Foot and Ankle Specialist in Midtown Manhattan, New York, NY

Extra-Corporeal Shockwave Therapy

1) What is Extra-Corporeal Shockwave Therapy (ESWT)?

ESWT was first reported in 1980 for treatment in kidney stones (breaking them up) and it is still used for such. It was then studied in orthopedics to help with fracture healing and overuse of tendons, ligaments and muscles. The results showed that ESWT increased their rate of healing.

ESWT is a non-invasive and highly effective treatment method that enhances blood circulation and accelerates the healing process  by causing damaged tissue to gradually regenerate which has been very helpful in athletes with muscle / tendon / ligament and bone injuries.

2) What conditions can be treated with ESWT?

ESWT works on many body parts but when it comes to the foot and ankle, ESWT can be used for:


  • Achilles Tendinopathy
  • Peroneal Tendinopathy
  • Plantar Fasciitis
  • Posterior Tibial Tendon

**Any tendon in the foot and ankle


  • Plantar Plate
  • Lateral Ankle Ligaments
  • Medical / Deltoid Ligaments
  • Spring Ligament

**Any ligament in the foot and ankle

Muscle Pathology:

  • Myofascial pain
  • Muscle strain without discontinuity
  • Midial Tibial Stress Syndrome


  • Delayed Healing / Non-union
  • Stress Fractures
  • Tibial Stress Syndrome
  • Avascular Necrosis

Extra-Corporeal Shockwave Therapy Q&A

ESWT delivers shockwaves (either radial or focused) in the form of energy and have mechanical and cellular effects that improve tissue healing and alter your pain signaling. They create little holes (microcavitation)  which improves blood flow creating pain relief and anti-inflammatories effects. It may also increase collagen synthesis as well as  increase the number of cells within tendons and ligaments.

When you experience chronic pain, your body no longer recognizes that there is an injury to that area. As a result, it shuts down the healing process and you no longer feel relief. The ballistic sound waves of the EnPuls (ESWT) penetrate deep through your soft tissue, causing micro-trauma and restarting the inflammation process, triggering your body’s natural healing response again. The energy emitted also causes the cells in the soft tissue to release certain bio-chemicals that intensify the body’s natural healing process. These bio-chemicals allow for the building of new microscopic blood vessels in the soft tissue.

There have been extensive studies done on Radial Shockwave Therapy over the past 20 years. These studies show an average 80% success rate.

The system is a machine with an applicator that looks like an ultrasound and is administered once a week for a series of 4 to 5 treatments.

Each treatment takes approximately 4-5 minutes depending on the size and number of areas treated.

Dr. Perez will place the applicator on the area and administers the ballistic waves by moving over the affected area in a very slow, circular motion.

During the treatment, there may be some minor discomfort. Painful areas are helpful in isolating the truly injured areas.

ESWT has a proven success rate that is equal to or greater than that of traditional treatment methods, including surgery. However, there are times when surgery is required and Dr. Perez will explain what is needed and when.

Patients treated with ESWT may be active immediately and resume their normal routine the same day. Many patients find a significant and immediate reduction in their pain. Some patients will feel results gradually after each treatment.

There have been very few side effects reported. In rare cases, skin bruising may occur. Patients may also feel soreness in the area for a day or two afterward, similar to a strenuous workout.

A day or two after the treatment you may feel a slight discomfort like a bruise, but that is normal and is a sign the treatment is working.

ESWT is not covered by insurance.

A recent study (randomized control study) show in-season athletes utilizing ESWT and benefiting from its effects. There is a preference because there is no downtime and they can continue with their sport.

Utilizing Extracorporeal Shockwave Therapy for in-Season Athletes
Healthcare (Basel). 2023 Apr; 11(7): 1006.
Hye Chang Rhim,1 Joanne Borg-Stein,1 Steven Sampson,2,† and Adam S. Tenforde1,*†

Make an appointment with Dr. Perez at flexfootankle.com and see if ESWT is a option choice for you.


Fusion Surgery
Osteochondral lesions


Fusion Surgery
Osteochondral lesions