Extracorporeal Shock Wave Therapy in the Foot and Ankle

John P. Furia

Eric M. Bluman

INTRODUCTION

Extracorporeal shock wave therapy (ESWT) is an effective treatment for both bony and soft tissue disorders. ESWT was initially utilized in musculoskeletal application as a treatment for bone pathologies.¹^, ² Investigators antidotally noted that when lithotriptor-type devices were utilized to treat nephrolithiasis, posttreatment radiographs revealed an osteoblastic response in the area of the treated tissues.¹ This prompted other investigators to utilize ESWT as a treatment for delayed healing of bone.³^, ⁴^, ⁵^, ⁶^, ⁷

Initial investigators utilized ESWT to treat delayed and established nonunions of fractures.³^, ⁴^, ⁵ Anecdotal experience was quite positive and this prompted other investigators to utilize ESWT as a treatment for soft tissue conditions.⁸^, ⁹^, ¹⁰^, ¹¹^, ¹²^, ¹³^, ¹⁴^, ¹⁵^, ¹⁶^, ¹⁷^, ¹⁸^, ¹⁹^, ²⁰^, ²¹^, ²²^, ²³^, ²⁴^, ²⁵^, ²⁶^, ²⁷^, ²⁸^, ²⁹^, ³⁰^, ³¹^, ³²^, ³³^, ³⁴^, ³⁵^, ³⁶

Presently, ESWT is used to treat both bone and soft tissue conditions. Bony conditions include delayed and established fracture nonunions, medial tibial stress syndrome, avascular necrosis, as well as stress fractures.¹^, ²^, ³^, ⁴^, ⁵^, ⁶^, ⁷^, ³⁷^, ³⁸^, ³⁹^, ⁴⁰^, ⁴¹^, ⁴²^, ⁴³^, ⁴⁴ Soft tissue conditions include plantar fasciopathy, lateral epicondylitis, greater trochanteric pain syndrome, calcific tendinopathy of the shoulder, as well as patellar tendinopathy.⁸^, ⁹^, ¹⁰^, ¹¹^, ¹²^, ¹³^, ¹⁴^, ¹⁵^, ¹⁶^, ¹⁷^, ¹⁸^, ¹⁹^, ²⁰^, ²¹^, ²²^, ²³^, ²⁴^, ²⁵^, ²⁶^, ²⁷^, ²⁸^, ²⁹^, ³⁰^, ³¹^, ³²^, ³³^, ³⁴^, ³⁵^, ³⁶

In addition to the above indications, ESWT has been shown to be a safe and highly effective treatment for both insertional and noninsertional Achilles tendinopathy¹¹^, ¹²^, ¹⁴^, ¹⁵^, ¹⁶^, ¹⁷^, ¹⁸^, ¹⁹^, ²⁰ and plantar fasciitis.⁴⁵^, ⁴⁶^, ⁴⁷ There are now numerous trials that support the use of this technology for these indications.¹¹^, ¹²^, ¹⁴^, ¹⁵^, ¹⁶^, ¹⁷^, ¹⁸^, ¹⁹^, ²⁰

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