Non-surgical “Shock Wave Therapy” for heel spurs!

High-heeled shoes, which women cannot give up, can cause some problems when used constantly. One of them is the heel spur. Fortunately, there is a method that solves the problem: ESWT…

Heel spurs, which occur with pain and a local stinging sensation as a result of the inability to heal the area where a membrane on the sole of the foot adheres to the heel, is usually seen between the ages of 40-60. Although a bony problem comes to mind when heel spur is mentioned, the real situation

not like that. The special connective tissue (plantar fascia) on the sole of the foot has the ability to absorb 20-25 percent of the pressure on our feet. This tissue, which covers the sole of our feet from our heel to our toes, is damaged and tears occur if our feet are forced more than necessary. Tissue inflammation and hardening due to injury exhibit a bony appearance coming out of the heel because the ligament is attached to the heel bone. This protrusion seen in X-ray films is called heel spur. Daily life

More detailed information about the heel spur, which limits his activities, and the curious ESWT method, Medistate Kavacık Hospital Physical Therapy and Rehabilitation Specialist Asst. Assoc. Dr. Ilker Garipoğlu and Physiotherapist Yavuz Sultan Selim Kavrik tell.



In general, women have problems with high arches and flat feet, have to stand for long periods of time during the day, are interested in work and sports that put a load on the feet, and have excess weight problems.

The formation of heel spurs is more common in people who have poor shoes and often choose the wrong shoes. The risk of heel spurs is also much higher in people who have problems such as sideways or inward pressing.

In addition to these, genetic factors are also effective in the formation of heel spurs.



Among the main reasons, we can say the presence of excess weight. When it comes to excess weight, the body wears out while carrying the extra weight and causes pain in the heel area. Because the feet are loaded with three times more weight and this causes damage to the feet. Apart from this, heel spurs can be seen in those who have trouble walking. Problems such as putting more weight on one area of ​​the foot or one of the feet while walking

can cause heel spurs. Wrong shoe selection is among the important factors that cause heel spurs; Hard-soled and poor-quality shoes cause pain in the heels, which leads to heel spurs.



It is normal to have pain in the heel when the foot is overtired. However, if there is a build-up of pain in the heel despite sitting for a long time and the pain is felt when stepped on, it means that there is a heel spur problem. The first and most important symptom of heel spur is heel pain. Patients feel most severe pain in the first hours of the day, that is, in the first few steps after getting out of bed. This pain feels like there is a nail under the heel when stepped on. The pain starts directly from the heel, does not spread from another area to the foot.

A normal pain, on the other hand, occurs locally and with a stinging sensation. Severe pain that is felt when waking up in the morning and goes away by itself during the day,

It can also manifest itself in the form of pain when standing up after sitting for a long time or pain after a long walk. Pain, as well as heel spurs, wobble

and can cause gait disorders such as walking by pressing inwards.



ESWT (Extracorporeal ShockWave Therapy), which is briefly called “shock wave therapy”; A new “non-invasive” (interventional intervention) based on focusing the generated powerful sound waves on a desired area of ​​the body by means of an ellipsoidal steel bowl.

not required) treatment. The working principle is that the currents produced outside the body produce sound in the tissue.

It is based on the principle of propagation in the form of waves.



It is not applied to the neck area, head and areas close to the nerves. Pregnant women, children who have not completed their developmental age, patients using drugs that prevent blood clotting, patients with a pacemaker are excluded from the treatment. Except for the temporary redness that can be seen on the skin

has no complications. After the application, the patient continues his daily life from where he left off.




  • Possibility of outpatient treatment
  • Anestezi gerekmemesi
  • Get fast results
  • Possibility of drug-free treatment
  • High achievement
  • Increase in quality of life



Physical therapy examination is very important in the diagnosis of heel spur. The diagnosis is made according to the patient’s history and clinical condition of the patient. If pain is felt when pressing under the heel during the examination, X-ray is requested and blood tests are performed with MRI if necessary.



If a heel spur is diagnosed, it is important for the patient to stay away from activities that cause pain in the first place. For example, patients; should not walk barefoot at home, use soft-soled slippers and prefer sports shoes if possible instead of hard-soled shoes. Apart from these measures, silicone heel supports can also be used.



