Shockwave Therapy
SHOCKWAVE THERAPY FOR PLANTAR FASCIITIS
At a glance
Shockwave therapy (ESWT) is one of the most effective non-invasive treatments for plantar fasciitis. A 2024 meta-analysis of 16 randomised trials found that shockwave produces better outcomes than corticosteroid injections at three and six months for pain, fascial thickness and foot function. A separate meta-analysis confirmed that radial ESWT, the type we use at our practice, is effective for plantar fasciitis with significant pain reduction. A typical course is 3 to 5 weekly sessions.
Plantar fasciitis is one of the most common causes of heel pain we see. That sharp stab under the heel with the first steps in the morning, the ache that comes back every time you stand up after sitting. The plantar fascia becomes overloaded and degenerates, often from a combination of tight calves, increased activity, prolonged standing or poor footwear. Despite the name 'fasciitis', research shows it is usually more of a degenerative process than a purely inflammatory one, which is why rest and anti-inflammatories alone often fail to resolve it.
For many patients, stretching, orthotics and load management are enough to turn the corner. But when heel pain persists beyond 6 to 8 weeks of conservative care, or keeps coming back, shockwave therapy is a well-supported next step. Plantar fasciitis is the most extensively studied musculoskeletal indication for ESWT, with more published trials behind it than any other condition treated with shockwave.
A 2024 meta-analysis comparing shockwave therapy to corticosteroid injections across 16 randomised trials found that shockwave was superior at both three months and six months for pain reduction, fascial thickness and foot function. Cortisone may provide faster initial relief, but the effects tend to wear off. Shockwave stimulates the tissue to repair rather than just suppressing the pain signal, which is why the results build and hold over time.
A separate 2024 meta-analysis of 11 randomised trials confirmed significant pain reduction with both radial and focused shockwave devices. Radial ESWT, the type we use at our practice, showed a comparable effect to focused ESWT. How the treatment is set up matters, which is why correct protocol selection by an experienced clinician makes a difference.
At our Sandton practice we deliver shockwave using the EMS Swiss DolorClast Smart20, the most extensively researched radial shockwave system in clinical use. We combine shockwave with chiropractic care because plantar fasciitis is rarely just a foot problem. Calf tightness, reduced ankle mobility, hip weakness and altered gait patterns all contribute to how the plantar fascia loads. Addressing these alongside the local tissue gives the best results and reduces the chance of recurrence.
WHEN TO CONSIDER SHOCKWAVE FOR PLANTAR FASCIITIS
Shockwave therapy may be appropriate for plantar fasciitis when:
- Heel pain has persisted for more than 6 to 8 weeks despite stretching, rest and conservative treatment
- Morning heel pain is not improving or is getting worse
- You have tried orthotics or new footwear with limited improvement
- Cortisone injections have provided only temporary relief or you want to avoid them
- The pain is limiting your ability to walk, exercise or stand for your work
- You want a non-invasive treatment that targets the tissue itself rather than just managing the pain
WHAT TO EXPECT FROM A COURSE OF SHOCKWAVE
Treatment follows a structured protocol:
- A thorough assessment at your first visit to confirm that shockwave is appropriate for your heel pain
- 3 to 5 sessions delivered once a week, each lasting about 15 minutes of shockwave treatment
- Each visit also includes a chiropractic assessment, calf and ankle mobilisation and rehabilitation exercises tailored to your foot
- Many patients notice a reduction in morning heel pain after the first or second session
- Mild tenderness or warmth in the heel for 24 to 48 hours after each session is normal and expected
- Avoid anti-inflammatory medication during the course where possible, as it can slow the healing response shockwave is designed to trigger
- Tissue remodelling continues for 6 to 12 weeks after the course ends, with ongoing improvement
- Progress is tracked through pain levels and function at each visit, with the treatment plan adjusted as you respond
If conservative care has not resolved your plantar fasciitis, shockwave therapy is a well-supported next step with stronger mid-term outcomes than cortisone injections. Read more about the condition, what drives it and the exercises that help in our detailed plantar fasciitis article.
Located on Rivonia Road in Morningside, we serve patients from Sandton, Bryanston, Fourways, Randburg, Sunninghill, Rivonia and surrounding areas of Johannesburg.
Shockwave therapy at our practice is offered by Dr Matthew Proctor. Book a shockwave appointment directly with him or get in touch to discuss your heel pain before booking.
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Frequently Asked Questions
Yes. Plantar fasciitis is the most extensively studied indication for shockwave therapy. A 2024 meta-analysis of 11 randomised trials found that both radial and focused ESWT significantly reduce heel pain. A separate meta-analysis of 16 trials found that shockwave produces better outcomes than corticosteroid injections at three and six months for pain, fascial thickness and foot function.
At mid-term follow-up, yes. A 2024 meta-analysis of 16 randomised trials found that shockwave was superior to corticosteroid injections at three and six months for pain reduction, fascial thickness and foot function. Cortisone may provide faster short-term relief, but the effects tend to wear off, while shockwave stimulates tissue repair that builds over time.
Most published trials use 3 to 5 sessions delivered once a week. Many patients notice meaningful pain relief after the first or second session, particularly a reduction in the sharp morning heel pain. The tissue remodelling triggered by treatment continues for 6 to 12 weeks after the course ends.
Shockwave delivers acoustic pressure waves into the damaged plantar fascia. This increases blood flow to an area that normally has poor circulation, stimulates new blood vessel growth and triggers a healing response in tissue that has stopped repairing on its own. It also has a direct pain-modulating effect by reducing Substance P, a neurotransmitter involved in pain signalling.
The treatment feels like rapid mechanical tapping against the sole of your foot. Over the tender area of the heel it can be intense for the first 30 to 60 seconds before the pain-modulating effect kicks in. Most patients describe the discomfort as a 3 to 5 out of 10 and entirely manageable. We adjust the energy level to your tolerance.
Shockwave is a good option when plantar fasciitis has not responded to stretching, orthotics, rest or other conservative measures over 6 to 8 weeks. It is also worth considering if you want to avoid cortisone injections or have had injections that provided only temporary relief. It is particularly effective for chronic cases where the tissue has stopped healing on its own.
You may feel mild tenderness or warmth in the heel for 24 to 48 hours afterwards. This is the healing response and is expected. We ask patients to avoid anti-inflammatory medication during the course where possible, as it can blunt the very response shockwave is trying to provoke. You can continue normal activities between sessions.
In most cases you do not need to stop running completely, but you may need to reduce your distance or intensity temporarily. The tissue needs controlled loading to repair. Your chiropractor can help you find the right balance between resting the fascia and maintaining your training during the course.
References
- Cortés-Pérez I, Moreno-Montilla L, Ibáñez-Vera AJ, et al. Efficacy of extracorporeal shockwave therapy, compared to corticosteroid injections, on pain, plantar fascia thickness and foot function in patients with plantar fasciitis: a systematic review and meta-analysis. Clinical Rehabilitation. 2024;38(8):1023-1043.
- Lippi L, Folli A, Moalli S, et al. Efficacy and tolerability of extracorporeal shock wave therapy in patients with plantar fasciopathy: a systematic review with meta-analysis and meta-regression. European Journal of Physical and Rehabilitation Medicine. 2024;60(5):832-846.