Does Shockwave Therapy Work For Plantar Fasciitis?

Understanding Plantar Fasciitis

Plantar fasciitis is a common cause of heel pain caused by degeneration and inflammation of the plantar fascia — the thick connective band that runs from the heel to the toes. Symptoms are often worst with the first steps in the morning or after long rest. While conservative care (rest, stretching, orthotics, activity modification, NSAIDs, physical therapy) helps many people, a subset remain symptomatic and need additional options. Extracorporeal shock-wave therapy (ESWT, aka shock-wave therapy) has become a well-studied, noninvasive alternative that can offer meaningful pain relief and functional gains for those patients.

How Shockwave Therapy Works For Plantar Fasciitis?

Shockwave therapy uses high-energy acoustic waves that are directed to the affected area. These waves create controlled micro-injuries within the tissue, which stimulate the body’s natural repair mechanisms and encourage faster recovery.

Some of the key benefits of shockwave therapy include:

Improved blood flow: Stimulates the formation of new blood vessels, delivering oxygen and nutrients to the injured tissue.
Pain relief: Provides strong stimulation to nerve endings, which can reduce pain almost immediately.
Breaking down deposits: Helps dissolve calcium build-up that may be contributing to chronic inflammation.
Enhanced cellular activity: Increases cell permeability, supporting tissue regeneration and healing.

Because shockwave therapy is noninvasive, it offers an excellent option for individuals seeking relief from plantar fasciitis and other chronic conditions without relying on long-term medication or undergoing surgery.

Typical treatment session & what patients can expect

ESWT is performed outpatient and is noninvasive. Sessions are usually brief (about 10–20 minutes per foot). Protocols vary: some practitioners deliver a single high-energy session (sometimes with local anesthesia), while others give multiple lower-energy treatments spaced over weeks. Mild to moderate post-procedure soreness, bruising, or numbness can occur but serious complications are uncommon. Many patients notice pain relief within weeks; some benefits accrue over months as the tissue remodels.

How effective is ESWT compared with other treatments?

Study #1: Xiong et al. (2019) — Meta-Analysis (PMCID PMC6420882)

What they did: Aggregated six randomized controlled trials comparing SW vs. CS in treating chronic plantar fasciitis.
Key findings:
- Pain relief: SW demonstrated significantly greater pain reduction, with a mean difference (MD) of –0.96 on the Visual Analog Scale (VAS), highly significant (P < 0.00001) PubMed Central.
- Function and fascia thickness: No significant differences were observed in function-related scores (Mayo CSS, FFI, etc.) or plantar fascia thickness at 3 months PubMed Central.
Conclusion: Both treatments worked for pain and function, but SW offered superior pain relief at 3 months.

Study #2: Cortés-Pérez et al. (2024) — Systematic Review & Meta-Analysis (PMID 38738305)

What they did: Included 16 RCTs (1,121 patients) comparing ESWT vs. CS injections, assessing pain, fascia thickness, and foot function at 3 and 6 months.
Key findings:
- At 3 months:
  - Pain: ESWT outperformed CS (SMD –0.6; 95% CI –1.1 to –0.11).
  - Fascia thickness: ESWT yielded greater reduction (SMD –0.4; 95% CI –0.8 to –0.01).
  - Foot function: Improved more with ESWT (SMD 0.27; 95% CI 0.12–0.44).
- At 6 months:
  - Pain: Continued advantage for ESWT (SMD –0.81; 95% CI –1.6 to –0.06).
  - Function: Even stronger improvements (SMD 0.67; 95% CI 0.45–0.89).
- Safety: Both were generally safe; ESWT’s adverse effects were mild—mostly local pain and slight erythema PubMed.
Conclusion: ESWT offers consistently superior outcomes in terms of pain, fascia thickness, and function—not only in the short term but at mid-term (6 months).

