Bony heel spurs can be either inferior or posterior calcaneal growths of bone usually on a point of pressure. The posterior spur is usually where the achilles tendon attaches into the calcaneus and the inferior spur is usually as the plantar fascia attaches to the calcaneus. These spurs are normally diagnosed on x-ray and are distinctive in appearance (as can be seen below). The effects of shockwave on a spur can be checked through further x-rays and this has made the condition a particular focus of research.
Ogden et al. (2001) performed a randomized, placebo-controlled study including a placebo group which led to the United States Food and Drug Administration approving shock-wave therapy for painful heels. Buch et al. (2001) did another randomized, placebo-controlled study (again for the United States Food and Drug Administration) and found the same good results.
There are 2 main ways of applying the radial shockwave for heel spurs:
1. Direct method or static treatment as shown in the video below on a posterior spur
This method is efficient and works the quickest but is also the most painful and can lead to skin damage very easily. Not recommended for large spurs (anything bigger than the treatment head) as you will make a cavity in the spur not elimiate it.
2. Spots of shocks in bursts of 200 from multiple angles
Less efficient and therefore needs more sessions, but easier on the skin and able to break up larger spurs. Less painful overall for the patient.
In the research Rompe, Schoellner & Nafe (2002) showed a satisfying clinical outcome after application of radial shockwave to heel spurs. Similar positive outcomes have been shown in various other studies (Krischek et al., 1998, Maier et al., 2000, Perlick, Boxberg & Giebel, 1998).
The progress seems to hold as well with Maier et al. (2000) reporting good or excellent results at twenty-nine months after treatment. Wang et al. (2000) reported that 80% of their patients were either free of symptoms or substantially better at twelve weeks after shockwave therapy. At three month follow up, 70% of the patients in the treatment group and 40% of those in the placebo group had reported good recovery (particularly in relation to morning pain). Chen et al. (2001) showed at six months post treatment 59% had no symptoms and 27% had substantial improvement. Rompe et al (2002) also found six months after radial shockwave treatment the results were significantly better than those of a placebo group (57% good or excellent outcomes compared with 10% good or excellent outcomes). At five years after the shock-wave therapy only 13% of the patients in the real shockwave group had proceeded to surgery compared to 58% of the patients in the placebo group. Rompe et al (2002) went on to say that "if even more patients in this group had undergone surgery, the ratings concerning pain and walking may have reached levels comparable with those in Group I". Or in other words, shockwave showed results in patient scores comparable to if not better than surgery.
It appears that the most popular method for treating spurs is to use high energy at lower frequency.
Settings: Anywhere from 3.0 bar or 120mj upwards. Normally 10hz or lower (lower is more painful) for 1000 to 2000 shocks.
Frequency: Repeated every 5-7 days. Sessions as required to eliminate the spur (normally 4-6 but can be 20+ on really big posterior spurs).