How Shockwave Stem Wave Therapy Can Treat Foot Pain

Foot pain can stop you from doing the simple things you love: walking the dog, taking a daily stroll, even standing comfortably. Over the years I have treated many people with plantar fasciitis, neuropathy, and other causes of foot pain. One highly effective option I now use is shockwave Stemwave therapy. Below I explain what the condition is, how the treatment works, what to expect, and how changing the way you walk can make the results last.

What is plantar fasciitis and why is it so stubborn?

Plantar fasciitis is inflammation of the plantar fascia, the thick band of connective tissue along the bottom of your foot. Think of the arch and bones of your foot as a bow and the plantar fascia as the bowstring. It is under constant tension whenever you stand or walk, and repetitive stress gradually wears it down, particularly with extra body weight, poor body mechanics and age.

"The plantar fascia is like the bowstring on a bow."

Two key reasons plantar fasciitis is hard to resolve:

• Poor blood supply. The plantar fascia does not receive robust circulation, so it struggles to clear inflammation and receive nutrients needed to repair itself.
• Continued irritation. If you keep stressing the tissue by walking or standing with the same mechanics, the tissue never gets a chance to heal.

How shockwave Stemwave therapy helps

Shockwave therapy uses pulses of acoustic energy directed at the painful tissue. The Stem wave device I use is the most focused and deeply penetrating system of acoustic shockwave available and sets in motion several biological steps that are crucial to healing tissue that does not heal well on its own.

Immediate anti-inflammatory signaling

The treatment triggers cells in the injured area to release signals that call for anti-inflammatory help. In other words, the tissue sends a "help" message to the body that it rarely sends on its own.

Microvascular growth

About three to four weeks after starting treatment the body begins to build small blood vessel networks into the injured tissue. Improved microcirculation brings nutrients, better oxygen supply and anti-inflammatory factors to the plantar fascia so real repair can take place.

Stem cell migration

The acoustic pulses also attract stem cells to the injured area. These cells contribute additional healing mechanisms and help remodel the tissue toward a healthier state.

Typical treatment course and what to expect

• Session length: A typical treatment takes 5 to 7 minutes per foot.
• Early improvement: Many patients notice a difference within the first session; most see clear improvement within two to three sessions.
• Recommended course: I recommend a minimum of eight treatments in the initial round. 10 treatments is now evolving as the ideal treatment length unless there is also a neuropathy present.  Years of experience show that a full course up front leads to much better long-term results.
• Outcome rate: Approximately 85 to 90 percent of people experience a good to very good response to pain with this therapy.

Treating neuropathy and nerve-related foot pain

If the nerves to the foot are damaged, the process is more complicated and requires more sessions. Nerve healing typically takes longer and I generally plan for 15 to 20 treatments for neuropathy. Even so, the majority of patients achieve meaningful improvement although we try to set realistic goals when the pain is primarily neuropathy related and we will not start the program if the patient would not be happy with a 50% reduction in pain.   We usually see better results than that but for some the damage is too extensive or the cause of the damage is still ongoing which limits the more robust 85% probability.  

Why biomechanics matter: Qi walking

Even the best biological repair will struggle if the mechanical cause of the irritation is not addressed. If you continue to stress your plantar fascia with poor walking mechanics, the tissue can remain chronically inflamed.

"If you continue to irritate something that's trying to heal, it will never heal."

That is why I pair shockwave therapy with a walking technique called Chi walking, developed from the work of Danny Dreyer, founder of the Chi Running method. Chi walking teaches you to walk in a way that reduces stress on the plantar fascia and on your weight-bearing joints.

• Benefits of learning Chi walking:
• Immediate reduction in stress on feet during walking
• Longer lasting improvement after completing shockwave therapy
• Reduced strain up the kinetic chain—knees, hips, low back, and even neck

Some patients choose not to learn the technique and still improve with shockwave therapy alone, but integrating Chi walking consistently increases the likelihood of durable, long-term benefit.

How we evaluate early response

We start with a mapping session to assess how your foot responds to an initial treatment. Even a small improvement during that first session strongly correlates with a high likelihood of long-term success, especially when the walking technique is added.

Who is a good candidate?

• People with chronic plantar fasciitis who have not responded to conservative measures.
• Those with foot pain from joint inflammation in the foot or ankle.
• Patients with neuropathy who are willing to commit to a longer treatment course.
• Anyone willing to improve walking mechanics to prevent re-injury.
• Anyone who can set realistic expectations and not expect miracles.  Sometimes the improvement seems near miraculous and I have been astounded over and over at the rapidity and completeness of the improvement, but it all still depends on the body responding to a known biological mechanism.  

What to expect when you sign up

1. Initial assessment and mapping session.
2. Short treatment sessions, typically 5 to 7 minutes each.
3. A recommended course of at least eight but preferably 10 sessions for plantar fasciitis; 15 to 20 for neuropathy.
4. Chi walking instruction to improve biomechanics and long-term results is offered and strongly recommended but some patients prefer to forego the strategy.
5. Follow-up to monitor progress and confirm lasting improvement.
6. Chi Walking is taught with each visit after the treatment and the multiple sessions allow a fine tuning of the strategy.  
7. The other distinctive in our office that we teach is Low Inflammatory Eating.   Somewhat analogous to learning Chi Walking to minimize the damage from biomechanical imbalances in the gait, our diet instruction markedly lowers the inner inflammatory damages that are happening from the ways we eat.  

Final thoughts

Shockwave Stemwave therapy can trigger biologic repair in tissues that normally do not heal well by themselves. It calls in anti-inflammatory signals, stimulates microvascular growth around three to four weeks, and attracts stem cells to aid repair. These changes that are set in motion early are sustained for many months after the treatment is completed.  Paired with improved walking mechanics through Chi walking, the combination can deliver meaningful, lasting relief for the vast majority of patients.

If you suffer from foot pain, plantar fasciitis, or neuropathy and want a program that combines targeted biological treatment with mechanical retraining, this approach is worth considering. The mapping session gives a quick indication of likely success, and many patients notice improvement early in the course of care.    The first step is to schedule a mapping session which only commits you to one session.   To do so or for more information feel free to call 814 583 7792.  

I wish you good health and steady, pain-free steps.

Stanley Lang, M.D.