Short-Term Outcomes Following Stand-Alone Extracorporeal Shockwave Therapy Differ Between Bony and Soft Tissue Pathologies of the Foot and Ankle.

INTRODUCTION/

OBJECTIVES

Extracorporeal Shockwave Therapy (ESWT) has emerged as a non-invasive option for treating musculoskeletal conditions. However, its effectiveness as a standalone treatment for certain foot and ankle pathologies needs further investigation. The purpose of this study is to evaluate ESWT's effectiveness as a primary intervention for bony versus soft tissue pathologies of the foot and ankle.

METHODS

A retrospective analysis identified patients who received three weekly ESWT sessions (2020-2024) from a single provider for foot and ankle pathology, using standardized parameters (10 mJ, 10 Hz, 1500 shockwaves). Outcome measures included Foot and Ankle Ability Measure (FAAM) scores, Visual Analog Scale (VAS) for pain, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, Global Rating of Change (GRC), and Patient Acceptable Symptomatic State (PASS) values, all collected pre-treatment and at least 4 weeks post-treatment.

RESULTS

Eighty-five patients (52 females, 33 males; mean age 34.7±18.1 years) were stratified into bony (n=39) and soft tissue (n=46) pathology groups. Of the 42 patients with reported outcome measures (20 bony, 22 soft tissue), bony pathologies showed statistically significant improvements in FAAM ADL, FAAM Sports, PROMIS Physical and Mental Health, and VAS (all p<0.001). Soft tissue pathologies showed modest, non-statistically significant improvements. GRC scores indicated improvement in 95% of patients with bony pathology, compared to 52.4% for those with soft tissue. PASS thresholds were achieved by 35% of patients with bony pathology, compared to 14.3% for those with soft tissue conditions. Bony tissue pathologies were predominantly observed in athletes (87.2%), while soft tissue pathologies were more common in non-athletes (80.4%).

CONCLUSION

In the short-term, ESWT provided noteable greater therapeutic benefit for bony tissue pathologies of the foot and ankle compared to soft tissue conditions.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.