Shockwave therapy for plantar fasciitis
Plantar fasciitis is the use of shockwave therapy with the most evidence behind it in the United Kingdom, and it is still the use NICE describes as inconsistent. The guidance, the place it belongs in the sequence and what a course involves are all set out below.
What you're seeing
Understanding plantar fasciitis and plantar heel pain
Shockwave therapy is a second-line treatment for plantar heel pain in the United Kingdom. NICE assessed it in interventional procedures guidance IPG311, now HealthTech guidance HTG200, under the title "Extracorporeal shockwave therapy for refractory plantar fasciitis". Refractory is the operative word: the guidance covers heel pain that has already been loaded properly for months and has not settled.
The finding is a pair, and both halves matter. NICE concluded that the evidence "raises no major safety concerns; however, current evidence on its efficacy is inconsistent", and that the procedure "should only be used with special arrangements for clinical governance, consent and audit or research". That is not a recommendation, and it is not a rejection. It is a statement that the safety picture is reassuring and the benefit picture is not settled.
The condition itself behaves like a capacity problem rather than an inflammatory one. The plantar fascia was asked to absorb more load than it had adapted to, and the tissue changes that follow are degenerative in character. That is why rest alone tends to disappoint, and why progressive loading of the calf and the fascia is the first-line answer everywhere.
Shockwave enters the picture when that loading programme has been followed for at least three months and the pain has not moved. Given earlier, it is being asked to do a job that load has not yet been given the chance to do. Extracorporeal shockwave therapy covers how a course is delivered, and the evidence on whether shockwave therapy works goes through the trial picture condition by condition.
Why it happens
What causes plantar fasciitis?
- A rise in running volume, walking distance or time spent standing that the fascia had not adapted to
- A change to flatter or less supportive footwear, often alongside a new commute or a new job
- Reduced calf strength and endurance, so the fascia absorbs a greater share of each step
- Limited ankle dorsiflexion, which raises the demand on the underside of the foot
- A long quiet period followed by a rapid return to previous activity levels
- A previous episode of plantar heel pain that eased before the strength was rebuilt
Treatment approach
Where shockwave therapy fits for plantar fasciitis
FAQ
Shockwave therapy for plantar fasciitis
questions people ask
Does shockwave therapy work for plantar fasciitis?
NICE concluded that the evidence raises no major safety concerns while the evidence on efficacy is inconsistent. That is its own wording and it is not a recommendation. Plantar fasciitis has the largest trial literature of any shockwave use in the United Kingdom, and the results across those trials still disagree with each other.
How many shockwave sessions does plantar fasciitis need?
Three to five sessions is the usual course, spaced roughly a week apart, with about five minutes of treatment each time. Protocols differ between clinics and between machines. What should not differ is that a loading programme for the calf and the fascia runs alongside the sessions rather than instead of them.
When is shockwave the right next step for heel pain?
Usually once the pain has run for at least three months and a proper loading programme has been followed without it shifting. The NICE title uses the word refractory for exactly this reason. Offered before load has been tried properly, shockwave is being asked to substitute for the treatment that changes the tissue.
How soon after a course would I know if it helped?
Six to twelve weeks after the final session. Very little changes during the course itself, which is the commonest reason people conclude too early that it has failed. The useful question at review is what the heel now tolerates over a day on your feet, rather than how it feels sitting still.
Is shockwave therapy painful on the heel?
It is uncomfortable while it runs and it is over in about five minutes. The energy is turned up to what you can tolerate, so some discomfort is part of the dose. Afterwards the heel is commonly sore for 24 to 48 hours, and that soreness settling is the expected pattern.
Get Started
Describe the problem and what has been tried.
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