Focused shockwave for heel pain (plantar fasciitis): what to expect

What is plantar fasciitis?

The plantar fascia is a thick band of tissue under the foot that runs from the heel bone to the base of the toes. It supports the arch and stores and releases energy as you walk. When it is loaded more than it can currently tolerate — more time on your feet, a new running plan, a change of footwear or weight gain — the area where it attaches to the heel can become irritated and thickened. This is plantar fasciitis, the most common cause of heel pain in adults.

The typical pattern is a sharp pain under the heel with the first steps in the morning or after sitting, which eases as you get moving and then builds again after long periods of standing or walking. Many cases improve over several months with simple measures, but for some people the pain lingers and starts to affect work, exercise and everyday walking.

When is shockwave considered?

Shockwave is not usually the first thing we reach for. Most people start with load management, calf and foot stretching and strengthening, supportive footwear and, where appropriate, orthotics. If heel pain has lasted around three months or more and has not settled despite that kind of care, focused shockwave may be worth discussing.

UK guidance from NICE (the National Institute for Health and Care Excellence) recognises extracorporeal shockwave therapy as an option for plantar fasciitis that has not responded to other treatment, and research suggests it may reduce pain for some people. Results vary, and it tends to work best as part of a wider plan rather than on its own.

At UK Pain Clinic, shockwave is offered after an initial assessment. That first appointment confirms the diagnosis and checks for other causes of heel pain — such as nerve irritation, a stress reaction in the heel bone or pain referred from the lower back — which would need a different approach.

How focused shockwave works

Our clinic uses a piezoelectric focused shockwave unit. It delivers short, precise acoustic pulses to a set depth in the tissue, and interchangeable heads let the clinician adjust that depth so the energy reaches the area being treated. The aim is to stimulate a healing response in long-standing tissue changes and to reduce pain sensitivity. "Focused" means the energy is concentrated at a chosen point beneath the skin rather than spread across the surface.

What a session feels like

You lie down with your foot supported. The clinician finds the most sensitive area, often with your feedback, applies gel to the skin and places the treatment head on the heel. A single area usually receives around 2,000 pulses, and the appointment for one area takes about 20 minutes.

Most people describe the sensation as a firm tapping or flicking that is mildly uncomfortable rather than painful. The intensity can be adjusted, and you can ask us to pause at any time. No needles or anaesthetic are involved, and you can walk out and carry on with your day.

A typical course

A course is usually three to six sessions, about a week apart, and your clinician reviews progress at each visit. Change is often gradual: the tissue response continues for weeks after the last session, so many people judge the effect over the following two to three months rather than straight away. If there is little change after a few sessions, we will discuss whether to continue or try a different approach.

Prices for single sessions and for four- and eight-session packages are on our fees page. Some insurance policies do not cover shockwave; if you plan to claim, please check with your insurer and check with us before you book.

Aftercare

• The heel may feel tender, warm or slightly red for a day or two. This is common and usually settles on its own.
• Normal walking is fine. Avoid running, jumping and other high-impact activity for around 48 hours, then build back up as your clinician advises.
• Keep up the home exercises from your plan unless they feel too uncomfortable on the day of treatment.
• Ask your clinician about ice and over-the-counter pain relief, as advice can differ depending on your plan.
• Contact us if pain increases markedly or you notice anything unexpected.

Who it may not be suitable for

Your clinician will check your medical history before treatment. Shockwave may not be suitable, or may need to wait, if you:

• are pregnant or might be pregnant
• have a blood-clotting disorder or take blood-thinning medication
• have an infection, open wound or skin problem over the heel
• have had a recent injection into the heel
• have reduced feeling in the foot, for example from diabetes-related nerve changes
• have a known tumour, bone condition or fracture in the area
• are under 18 and still growing

Please tell us about any implanted device, such as a pacemaker, and about your medical conditions and medication at your assessment.

Combining shockwave with other care

Shockwave is most useful as one part of a plan that addresses why the fascia became overloaded. That usually includes:

• Exercise — calf stretching, progressive strengthening of the calf and the small muscles of the foot, and a gradual return to walking or running.
• Footwear — supportive shoes with a cushioned heel, and avoiding long periods barefoot on hard floors while symptoms are active.
• Orthotics — where a 3D foot scan suggests your foot posture is adding to the strain, custom orthotics made from your scan by a UK manufacturing laboratory may help spread the load.
• Load management — adjusting standing time, training volume or daily step count while the heel settles.

Outcomes vary from person to person, and shockwave does not suit everyone. If heel pain has been going on for a while, an initial assessment at our Bloomsbury clinic is a sensible first step: we will examine your foot, explain what we find and agree a plan with you.