# Shockwave therapy

> Shockwave therapy (ESWT) passes sound waves through the skin to treat long-standing heel and tendon pain, without injections or surgery. It has the best support for plantar heel pain, and results vary by condition. It's usually tried after other treatments haven't been enough.

Guide in [Treatments](https://footanklelowerlimb.com.au/learn/topics/treatments), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/shockwave-therapy
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026.
Next review by 27 October 2027.

- **It's a non-invasive treatment:** a hand-held device sends sound waves through your skin to a sore heel or tendon.
- **Support is strongest for plantar heel pain,** and weaker for Achilles tendon problems.
- **It's usually tried later,** once other care such as exercise and footwear changes hasn't been enough.
- **It isn't for everyone,** including people who are pregnant, under 18 or have a pacemaker.
- **Side effects are mostly mild,** though tendon rupture is a rare risk.

## What is shockwave therapy, and how does it work?

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment: a hand-held device passes sound waves through your skin to the sore area [1]. The waves are mechanical, not electrical [1].

There are two types. Focused shockwaves deliver concentrated energy to deeper tissue, while radial shockwaves spread over a larger, more superficial area [2]. Researchers think ESWT may encourage healing and calm pain-sensing nerves, but how it works isn't fully understood [3]. It's fair to ask which type will be used and why.

## What is shockwave therapy used for, and does it work?

It's mainly used for long-standing heel and tendon problems in the legs and feet [1]. How well it works depends on the condition.

**Plantar heel pain** (pain under the heel, also called plantar fasciitis) is where support is strongest. ESWT seems to be an effective and tolerable treatment [4], with benefit across a wide range of measures [3].

**Achilles tendinopathy** (a sore Achilles tendon) is less clear. In adults, ESWT hasn't shown a meaningful benefit over a dummy (sham) treatment, so it shouldn't be a routine choice [5]. Adding it to exercise didn't improve pain or function where the tendon meets the heel bone (insertional Achilles tendinopathy) [6]. Some reviews still list the middle part of the tendon among its stronger uses [7], so don't assume it will work for every tendon problem.

It may also ease pain at the side of the hip (greater trochanteric pain syndrome) for one to three months [8]. ESWT seems to suit long-standing, degenerative tendon problems best, and may not help early or reactive ones [9][10]. For foot and ankle soft tissue problems, around 5 to 7 out of 10 people find it effective [11].

## Is shockwave therapy right for me?

ESWT is generally offered to adults whose heel or tendon pain has lasted at least 3 to 6 months and hasn't improved with other care, such as physiotherapy, activity changes, orthotics or painkillers [12][11]. Some services ask for at least 6 months [13].

It isn't suitable for everyone. Services don't offer it if you're under 18, pregnant or trying to conceive, have a pacemaker or other cardiac device, have an infection or tumour at the treatment site, or have had a steroid injection in the area recently [12][13][11]. How long to wait after an injection varies, from 6 to 8 weeks to 12 weeks [13][12]. A clotting disorder, or blood-thinning or anti-platelet medicine, needs a clinician's review first [12]. Because lists differ between services, the clinician should check yours.

> [!tip] Try this
> Before you book, jot down anything the clinician should know: pregnancy, a pacemaker or other implant, a clotting disorder, blood-thinning or anti-platelet medicine, recent steroid injections, and any cancer or infection. Ask how long symptoms need to have lasted and which earlier treatments the service expects you to have tried.

## What happens during shockwave therapy?

Before treatment, tell the clinician about anything on your list. If you're over 60, or have had a tendon tear or rupture, ask whether a scan is needed first [8].

A hand-held applicator is placed on the sore area, and each treatment takes about 5 minutes [14]. Most people feel some pain or discomfort during it [12]. Focused treatment can be painful and is sometimes given with anaesthesia; radial treatment is generally given without it [15]. Tell the clinician if it becomes too much.

## What are the risks and side effects of shockwave therapy?

Most side effects are mild and short-lived: pain during or after treatment, bruising, swelling, skin reddening, headache, and numbness or altered feeling [11][16]. Serious problems are rare [7].

The main one is tendon rupture (a tear), which is a small risk. Achilles ruptures have been reported after focused treatment [5][11]. Adults over 60, and people with an advanced tendon injury such as a partial Achilles tear, should be told about a possible higher risk in the first 2 weeks after high-energy focused treatment, and may be advised to adjust their activity [17]. Ask your clinician about this before you start.

## How does shockwave therapy compare with other options?

ESWT hasn't been shown to clearly beat other options. It's usually tried after other care, such as exercise, footwear changes and orthotics, hasn't worked [12].

For Achilles tendinopathy, it may add only a small short-term effect compared with conservative treatments such as eccentric exercises (a type of tendon-loading exercise) [8], and alternatives should be prioritised [5]. Some reviews suggest ESWT with exercise beats exercise alone [8], but a small trial found no added benefit in insertional Achilles tendinopathy [6]. So treat ESWT as an addition to a rehabilitation plan, not a replacement for one. Radial and focused shockwaves show no clear winner over each other [10]. Ask how it compares with exercise, orthoses or injections for your condition.

## When to see a podiatrist

See your GP or a podiatrist the same day if you have sudden pain in the treated area or any loss of function after treatment, and don't wait to see if it settles [14]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic.

See a podiatrist if your pain is persistent or getting worse, or limits your usual activities, whether or not you've had shockwave therapy.

It's worth asking a podiatrist about ESWT if heel or tendon pain has lasted for months despite exercise, footwear advice or orthoses. They can tell you whether it suits your condition and whether you meet the service's checks.