Study #3: Eslamian et al. (2016) — Single-Blinded RCT (Pain Medicine 2016 Sep;17(9):1722–1731)

What they did: Directly compared radial ESWT vs. CS injections for chronic plantar fasciitis.
Key point: This trial specifically targeted individuals with persistent plantar fasciitis and evaluated outcomes of pain and functionality.
Conclusion: While this RCT supports the efficacy of ESWT, the broader meta-analyses already encompass its findings. Inclusion highlights that direct clinical comparisons corroborate the meta-analytic trends Oxford Academic.

Study #4: Sciencedirect Abstract — ESWT vs. PRP (2024)

Note: Although this study (S126877312400239X) compares ESWT with PRP—and not CS—it reinforces that ESWT is a successful approach for plantar fasciitis. However, since it doesn’t involve CS, it’s less directly relevant to the core comparison ScienceDirect+1. We mention it briefly for context: ESWT is broadly effective across comparison groups.

Pain relief: Both meta-analyses (2019 and 2024) show that shock-wave therapy provides superior pain reduction compared to corticosteroids.
Structure & function: The 2024 meta-analysis additionally demonstrates ESWT improves plantar-fascia thickness and functional outcomes more than CS, particularly over longer follow-up.
Safety profile: ESWT is generally safe with only mild transient side effects; CS injections may carry risks like heel pad atrophy or fascia rupture (noted in Xiong et al.’s discussion) PubMed Central.
Mechanistic advantage: ESWT stimulates healing via biological pathways rather than simply suppressing inflammation. This potentially offers more sustained relief and improved tissue health.

How effective is shockwave therapy for plantar fasciitis?

Multiple clinical studies have shown that shockwave therapy can provide significant relief for patients struggling with chronic plantar fasciitis:

- Pain reduction: Many patients report noticeable pain relief within weeks of starting treatment.
- High success rates: Research shows success rates ranging from 70–90%, making it one of the most effective non-surgical treatment options available.
- Long-term results: Unlike temporary relief from medications or injections, shockwave therapy addresses the root cause by stimulating true tissue healing.
- Fewer side effects: Because the treatment is noninvasive, it avoids the risks associated with surgery or long-term medication use.

What Are the Advantages and Disadvantages of Shockwave Therapy?

Shockwave therapy can be a highly effective option for many people dealing with plantar fasciitis, but like any treatment, it has both strengths and limitations.

Potential Benefits of Shockwave Therapy:

Non-surgical approach: No incisions or anesthesia are required, and recovery time is minimal.
Fast pain relief: Many patients notice improvement within weeks.
Safe and low risk: Side effects are usually mild and temporary compared to medications or invasive procedures.
Surgery avoidance: Particularly useful for plantar fasciitis patients who want to reduce the likelihood of needing surgery.
Fewer complications: Compared to long-term drug use or surgical treatment, the risks are much lower.

Possible Drawbacks to Consider:

Variable results: Not every patient experiences the same level of success.
Multiple sessions may be needed: Lasting results often require a series of treatments.
Cost concerns: Insurance coverage is inconsistent, and out-of-pocket costs can be significant.
Temporary side effects: Some patients may experience discomfort, bruising, swelling, or tingling after treatment.

How Much Does Shockwave Therapy for Plantar Fasciitis Cost?

The cost of shockwave therapy for plantar fasciitis can vary depending on the clinic, the technology used, and the number of sessions needed. On average, patients can expect to pay between $250 to $450 per session, with most treatment plans requiring 3 to 6 sessions for optimal results. While insurance may not always cover this advanced treatment, many patients find it a worthwhile investment because it provides long-lasting relief, reduces the need for ongoing medications, and helps avoid more invasive procedures like surgery.

Practical takeaways

Shockwave therapy has been widely used for more than 20 years and has shown promising results in easing heel pain caused by plantar fasciitis. Still, outcomes vary from person to person, and not all patients experience the same level of relief. Another important factor to consider is that this treatment is typically not covered by most insurance providers. If you’re exploring options for managing plantar fasciitis, consulting with a foot and ankle specialist is the best way to determine whether shockwave therapy is a suitable choice for your needs.