Extracorporeal shockwave therapy

Extracorporeal Shockwave Therapy or ESWT is a method of treatment for multiple tendonopathies, derived from lithotripsy.

Procedure
When ESWT was used for plantar fascia treatment, the procedure used to be performed in an out-patient setting, under local anesthesia, taking up to 30 minutes. Now with newer technology, it can be done without anesthesia in the physician's office in less than 10 minutes. Research indicates that there is significant reduction in intensity of application pain with the use of castor oil rather than ultrasound jelly. The positive effect of castor oil can be explained by its cavitation-free quality. The patient is afterwards able to walk out, the major complaint being of a thumping feeling on the heel. Because re-inflammation is being introduced, the patient cannot take anti-inflammatory medication afterward, nor should the area be iced. Acetaminophen/Paracetamol with codeine may be utilized.

Contraindications for this procedure include: neurological and vascular disease of the foot; history of rupture of the plantar fascial ligament; open bone growth plates; pregnancy, implanted metal in the area (bone screws and pins); and people on medication that interferes with blood clotting such as coumadin and prophylactic aspirin.

Efficacy
The medical value of extracorporeal shockwave therapy is disputed. A number of both favorable and unfavorable studies exist, some utilizing deficient research practices. However, the use of ESWT continues to expand across medical disciplines, such as cardiology, urology (erectile dysfunction), and wound applications. A 2013 meta-analysis of seven randomized controlled trials found extracorporeal shockwave therapy to be an effective treatment modality for plantar fasciitis pain which has been unresponsive to nonsurgical measures for at least three months with evidence suggesting significant pain relief for up to one year.

Approval
Presently this technology is approved in the US by the Food and Drug Administration (FDA) for treatment of only plantar fasciitis and tennis elbow. There is an FDA study to treat recalcitrant diabetic wounds.

There are several theories as to how ESWT may or may not help promote better healing. The most accepted one is that the microtrauma of the repeated shock wave to the affected area creates neo-vascularization (new blood flow) into the area. It is this new blood flow that promotes tissue healing. For treatment of heel pain, the FDA study criteria are quite specific. A person has to have experienced heel pain for at least six months and had at least three other types of treatments (cortisone injections, oral anti-inflammatory medication, orthotics, physical therapy, etc.) without relief.

Use on Horses
ESWT is commonly used for treating orthopedic problems in horses, including tendon and ligament injuries, kissing spine, navicular syndrome, and arthritis. Because it can produce temporary analgesia, usually around 4 days, care must be taken not to push the horse too hard after treatment, since the animal may not guard the injury as well as they did previously. ESWT is often used in conjunction with rest and other therapies to help return the horse to soundness. Since the treatment is slightly uncomfortable, horses are sedated for treatments.