on your condition, this may be based on your clinical examination and ultrasound findings.

A coupling gel is applied to the skin and the focused shockwave applicator is positioned over the treatment area.

A series of shockwaves is then delivered.

The energy level can be adjusted according to:

• the condition being treated
• the depth and location of the tissue
• your individual tolerance; and
• your response during treatment.

Treatment itself normally takes only a relatively short period and does not usually require local anaesthetic.

What does focused shockwave feel like?

You will normally feel repeated tapping or pulsing sensations within the treatment area.

Treatment can be uncomfortable and sometimes painful, particularly when initially treating a sensitive area.

Your podiatrist will normally begin at a tolerable level and adjust the treatment according to your response.

Some discomfort during treatment is expected, but you should communicate with your podiatrist throughout the procedure.

How many treatments will I need?

At The Podiatry Clinic, a typical focused shockwave programme consists of:

3–6 treatment sessions

Appointments are normally approximately 7–10 days apart.

The exact number of sessions depends on:

• the condition being treated
• how long you have had the problem
• the severity of symptoms
• your clinical findings
• your response to treatment; and
• your overall rehabilitation plan.

Improvement does not necessarily occur immediately, and treatment should not be judged solely by how you feel after the first session.

What results can I expect?

Focused shockwave is a well-established and extensively researched treatment for a number of persistent musculoskeletal conditions, particularly plantar heel pain.

Many patients experience meaningful improvements in pain and function during or after a treatment course.

The response can vary depending on the condition being treated, how long it has been present, the severity of the problem and individual factors.

For this reason, your podiatrist will explain what improvement is realistically expected for your particular condition.

Focused shockwave is not a guaranteed cure, but when it is used for an appropriate diagnosis and combined with rehabilitation, it can be a valuable treatment option for persistent pain and dysfunction.

Shockwave works best as part of a treatment plan

Focused shockwave is usually not used in isolation.

For many tendon and plantar fascia conditions, progressive rehabilitation and appropriate loading remain an important part of recovery.

Your treatment plan may therefore also include:

• progressive strengthening and loading exercises
• temporary activity modification
• footwear advice
• taping
• orthotics where clinically appropriate
• gait or pressure analysis
• management of training or occupational load; and
• other treatments where appropriate.

Think of shockwave as a treatment designed to support the rehabilitation process, rather than replace it.

Following the exercise and loading programme recommended by your podiatrist is therefore an important part of treatment.

What happens after treatment?

Most patients can walk immediately and continue normal everyday activities following focused shockwave treatment.

The treated area may temporarily feel:

• tender
• sore
• aching
• mildly swollen; or
• more sensitive than usual.

Occasionally symptoms can temporarily increase for a short period following treatment.

This does not necessarily mean that the condition has worsened.

Your podiatrist may recommend temporarily modifying strenuous or high-impact activity depending on the condition being treated.

When should I expect improvement?

Some patients notice improvement during their treatment course, while for others improvement develops more gradually.

The biological response stimulated by shockwave continues after the treatment session.

It may therefore take several weeks, and sometimes longer, before the full response can be assessed.

For longstanding tendon and plantar fascia conditions, rehabilitation also takes time. Feeling better does not necessarily mean the tissue has completed its rehabilitation, so continue your exercise programme as advised.

Anti-inflammatory medication

We generally advise avoiding non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen, naproxen or diclofenac during your shockwave treatment course unless they have been medically prescribed or you have been specifically advised otherwise.

Do not stop medication prescribed by your GP or another healthcare professional without discussing this with them or your podiatrist first.

If you require pain relief, ask your podiatrist or pharmacist what is appropriate for you.

What are the potential benefits?

Potential benefits of focused shockwave include:

• non-invasive treatment
• no injection or surgical incision
• treatment targeted to a specific area and depth
• no local anaesthetic normally required
• short treatment sessions
• little or no downtime for most patients
• ability to combine treatment with rehabilitation
• potential improvement in pain and function; and
• an additional treatment option for persistent conditions that have not responded sufficiently to initial management.

What are the possible side effects and risks?

Focused shockwave is generally well tolerated when appropriately performed.

Common temporary effects can include:

• discomfort during treatment
• tenderness or aching afterwards
• redness
• mild swelling
• bruising; and
• temporary aggravation of symptoms.

Less common complications may include:

• more significant bruising or haematoma
• temporary altered sensation or nerve irritation
• skin irritation; and
• prolonged increase in symptoms.

Serious complications are uncommon when shockwave is appropriately selected and performed.

Your podiatrist will assess the condition and treatment area before recommending shockwave and select treatment parameters appropriate to your circumstances.

Is focused shockwave suitable for everyone?

Focused shockwave is not appropriate for every patient or every condition.

Your podiatrist will consider factors including:

• the diagnosis and tissue being treated
• pregnancy
• blood-clotting disorders
• anticoagulant medication
• significant neurological or vascular problems
• active infection
• malignancy in or around the treatment area
• implanted electronic devices where relevant
• recent injections or procedures
• previous surgery; and
• other medical conditions or medications that may affect treatment.

Certain structures should not be exposed to high-energy focused shockwaves.

Please tell your podiatrist about any change in your health, medication or pregnancy status during your treatment course.

What are the alternatives?

Your alternatives depend on the condition being treated.

These may include:

• continued rehabilitation and progressive loading
• activity modification
• footwear changes
• taping or bracing
• orthotics where appropriate
• Class IV laser therapy
• radial shockwave therapy
• injection therapy where clinically appropriate
• medication
• further imaging or specialist assessment; or
• choosing not to have shockwave treatment and continuing with conservative management.

Your podiatrist can explain which alternatives are relevant to your particular diagnosis.

How much does Focused Shockwave Therapy cost?

Single treatment: £110

Course of 3 treatments: £300

Course of 5 treatments: £475

Your podiatrist will recommend the most appropriate treatment course according to your condition.

When should I contact the clinic?

Temporary soreness or tenderness after treatment can be normal.

Please contact us if you experience:

• severe or unexpectedly increasing pain
• significant swelling or bruising
• persistent numbness or altered sensation
• sudden loss of function
• inability to comfortably weight-bear
• symptoms that are substantially different from your usual condition; or
• anything else that concerns you following treatment.

Your next step

If you have already booked your treatment

Please attend your appointment as arranged.

Continue any exercises, loading programme or other treatment recommended by your podiatrist unless you have been advised otherwise.

If there has been a significant change in your health, medication or symptoms, please tell your podiatrist before treatment.

If focused shockwave has been recommended but you have not yet booked

You can book your Focused Shockwave Therapy – Follow-Up appointment when you are ready to proceed.

£110 per treatment | 3 treatments £300 | 5 treatments £475

Important information

This information sheet supports the discussion you have had with your podiatrist and is intended to help you make an informed decision about treatment. It does not replace individual clinical advice.

Focused shockwave is a well-established treatment option for selected persistent musculoskeletal conditions, and many patients experience meaningful improvement in pain and function.

Results vary between individuals, and improvement cannot be guaranteed.

Before each treatment, your podiatrist will confirm that treatment remains appropriate and you will have an opportunity to discuss any questions or concerns.

The Podiatry Clinic