Shockwave Therapy

Shockwave therapy is highly effective at treating a variety of chronic musculoskeletal conditions affecting the muscles, tendons, ligaments and connective tissues in the feet and ankles, including, but not limited to:

• Plantar Fasciitis
• Achilles Tendonitis/ Achilles Tendinosis
• Morton’s Neuroma
• Tight tendons in the feet (which can coincide with hammertoes and bunions)
• Tendon and muscle issues associated with flat feet (after or in conjunction with other treatments)
• Joint and muscle strain in the feet
• Other tendon and repetitive strain injuries to the feet and ankles

Note: we cannot apply shockwave therapy treatment to any area above the ankle.

At your first appointment, the chiropodist will perform a foot assessment with a full biomechanical and gait analysis in order to diagnose your foot condition, its underlying causes, and determine the best course of treatment. If shockwave therapy is recommended, the chiropodist will commence treatment.

The following will happen during your shockwave therapy treatment:

• First, the chiropodist will examine and assess your foot to determine the exact area to apply treatment.
• They will then apply a special gel (like the gel used in an ultrasound) over the area being treated. The gel acts as a barrier to control the waves and ensure the energy pulses do not cause harm or excessive discomfort.
• The chiropodist will then set the frequency, pressure and number of shocks best suited for treating your injury on the shockwave therapy machine. To ensure you don’t feel pain or discomfort, we’ll start with low frequency pulses (lower energy) and less pressure, and then gradually work our way up according to your level of comfort.
• The chiropodist will then place a special applicator over the gelled area and start treatment. The applicator delivers the energy pulses through the gel to the underlying tissue. During the treatment, the applicator will be moved to different parts of the foot to ensure all affected muscles, tendons and ligaments are treated.

During a shockwave therapy session, the treatment (shocks) will be applied in segments to see how you’re feeling and tolerating the treatment. The chiropodist will then adjust the intensity level according to your comfort level. Ideally, the frequency and intensity of the shocks will be increased over time in order to maximize the healing benefits; the higher the intensity, the more effective the treatment.

A treatment can last between 5 and 20 minutes, depending on the nature of the injury being treated. Three to five therapy sessions are typically recommended; however, every person and every injury is different – some people require more treatments, some people less. The treatments are usually scheduled 5 to 10 days apart. Most patients start noticing improvement after the first treatment.

A special machine is used to deliver high-energy short pulses of sound waves (the “shockwaves”). These shockwaves radiate through the skin to the underlying injured tissue. The more you push onto the skin, the deeper the wave will penetrate, which lets it work on deep tissue injuries, whereas less pressure will be applied to bony injuries closer to the surface of the skin.

The mechanical energy and pressure from these waves trigger natural inter-related biological processes that heal the injury and reduce pain. It specifically does the following:

1. Stimulates our body’s natural healing response
2. Increases blood flow to the area
3. Boosts Cellular Metabolism
4. Myofascial Release
5. Disperses Neurotransmitters that cause pain and reduces swelling

All these effects combined equip your body with what it needs to properly heal chronic foot and ankle injuries, and thereby decrease your pain.

A. Stimulates our Body’s Natural Healing Response

This is one of the main benefits of shockwave. To fully understand how shockwave therapy stimulates this healing response, we need to first explain our body’s immune system and its inflammatory response:

You can think of our immune system as our body’s defence force. It’s responsible for detecting and responding to anything that can harm it. When an injury is detected, it initiates your body’s inflammatory response. The inflammatory response signals and dispatches your body’s armies, peacekeeping forces and soldiers to the injured area to protect and fix the injury. It also boosts blood flow to the area, which provides a strong communication and supply line to continuously dispatch all the nutrients needed to heal the injury.

The inflammatory response is a good, healthy reaction to injury. However, in the case of chronic injuries, it stalls or goes into overdrive even after the injury is healed. That’s where shockwave therapy comes in:

Although it may sound a little counter-intuitive, the energy pulses from shockwave therapy causes controlled small microtears – or microtrauma – to the area. Don’t worry: this microtrauma is actually good for you. It literally “shocks” your body’s defence forces into action by stimulating the inflammatory response. This dispatches your body’s healing armies and peacekeeping forces to the area to fix it. Thanks also to the increased blood flow, your body’s army can now focus on repairing the affected area with everything it needs.

This process is similar to what happens when you work out: when you strengthen muscles it also causes microscopic microtears in those muscles, which activates the inflammatory response. The inflammatory response then increases blood flow to those muscles and transports white cells and nutrients to the area, which regenerates the muscles and makes them stronger. Shockwave works the same way.

Essentially, shockwave triggers your body’s initial natural response to an acute injury (a sudden, short-term injury). When we first get an injury, all your body’s defences and armies are activated and work to heal the area. However, when an injury becomes chronic, the body’s response changes, and the healing process stalls; shockwave brings it back to its prime.

B. Increases Blood Flow to the Area

Our blood vessels are our body’s transportation network. Oxygenated blood is the vehicle through which our organs, cells and tissues get what they need to function. Our body’s immune system also uses this transportation network to identify injured areas and reach them so your body can heal and protect itself. By boosting blood flow to the injured area, shockwave therapy facilitates the speedy delivery oxygenated blood and white cells to the area, which nourishes the injured tissues and gives them what they need to heal.

