Shock Wave Therapy and Plantar Fasciitis

SHOCK WAVE THERAPY AND PLANTAR FASCIITIS

What is plantar fasciitis?

Plantar fasciitis, also known as plantar aponeurosis pain, is a common condition characterised by pain under the heel, particularly during the first steps in the morning or after prolonged periods of rest. It results from strain on the plantar fascia, a band of fibrous tissue connecting the calcaneus to the toes, which plays a fundamental role in supporting the arch of the foot.

A heel spur (calcaneal exostosis) is a calcification that may develop at the insertion of the plantar fascia on the calcaneus. Often discovered incidentally on X-ray, it is a consequence of chronic traction on the enthesis rather than the direct cause of pain in the majority of cases.

Consultations take place at the clinic located at 9 Rue du Regard, 75006 Paris, in the 6th arrondissement.

WHY DOES PLANTAR FASCIITIS BECOME CHRONIC?

The plantar fascia is a poorly vascularised tissue, particularly at its calcaneal insertion. When the mechanical load exceeds the tissue's capacity to adapt, a degenerative process gradually develops: this is more accurately described as plantar fasciopathy rather than acute inflammation. This impaired healing response explains why some cases of plantar fasciitis resist conventional conservative treatments (rest, orthotic insoles, stretching) and persist beyond 3 months.

MECHANISM OF ACTION OF SHOCK WAVES ON THE FASCIA

Radial shock waves act on fascial tissue through several complementary mechanisms:

• Stimulation of neovascularisation: the acoustic waves promote the formation of new blood vessels in the injured area, improving the supply of oxygen and nutrients required for tissue repair.
• Activation of healing processes: the mechanical stimulation restarts a biological response in tissue where the healing process is insufficient or stagnant.
• Analgesic effect: shock waves modify pain signal transmission at the level of local nerve endings (gate control theory and substance P release).
• Fragmentation of calcific deposits: in the presence of a heel spur, the waves can contribute to the progressive resorption of the calcification.

TREATMENT PROTOCOL

The protocol generally consists of 3 to 5 sessions, spaced 5 to 10 days apart. Each session lasts approximately 5 to 10 minutes for the treated area. The intensity is gradually adjusted according to the patient's tolerance.

Shock wave therapy is indicated when conservative treatment (relative rest, calf and plantar fascia stretching, orthotic insoles) has not provided satisfactory improvement after a minimum of 3 months. This duration criterion is important to ensure that first-line approaches have been properly followed before considering shock wave therapy.

SESSION PROCEDURE

At each session, the point of maximum tenderness is located by palpation. A coupling gel is applied to the area, and the applicator delivers the acoustic waves. The sensation is that of a rapid, repeated percussion of adjustable intensity. Most patients describe moderate discomfort that remains tolerable. After the session, local tenderness may persist for a few hours. Walking is possible immediately.

COMBINATION WITH OSTEOPATHY

Plantar fasciitis is rarely an isolated problem of the foot. The osteopathic approach allows identification and treatment of the biomechanical factors contributing to overload of the plantar fascia:

• Ankle mobility: limited ankle dorsiflexion (often related to calf muscle tightness) increases the strain on the plantar fascia.
• Foot biomechanics: excessive pronation, forefoot rigidity, imbalance of the intrinsic foot muscles.
• Hip and pelvis: posterior chain imbalances and pelvic asymmetries can alter load distribution at the foot.
• Overall posture: a comprehensive postural assessment helps identify remote compensations that perpetuate the condition.

Combining shock wave therapy (targeted action on the injured tissue) with osteopathic treatment (correction of contributing biomechanical factors) provides a more comprehensive approach and aims to reduce the risk of recurrence.

FREQUENTLY ASKED QUESTIONS

Is shock wave therapy effective for plantar fasciitis?

Several randomised controlled trials have shown that radial shock wave therapy is an effective treatment for chronic plantar fasciitis, particularly when conservative approaches have failed to provide satisfactory results after 3 months. The favourable response rate is generally above 60% in the published literature.

How many shock wave sessions are needed to treat plantar fasciitis?

The standard protocol consists of 3 to 5 sessions, spaced 5 to 10 days apart. The exact number is adjusted based on clinical progress. Some improvement may be felt after the first sessions, but the full benefit often develops in the weeks following completion of the treatment course.

Can I walk normally after a shock wave session on the foot?

Yes, walking is possible immediately after the session. Some local tenderness may persist for a few hours. It is advisable to limit intense sporting activities for 24 to 48 hours after each session.

References

• Gerdesmeyer L, Frey C, Vester J et al. (2008). Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. The American Journal of Sports Medicine, 36(11):2100-2109. PMID 18832341
• Rompe JD, Cacchio A, Weil L Jr et al. (2010). Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. The Journal of Bone and Joint Surgery, 92(15):2514-2522. PMID 21048171