Extracorporeal Shockwave Therapy (ESWT) is cleared by the FDA for use on a few conditions, one being plantar fasciitis. This is very exciting as plantar fasciitis is the most common form of heel pain and it can be quite debilitating condition. Podiatrist, orthopedists, PTs, and sports chiropractors all work with patients who suffer from plantar fasciitis, and we are always looking for more and better ways to help these patients. When a proper diagnosis is made (and this means being quite sure to R/O calcaneal stress reaction), the faster we can address a problem and the faster we can fix it.
The problem with the broad label of ESWT for plantar fasciitis is that any and every company that makes a ESWT unit is going to claim that their device works for plantar fasciitis, even with no evidence their particular unit works. Even modalities promoted as ESWT, that do not produce shockwaves, like radial wave therapy (they are pressure waves), often times gets thrown inappropriately into the discussion of shockwave therapy. This isn’t to say that radial wave therapy, or even ultrasound (oscillating waves) for that matter, don’t help, but true shockwaves are a unique and highly successful treatment approach.
One more topic to quickly address are the 3 different types of true shockwaves. Electrohydraulic is the original, and truest producer of shockwaves. As noted in a previous blog, this system uses an electrode and passes electricity through it to produce a plasma bubble, which explodes and creates a shockwave. This shockwave is then directly by a focused (or unfocused) applicator head into the body. It is very safe and very comfortable. The other two types of true shockwave producers, electromagnetic, and piezoelectric, utilize focused shockwaves that treat a very small area (which is difficult to determine for depth and specific treatment location) and can be quite painful. In addition, they require much more energy intensity to do the work that can be accomplished by far less intensity work as performed by an electrohydraulic ESWT unit. Their depth penetration is also an issue.
A big thank you goes out to Ashraf Fansa, et. al. with their study “Efficacy of Unfocused Medium-Intensity Extracorporeal Shock Wave Therapy (MI-ESWT) for Plantar Fasciitis“, published late 2021 in the The Journal of Foot & Ankle Surgery. This study puts the Orthogold100 (SoftWaves) into the medical index for success with plantar fasciitis. This is a very significant study!
SoftWave helps patients with many issues. Plantar Fasciitis being one of them!
Just to reiterate it’s one thing to say ESWT works for plantar fasciitis, but, does the ESWT our patients are receiving work for plantar fasciitis. For those of us with an OrthoGold100, the answer is yes.
Now onto the topic of Medium Intensity vs. Low Intensity shockwaves. Those of us who have an OrthoGold100 are traditionally told that it is low intensity. This is true. However, there is a bit more to discuss with this topic. To fully understand the intensity levels of the OrthoGold100, and according to the above referenced study, low energy refers to <.1 mJ/mm2 intensity and medium intensity refers to .1-.2 mJ/mm2. High intensity is considered to be above .3 or .4 mJ/mm2 , depending on the source (I will note that there is a debate about high intensity as some feel above .4 mJ/mm2 constitutes such.) If we touch the “Setup” button on the Orthogold100 and then touch the “Intensity” setting, we can see that the intensity is shown in either levels 1-16, mJ, or mJ/mm2. Levels 1-16 equate to .01-.18 mJ/mm2 of intensity. (As a comparison, the StemWave we have goes up to .25mJ/mm2, but it’s unlikely we’d be using it to that level.) Adjusting the intensity levels allows us to see that the OrthoGold100 most certainly can be set at levels above low intensity. This is not a good thing or bad thing, but rather an observation. Sometimes, we need very little intensity and sometimes, we need more. In most all circumstances, the OrthoGold100 can most certainly deliver the amount of intensity necessary to get the job done and many times it can be performed with what is considered to be low intensity! With this study, they used intensity levels of .06 to .17 mJ/mm2. This equates to levels that are of medium intensity.
With this study, 500 introductory shockwaves were given at .06 mJ/mm2 moving up to .1 mJ/mm2. The patients then got 2000 shockwaves a week for 3 weeks, with intensity levels of .12 to .17 mJ/mm2. (Please note that this is only one treatment approach, and many are used in the field. Is it possible that this is the only protocol that will yield results? It’s possible…but not likely. Please keep this in mind if you receive SoftWaves care. Each doctor should be looking for what protocol works best for each individual patient.)
This particular study showed 61% reduction in pain intensity and greater than an 80% satisfaction rate. These findings are similar to what has been found with other tested ESWT machines and FDA findings. This begs the question: how can we use our skills, as doctors, to further reduce the pain intensity, and where does rehabilitation play in? How much higher can we get the pain reduction and further improve satisfaction? There is actually a lot that can be done, in conjunction with SoftWaves, to help patients with plantar fasciitis.
From a patient perspective, you can try many of the available interventions for true plantar fasciitis. Some may work for you and some may not. Some may take a long period of time and some might be a bit faster. One thing for sure is that if you have access to the OrthoGold100, you can be 80% sure that you’ll be happy you did and you can likely count on something around a 61% reduction in pain. If your doctor is skilled in sports medicine, you can likely expect even more satisfaction and reduction in pain as rehabilitative interventions will also be utilized with SoftWave’s regenerative effects. This will help reduce the likelihood of future plantar fascial issues.
One thing is for sure: SoftWaves, as produced by the OrthGold100, do help with plantar fasciitis and using it for a course of treatment makes sense!
