Plantar fasciitis: is shockwave therapy worth it?

What is plantar fasciitis?

The plantar fascia is a thick band of tissue running from your heel bone to the base of your toes. It supports the arch and stores and releases energy every time you walk. When it is irritated, people usually feel a sharp pain on the inside of the heel that is worst first thing in the morning or after sitting, eases a little once you get going, then builds up again after a long day on your feet.

You will often hear it called plantar heel pain these days, which is a broader name for the same problem.

How long does plantar fasciitis last?

Longer than most people are told. In a Danish study that followed 174 people for an average of almost 10 years, 80.5% still had symptoms a year after they started, about half still had symptoms at 5 years and 45.6% at 10 years. The people who did recover had symptoms for an average of 725 days, roughly two years (Hansen et al., 2018).

That group came from a hospital clinic, so they were probably harder cases than the average person with sore heels, and an overview in BMJ Clinical Evidence notes that symptoms do seem to settle over time for most people (Landorf, 2015). The point stands, though. If your heel has been sore for six months, you are not doing anything wrong, and waiting it out can take a long time.

One more useful finding from the same study: having a heel spur on an X-ray, or a thickened fascia on a scan, made no difference to how people did in the long run (Hansen et al., 2018). So if you've been told you have a spur, it isn't the thing that decides whether you get better.

What is shockwave therapy?

Extracorporeal shockwave therapy (ESWT) sends high energy sound waves through the skin into the sore tissue. A gel is put on the heel and a handpiece is pressed against it while the machine delivers a set number of pulses. There are two main types. Focused shockwave concentrates its energy at a set depth, and radial shockwave spreads out from the surface of the skin.

In the largest trial, people had three sessions a week apart, without any local anaesthetic (Gollwitzer et al., 2015).

What does the research say about shockwave for plantar fasciitis?

Most of the evidence is positive, though not all of it.

On the positive side, a trial of 250 people with long standing heel pain compared focused shockwave with a sham (a fake treatment that looks and sounds the same). Heel pain fell by 69.2% in the shockwave group compared with 34.5% in the sham group (Gollwitzer et al., 2015). A meta-analysis pooling 9 trials and 935 patients found people having shockwave were about 2.6 times more likely to improve than those given a placebo (Sun et al., 2017). A large overview of 96 systematic reviews found general agreement that shockwave is an effective treatment for plantar fasciitis (Rhim et al., 2021), and a 2024 review in athletes found most were able to keep training while having it (Rhim et al., 2024).

NICE, which advises the NHS, last reviewed shockwave for stubborn plantar fasciitis in 2009. It found no major safety concerns but described the evidence on effectiveness as inconsistent, and asked clinicians to make sure patients understand that uncertainty before starting (NICE, 2009). A lot of the better trials have been published since then. The NHS now lists shockwave as an option when physiotherapy or podiatry hasn't helped (NHS, 2025).

Focused or radial shockwave: does it matter?

The research can't settle this yet. One meta-analysis was most confident in focused shockwave and found radial results too variable to draw firm conclusions (Sun et al., 2017). Another found that only radial shockwave beat placebo for pain, and only over the first 6 weeks (Li et al., 2018). A 2026 review found radial shockwave was no better than other electrotherapy treatments, although most of the studies it included had a high risk of bias (Guede-Rojas, Rodriguez-Lagos and Carvajal-Parodi, 2026).

In practice we pay more attention to the dose, the number of sessions and what you are doing alongside it than to the label on the machine.

Shockwave or a steroid injection?

This is the other question that comes up a lot. A 2024 review of 16 trials and 1,121 patients found shockwave gave better pain relief and foot function than a steroid injection at both 3 and 6 months (Cortés-Pérez et al., 2024). A separate meta-analysis of 47 trials found that steroid injections were no better than a placebo injection for heel pain once the lower quality studies were set aside (Whittaker et al., 2019).

Steroid injections into the heel also carry a specific risk. At one specialist foot clinic, 44 of 51 plantar fascia ruptures were linked to a previous steroid injection, and half of those people still had fair or poor results more than two years later (Acevedo and Beskin, 1998). We still use injections for some problems, but for heel pain shockwave usually comes first.

If you have already had an injection, it doesn't rule shockwave out. One study found it worked about as well in people who had previously been injected (Ogden et al., 2005).

Does shockwave hurt, and are there side effects?

It is uncomfortable during treatment, and we adjust the intensity to what you can tolerate. Across 16 trials the most common side effects were short lived pain where the treatment was given and some mild redness (Cortés-Pérez et al., 2024). In the large trial the only problems linked to the machine were temporary pain and swelling (Gollwitzer et al., 2015).

What else helps plantar fasciitis?

Shockwave works best as part of a plan, not on its own.

Strength. A trial of 48 people compared high load heel raises (done slowly, with a towel rolled under the toes, every other day) with stretching. The strength group had better foot function at three months, although by 6 and 12 months both groups had caught up (Rathleff et al., 2015). So it seems to speed things up rather than change the end result, which is still worth having when every step hurts.

Insoles. Across 19 trials and 1,660 people, insoles reduced pain a little more than sham insoles over 7 to 12 weeks, and off the shelf insoles worked as well as custom made ones (Whittaker et al., 2018). The effect was small, so we'd suggest a decent pair from a shop before spending a lot on custom orthotics.

Taping. There is limited evidence that taping eases pain for about a week (van de Water and Speksnijder, 2010). Useful for an event or a busy week at work, less so as a long term answer.

So is shockwave worth it?

For the right person, yes. If your heel pain has been there for three months or more and you have already given strength work, sensible footwear and insoles a fair go, the evidence supports shockwave as a reasonable next step, and it compares well with a steroid injection. It is not where we would start with heel pain that came on three weeks ago, because simpler changes are the sensible place to start.

We will also tell you plainly if we don't think it is right for you.