Shockwave therapy
Extracorporeal shockwave therapy (ESWT) is a valuable conservative treatment strategy with solid evidence supporting its use for chronic musculoskeletal pain and
tendinopathies. In the context of surgical planning, it can help optimise patient symptoms and tissue environment before operative intervention. Post-surgical
application shows promise for improving recovery outcomes in some cases.
Shockwave therapy (ESWT): Clinical role in pre-surgical management
ESWT is a non-invasive modality that delivers focused acoustic waves to targeted tissues. It’s increasingly used in musculoskeletal practice for pain reduction, tissue healing and enhanced biological response in both soft tissues and bone structures. Clinical evidence supports its role for a range of lower limb conditions, providing measurable benefits in appropriate cases. It is a validated non-invasive adjunct in the conservative management of chronic foot and ankle pain conditions that may reduce the need for surgery.
ESWT as a pre‑surgical option
One of the most established applications of ESWT is for chronic tendinopathies and
plantar fasciopathy. Much research has shown it can significantly reduce pain and
improve function—often when other conservative treatments have failed—making it
a valuable intermediate step before surgery, especially for conditions like chronic
heel pain or tendinopathies.
In plantar fasciitis, for example, evidence supports ESWT as an effective nonsurgical
treatment that may be considered before surgical intervention is undertaken, potentially reducing the need for surgery in resistant cases.
Mechanistic rationale
Clinically, ESWT is thought to enhance local blood flow, stimulate angiogenesis and
connective tissue regeneration, and modulate pain signalling pathways—all of which
support improved healing potential in chronic injuries. This can change the symptom
trajectory before surgery, helping clinicians and patients decide whether surgery is
necessary or if further conservative care is appropriate.
Before surgery:
ESWT serves as an effective, non‑invasive conservative option for chronic
tendinopathies and plantar heel pain that may reduce or delay the need for surgery
when other treatments have failed.
Healing and tissue response:
Across soft tissue and bone healing applications, systematic reviews suggest ESWT
has the biological potential to enhance repair processes, improve circulation, and
reduce healing time when used as an adjunct to standard care.
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