Extracorporeal shockwave therapy for Achilles tendinopathy and plantar fasciitis

Achilles tendinopathy is a condition that causes pain, swelling, stiffness and weakness to the Achilles tendon, which attaches your calf muscle to your heel bone. It is thought to be caused by repeated small injuries to the tendon that do not heal, and build up over time.

Plantar fasciitis is inflammation (swelling) of the plantar fascia. This is a thick fibrous band of tissue at the bottom of your foot that lies between your toes and your heel. Repeated small injuries to the plantar fascia are believed to be the cause of the inflammation.

People who have either of these conditions may be offered a procedure called extracorporeal shockwave therapy (ESWT) for Achilles tendinopathy and plantar fasciitis. 

How ESWT works

ESWT is a procedure where shockwaves are passed through the skin to the injured part of the foot using a special device. Extracorporeal means outside of the body. The shockwaves are mechanical and not electric. They are audible, low energy sound waves, which work by increasing blood flow to the injured area.

This speeds up the body’s healing process. You will usually require a course of 3 treatments, 1 to 2 weeks apart.

If ESWT does not help your pain, then sometimes an operation may be available, depending on your condition. Your consultant will discuss this with you.

Who can have ESWT

It is offered to patients who have not responded well enough to other non-surgical treatments, such as:

  • physiotherapy
  • orthotics (insoles or leg braces)
  • rest
  • ice therapy
  • painkillers

It is a minimally invasive treatment that is done as an outpatient and you can go home the same day. ESWT can offer relief from pain and other symptoms.

You must not have ESWT if you:

  • are pregnant
  • are taking antiplatelet medicine, excluding aspirin 75mg, (for example clopidogrel) or anticoagulant medicine (such as warfarin or rivaroxaban)
  • have a blood clotting disorder
  • are under the age of 18
  • have a history of bone cancer or are being treated for any active cancer
  • have an infection in the foot
  • have a history of Achilles tendon or plantar fascia ligament rupture
  • have had a steroid injection into the affected area in the previous 12 weeks
  • have a cardiac pacemaker


Studies have shown that 5 to 7 out of 10 patients have found ESWT to be effective.

You will be asked to complete a questionnaire before your treatment starts and again at 3 and 12 months after your treatment.

There is a small chance that, after the treatment, the condition may get worse. Your doctor or healthcare practitioner explains the benefits and risks of the procedure in more detail when you are offered the treatment. Please let them know if you have any questions or would like any further information.

Side effects

You will feel some pain or discomfort during the treatment, but most people find this manageable.

After the treatment, you may have redness (this may be harder to notice on brown or black skin), bruising, swelling and numbness to the area. These should improve within a week and before your next treatment.

There is a very small risk of tendon or ligament rupture and damage to the soft tissue.

We want to involve you in decisions about your care and treatment. If you decide to have ESWT, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

You can read more about our consent process.

Resource number 3914/VER4
Published date: October 2023
Review date: October 2026

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