Extracorporeal Shockwave Therapy
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Extracorporeal shockwave therapy (ESWT) uses a hand-held device to pass sound waves through your skin to a painful area. It is used mainly for long-lasting tendon problems and heel pain under the foot, usually after other treatments haven't worked. It seems to help most for heel pain under the foot. For Achilles tendon pain the results are mixed. Each treatment takes about 5 minutes and you can expect some discomfort. It isn't suitable for everyone, including people who are pregnant, under 18 or have a pacemaker.
What is it?
Extracorporeal shockwave therapy (ESWT) is a treatment where a hand-held device passes sound waves through your skin to an injured or painful area. "Extracorporeal" just means outside the body. There are no injections, no medicine and no surgery.
The waves are mechanical sound waves, not electrical ones. They are low in energy and you can hear them.
There are two types. Focused waves put their energy into one point, at a set depth in the tissue. Radial waves spread over a wider, shallower area. No clear winner has been found between the two.
How ESWT works isn't fully understood. Ideas include new blood vessel growth, better blood flow, help with healing, and calming the nerve endings that sense pain. These are still theories.
What is it used for?
ESWT is used mainly for tendon problems in the legs and for heel pain under the foot (plantar fasciopathy, also called plantar fasciitis). The plantar fascia is a thick band of tissue along the sole of your foot. How well it works depends on the problem being treated.
Heel pain under the foot is where the support is strongest. ESWT seems to be an effective and well-tolerated treatment for it.
For pain on the outside of the hip (greater trochanteric pain syndrome), ESWT has given pain relief over the following one to three months. The support is more limited than for heel pain.
For Achilles tendon pain (the thick cord at the back of your ankle), the picture is mixed. For pain where the tendon joins the heel bone, ESWT hasn't shown a meaningful benefit over a sham treatment. For pain in the middle of the tendon, the latest advice is that ESWT shouldn't be a routine treatment and that other options should come first. Some experts still list it as a useful option here, so it isn't clear yet how much it helps.
ESWT is also offered for other tendon problems, tendon calcification, and golfer's and tennis elbow. These include tendons at the knee, buttock, upper hamstring, groin and elbow. It isn't clear yet how much it helps for these.
Is it right for me?
ESWT is usually offered to adults whose tendon or plantar fascia pain has lasted at least 3 to 6 months. One service asks for at least 6 months. It is for pain that hasn't improved with care such as physiotherapy, changing your activity, shoe advice or orthoses (shoe inserts).
It is generally used later on, alongside a plan to gradually build up the load on the tendon, and before surgery is considered. It seems to suit long-standing, worn tendons best. It may not help an early, irritated tendon.
Some people shouldn't have ESWT. Services don't treat:
- people under 18
- people who are pregnant or trying to conceive
- people with a pacemaker, an implanted defibrillator or another heart device
- people with cancer or a tumour at the treatment site
- people with an infection at the treatment site
- people who have had a steroid injection in the area recently
- people with haemophilia, a clotting disorder, a risk of heavy bleeding or an unstable heart condition
Some services also don't treat people with a current blood clot, epilepsy, or acute inflammation in the area. Others add a recent course of radiotherapy there, or a torn tendon or plantar fascia.
The waiting time after a steroid injection is 6 to 8 weeks at some services and 12 weeks at others. Each service has its own list, so your podiatrist will check you against it.
Some things need a check first. These include blood-thinning medicines (such as warfarin or rivaroxaban) and anti-platelet medicines (such as aspirin or clopidogrel). They also include a broken bone near the area, a joint replacement, a past Achilles tendon rupture, and some antibiotics. Tell your podiatrist about all of these.
What happens?
Your podiatrist holds a probe or applicator against your skin over the sore area. The waves pass through the skin into the tissue underneath. At one service the pulses are made by compressed air in the hand-held piece. Each treatment takes about 5 minutes.
Before treatment, tell your podiatrist your age and about any past tendon tear or rupture. Ask whether a scan is needed first. A scan is recommended before treatment, especially if you are over 60.
You can also ask:
- whether a focused or radial device will be used, and why
- how the strength will be adjusted to your comfort
How well does it work?
For heel pain under the foot, ESWT reduces pain. This is true for both focused and radial types. Results seem to depend on the settings used, and these affect both pain relief and how well people put up with treatment. Heel pain under the foot often settles by itself, but it can last for months or longer. That is why ESWT is considered when first-line care hasn't worked.
Overall, between 5 and 7 out of 10 people have found ESWT effective. For long-standing Achilles tendon pain, about 46 per cent of adults had a good result. People with milder symptoms to start with did better. It isn't clear yet whether age makes a difference.
ESWT hasn't been shown to clearly beat other options. For Achilles tendon pain, it may add only a small short-term benefit over other conservative treatments. Opinions differ on whether adding it to exercise helps. Think of ESWT as an addition to an active rehabilitation plan, not a replacement for one.
Risks and side effects
Most side effects are mild and short-lived. They can include:
- pain during or after treatment
- bruising, swelling or reddening of the skin
- small skin bleeds
- headache
- numbness or a change in feeling
A tendon or plantar fascia can rupture (tear) after treatment. This is a small risk, and serious problems are rare. Achilles tendon ruptures have been reported within 2 weeks of a first focused treatment, in women older than 60.
If you are over 60 or have an advanced tendon injury, your podiatrist should talk with you about this risk for the first 2 weeks after high-energy focused treatment. You may be advised to change your activity during that time.
Afterwards
Your service will give you written instructions about activity after treatment. Follow them closely.
Keep up the exercise or tendon-loading plan your podiatrist or physiotherapist gave you. Ask how and when your progress will be checked, for example with pain and function scores before and after your course.
Pain that keeps going or gets worse, or pain that limits what you normally do, should be checked by a health professional rather than managed on your own.
When to see a podiatrist
Book an appointment if
Your pain is not settling or is getting worse, it limits what you normally do, or other treatments haven't helped after several months and you'd like to ask your podiatrist whether shockwave therapy is an option for you.
Seek prompt assessment if
you get sudden pain in the treated area, or lose any function there, after treatment. This could mean damage to the tendon or other tissue. Contact the podiatry team that treated you, or see your GP or another doctor today, and don't wait to see if it settles. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
Frequently asked questions
Does shockwave therapy hurt?
Most people feel some discomfort during treatment, and some have pain afterwards for a short time. Focused treatment can be quite painful and is sometimes given with anaesthesia. Radial treatment is usually given without it. Tell your podiatrist if it becomes too much, as the strength can be adjusted.
How many sessions will I need?
It isn't clear yet what the best number of sessions or the best strength is. Your podiatrist will follow their service's own plan. Ask how many sessions are planned, how far apart they are, and how your progress will be checked along the way.
Should I stop my exercises while having shockwave therapy?
No. ESWT is meant to be used alongside an active plan, such as exercises and gradually building up the load on a tendon. It works best as an addition to that plan, not a replacement. If you are over 60 or have an advanced tendon injury, your podiatrist may ask you to modify your activity for the first 2 weeks.