Not only does shockwave therapy increase blood flow, but it also stimulates the formation of new blood vessels in the treated area. This allows even more avenues for oxygenated blood and nutrients to reach and heal the injury.

C. Boosts Cellular Metabolism

By boosting the metabolism of the cells in the injured area, it allows smoother delivery of nutrients, and removal of damaged tissue.

D. Breaks Down Scar Tissue and Calcific Deposits

The pressure from the mechanical energy of the shockwaves physically breaks apart scar tissue and unwanted calcium deposits. This is very similar to the way sound waves are used to break apart kidney and gallstones (in fact, that’s the principle that led to the discovery of shockwave therapy’s therapeutic benefits for treating injuries). The breakdown of scar tissue also stimulates the immune system.

E. Myofascial Release

Although not the primary goal of shockwave therapy, myofascial release (the release of trigger points) is a beneficial byproduct. Trigger points are areas where muscles that become so tight, they form knots, cut off their own blood supply, and become tender. As explained before, shockwave therapy involves pulses of mechanical energy. In addition to breaking apart scar tissue, the pressure from this energy can physically release tension in trigger points. This is similar to the way dry needling, trigger point injections and deep tissue massage works. However, unlike these treatments, shockwave therapy is non-invasive and not as painful.

F. Reduces Pain and Swelling

The way we feel and interpret pain involves a complex neurological process. In a nutshell, neurotransmitters send “pain signals” from the injured area to our brain. Once this signal reaches the brain, we start to feel pain. The purpose of this is to let us know when something is wrong so we can fix it. However, with chronic injuries, the neurotransmitters keep firing, and sometimes misfire.

One of these neurotransmitters is called “Substance P”. In addition to sending pain signals to our brain, Substance P also causes swelling. The waves delivered by shockwave therapy disperse and reduces Substance P, which in turn reduces pain and swelling in the area.

All this talk of “pressure”, “shockwaves” and “microtrauma” may sound painful. Rest assured, it sounds worse than it actually is. The energy pulses are applied only for short periods of time, and are not as painful as other more invasive treatments commonly used for treating soft tissue injuries, like dry needling or deep tissue massage.

In fact, shockwave therapy in and of itself is a form of pain relief. This is because the energy from the sound waves lowers one of the substances responsible for sending pain signals to your brain, which in turn reduces pain.

You will likely feel some pressure, soreness, mild discomfort and tenderness during the actual treatment itself; this will quickly go away after the treatment. Discomfort is usually felt more in areas where the skin is thinner (i.e.: over the bony parts of the foot). That said, some actually find relief from the pressure because you can literally feel the “knots” and tight muscles being released (kind of like a massage).

Some people feel a little sore afterwards – like having a bruise. However, this feeling usually quickly goes away.

Most patients report feeling improvement immediately, or shortly after their treatment.

Because shockwave therapy is non-invasive, there are relatively few side effects. In rare cases, patients may feel a little sore for up to 24 hours after treatment. Some people may have an inflammatory reaction and experience redness and swelling; however this again is rare and often subsides shortly after treatment.

Shockwave therapy may be contraindicated for people with the following conditions:

1. Pregnancy
2. Nerve disorders
3. People with pacemakers
4. Severe blood clotting disorders
5. People on blood thinners
6. People with open wounds or an infection at the treatment site
7. Tumours at the treatment site
8. Acute (short-term) injuries (i.e.: a trauma)

Your chiropodist will go over your medical history and determine with you whether you have any conditions that may affect your treatment.

As noted above, shockwave therapy is not recommended for treating acute (short-term injuries), such as a trauma. This is because shockwave therapy is designed to trick your body into thinking that your chronic injury is in the initial acute stage; if you actually have an acute injury, that reaction is already in effect. The two combined would be overkill and could cause inadvertent side effects.

At Feet First Clinic, we take a comprehensive approach to foot care. Foot pain is complex: there are often many factors at play and it’s important to make sure they’re all being properly addressed. Our Chiropodists genuinely care about your recovery and want to see you achieve your goals.

Our chiropodists are foot specialists. As such, they do more than apply shockwave therapy: they can also diagnose and address any underlying causes or contributing factors to your foot pain. Whether it’s addressing biomechanical irregularities with your gait, finding good supportive footwear, or other recommendations, we strive to address foot health from all angles, so that we can give you the best results.

When it comes to treating foot pain and deciding where to get your shockwave therapy, it’s always best to put your trust in a foot specialist and the people who know your feet best.

Ready to put your feet first? Contact us at 416-769-3338, or use our online booking form. No referral is required.

Shockwave therapy is covered by most extended health benefits plans. Shockwave therapy is not covered by OHIP.

If you are unsure about your coverage, we recommend contacting your benefits plan provider directly to verify whether you are covered for shockwave therapy delivered by a chiropodist.

For more information, feel free to call us at 416-769-3338 to ask any questions and book your shockwave therapy session today!