Extracorporeal Shockwave Therapy involves the use of sonic shockwaves to induce tissue repair.
The use of shockwaves in medicine started about 25 years ago as a means to treat kidney stones (urolithiasis) non-invasively. It was noted, incidentally, that kidney tissue in the path of the shockwave demonstrated improved tissue quality. That observation prompted research on the effects of ESWT on diseased tendons and ligaments.
What is meant by a “shockwave?”
The shockwaves we utilize are acoustic waves. Some examples of acoustic waves include what one hears when a tire blows out and the windows then rattle. The sound of thunder is an acoustic wave. Acoustic waves can transmit mechanical energy and that energy has an effect on human tissue.
How are shockwaves generated?
There are four means of generating shockwaves, electrohydraulic, electomagnetic, piezoelectric and electromechanical.
- Electrohydraulic generators use an electrode, basically a spark plug which vaporizes water between it’s tips, releasing a shockwave through a fluid filled bladder.
- Electromagnetic generators utilize a magnetic coil with an adjacent metal membrane. A high current pulse travels from the coil to the metal membrane deforming the metal membrane which rebounds to release a shockwave.
- Piezoelectric generators use large numbers of piezoelectric crystals mounted on a spherical surface. A high voltage electrical pulse sent to the crystals cause them to immediately contract then expand with a shockwave released upon expansion.
- Electromechanical generators are now common in the type of ESWT machines termed “radial shockwave therapy” and involve a electrical pulse which activates and accelerates a bullet like object in a sealed tube. The object strikes the end of the handpiece generating a shockwave.
We utilize the Swiss Dolorclast which utilizes radial shockwave technology.
ESWT has been utilized with considerable success in plantar fasciitis or plantar fasciosis. Plantar fasciosis, previously termed “intractable plantar fasciitis” involves a degenerative process of the plantar fascia that may respond poorly to conventional treatments for plantar fasciitis. Before ESWT a number of such patients were treated surgical with plantar fascial release surgery which is now an obsolescent procedure. ESWT has also been used effectively in Peyronnie’s disease in which fibrous constrictions cause penile deformation.
If ESWT has shown good effectiveness in effecting tissue remodeling in fibrous diseases of tendon and ligaments then it would appear to be an option for treatment of Ledderhose Disease or Plantar Fibromatosis.
J. Haist (J. Haist Orthopädische, Gemeinschaftspraxis Worrstadt, Germany) studied 40 Ledderhose disease patients, submitting his study in 1992 but did not see significant improvement after its use.
K. Knobloch and P. Vogt studied 5 patients and noted pain reduction but did not discuss change in nodule size: http://www.biomedcentral.com/1756-0500/5/542
1) There is insufficient research on this subject.
2) It is our experience that ESWT is not sufficient for use as a standalone treatment for Ledderhose Disease or Plantar Fibromatosis.
3) There is often plantar fasciitis/fasciosis associated with plantar fibromatosis which may benefit from ESWT.
4) ESWT may be used as an adjunctive treatments after the nodules have been reduced in size by other treatments.