## Common questions

### How many shockwave sessions will I need?

It varies between services, and no single number suits everyone. Each treatment takes about 5 minutes. Ask the service how many sessions are planned, how far apart they are, and how the intensity will be adjusted to your comfort.

### Can I exercise after shockwave therapy?

Follow the service's written instructions about activity after treatment. Keep up any exercise or load-management plan you've been given, as ESWT is meant to sit alongside rehabilitation. If you're over 60 or have an advanced tendon injury, you may be advised to modify your activity in the first couple of weeks.

### Can I take ibuprofen or use ice around shockwave treatment?

Ask your clinician before your first session, as services give their own advice. A pharmacist or doctor can advise on pain relief such as paracetamol, and should be asked before you change any medicine. Always mention blood-thinning or anti-platelet medicines to the clinician.

## Further reading

- [Shockwave therapy on Clindice](https://clindice.com/extracorporeal-shockwave-therapy-podiatry)
- [Extracorporeal shockwave therapy (ESWT)](https://www.kentcht.nhs.uk/leaflet/extracorporeal-shockwave-therapy-eswt/), NHS
- [A Patient's guide to Radial Extracorporeal Shockwave Therapy (ESWT) :: Royal National Orthopaedic Hospital](https://www.rnoh.nhs.uk/patients-and-visitors/patient-information-guides/radial-extracorporeal-shockwave-therapy-eswt), NHS
- [Extracorporeal Shockwave Therapy](https://www.ouh.nhs.uk/media/35kl5xmx/117207extracorporeal-shockwave-therapy.pdf), NHS
- [Shockwave Therapy](https://www.whittington.nhs.uk/default.asp?c=46654), NHS

## Sources

1. Extracorporeal Shockwave Therapy · NHS. https://plr.cht.nhs.uk/download/1223/Extracorporeal%20shockwave%20Therapy%20A4
2. Extracorporeal shockwave therapy versus sham extracorporeal shockwave therapy for chronic Achilles tendinopathy: a meta-analysis of randomized controlled trials · Ni T, Zhao Y, Pang L et al. · PeerJ · 2026. https://doi.org/10.7717/peerj.20506
3. Comparative effectiveness of minimally invasive therapies for plantar fasciitis: a systematic review and network meta-analysis · Tien CH, Chiu MC, Shen YL et al. · Scientific Reports · 2026. https://doi.org/10.1038/s41598-026-40038-z
4. Efficacy and tolerability of extracorporeal shock wave therapy in patients with plantar fasciopathy: a systematic review with meta-analysis and meta-regression · Lippi L, Folli A, Moalli S et al. · European Journal of Physical and Rehabilitation Medicine · 2024. https://doi.org/10.23736/s1973-9087.24.08136-x
5. Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-Analysis · Korakakis V, Kotsifaki R, Sotiralis Y et al. · The Journal of Orthopaedic and Sports Physical Therapy · 2026. https://doi.org/10.2519/jospt.2026.13985
6. Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial · Alsulaimani B, Perraton L, Vallance P et al. · Clinical Rehabilitation · 2025. https://doi.org/10.1177/02692155241295683
7. Extracorporeal shockwave therapy in musculoskeletal conditions: a narrative review · Wood D, Paul J, Zaveri F et al. · Regenerative Medicine · 2026. https://doi.org/10.1080/17460751.2026.2741432
8. Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review · De la Corte-Rodríguez H, Román-Belmonte JM, Rodríguez-Damiani BA et al. · Healthcare (Basel, Switzerland) · 2023. https://doi.org/10.3390/healthcare11212830
9. ESWT for tendinopathy: technology and clinical implications · van der Worp H, van den Akker-Scheek I, van Schie H et al. · Knee Surgery, Sports Traumatology, Arthroscopy · 2013. https://doi.org/10.1007/s00167-012-2009-3
10. Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis · Stania M, Pawłowski M, Benduch M et al. · Scientific Reports · 2026. https://doi.org/10.1038/s41598-026-37160-3
11. Having shockwave therapy (ESWT) for soft tissue disorders in your foot/ankle · NHS. https://yourhealth.leicestershospitals.nhs.uk/library/musculoskeletal-specialist-surgery-mss/elective-orthopaedics/2350-having-shockwave-therapy-eswt-for-soft-tissue-disorders-in-your-foot-ankle/file
12. Shockwave Therapy · NHS. https://www.wwl.nhs.uk/pdfreader/accessiblePDF/cnv-wwl-68ca8bcf6fb0d9.52921474
13. Podiatry - Extracorporeal Shockwave Therapy (ESWT) · NHS. https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/podiatry-extra-corporeal-shockwave-therapy-eswt?q=%2Fpatient-information%2Fpatient-leaflets%2Fpodiatry-extra-corporeal-shockwave-therapy-eswt
14. Download.cfm · NHS. https://www.nhft.nhs.uk/download.cfm?doc=docm93jijm4n13058.pdf&ver=69066
15. Therapeutic Ultrasound and Shockwave Therapy for Tendinopathy: A Narrative Review · Smallcomb M, Khandare S, Vidt ME et al. · American Journal of Physical Medicine & Rehabilitation · 2022. https://doi.org/10.1097/phm.0000000000001894
16. Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review · Roerdink RL, Dietvorst M, van der Zwaard B et al. · International Journal of Surgery (London, England) · 2017. https://doi.org/10.1016/j.ijsu.2017.08.587
17. Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration · Tenforde AS, Borgstrom HE, DeLuca S et al. · PM & R · 2022. https://doi.org/10.1002/pmrj.12790

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This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.