First of all, in the treatment of heel spurs; Massage and cold applications are used accompanied by pain reliever creams. Massage should be done by pulling the toes back and applying cold on the heel for 5 minutes, then applying pain reliever creams. This application should be repeated 4-5 times a day. As a result of using soft-soled shoes together with massage application, most of the patients have complaints without the need for additional treatment. It should not be forgotten here; heel spur slowly

As it is a disease that begins, its recovery will not take place in a day. It may take 3-4 weeks for the pain in the heel to go away.




There are many other options in the treatment of patients who do not benefit from massage and cold application. The most common method is injection under the heel. Before the injection, the heel or foot should not feel any pain during the procedure.

A drug injection is made from his wrist. Cortisone injection or PRP injections prepared from the patient’s own blood are used here. PRP is prepared from the patient’s own blood.

and a method that increases improvement. The aim of the injections is to accelerate the healing of the non-healing tissue in the heel and to relieve the pain. The pain is great after this application.

rate passes. Patients whose pain persists after the first application can be injected again 10-15 days later.



ESWT, that is, “shock wave therapy”, can be applied to patients who are inconvenient to receive injections due to health problems or who do not receive a positive response from this treatment, and most of the patients recover with this procedure. X-ray for this procedure in public

It is thought that the bone protrusion seen is broken, but the procedure is actually to increase the healing rate by re-destroying the non-healing tissue that causes pain in the heel area in a controlled manner. In the method, a bleeding is initiated in that area with approximately 2000-3000 sound waves to be applied to the heel. The resulting shock waves are called high-energy and these devices deliver 10 times higher energy than ultrasonic devices in a very short time (1 microsecond) to the application area. Surgery is the last option in the treatment of heel spurs, and in most patients, the treatment is successfully completed without the need for surgery. The ESWT method also provides the patient with non-surgical, cortisone-free treatment.



One of the most important advantages of ESWT treatment is that its effect is long-lasting. The clinical

In studies, it was observed that the disease did not recur in 1-2 years after treatment. ESWT treatment provides permanent improvement with treatment for the causes of the disease. Also, because the body uses its own healing mechanisms when treating, once the disease is cured, the chance of recurrence is very low. One of the important issues here is how much treatment

The earlier it is started, the better the result will be.



Acute pains and blunt injuries

  • Radial humerus epikondiliti (Tennis elbow)
  • Ulnar humerus epikondiliti (Golfer’s elbow)
  • Tendinozis Calcarea (Calcified shoulder tendinitis)
  • Trochanterik bursit
  • Patellar tendinitis
  • Tibialis anterior sendromu
  • Aşilodini (Aşil tendiniti)
  • Plantar facitis
  • Epine calcanei (Heel spur)
  • Kronik entesopatiler (Tendon irritations)
  • Psödoartrozlar (Non-union fractures)



In the first stage before the application, the problem area is detected and marked as a result of x-ray ultrasound findings and palpation. Ultrasound gel is applied to the marked area by focusing on the point where the disease is. In order not to reduce the effect of sound waves, it is ensured that no air remains between the stone crushing head and the body. ESWT application starts with a very small “click” sound that the patient will hear. The patient hears this sound at short intervals continuously and feels the vibration in his body very slightly. Meanwhile, the ESWT application focus is checked frequently. The energy level is increased in a controlled manner without disturbing the patient. During the application, the strength and amount of energy are regulated according to the patient’s comfort, the type of stone and its location. The procedure is as painless as possible, or there may be mild pain that the patient can accept.


Session durations in ESWT treatment may differ according to the number of shocks, frequency and energy level, but an average session takes 20-25 minutes. In soft tissue applications, it is expected that the patient will get rid of the complaint within 3 to 5 sessions. As a matter of fact, a decrease in pain can be seen within a week from the first session.


ESWT method; It is a method that provides 80% and higher success rates in shoulder patients, 80% in tennis and golfer’s elbow, and 70% in heel spurs.


Shock wave therapy ESWT has been approved as a treatment accepted by the whole world and has taken its place in clinics as a nanotechnology product. The treatment has been FDA approved since 1997 for heel spurs and since 2000 for tennis elbow.



  • Choose shoes with good back support or heel support. If your job requires you to stand on hard floors, stand on a thick rubber mat to reduce the pressure on your feet.
  • Exercise to stretch the Achilles tendon at the back of your heel and the fascia on the bottom of your foot. This is especially important before sports.
  • Stay at a healthy weight suitable for your height.
  • Get into a good exercise habit. Increase your exercise levels slowly and wear supportive shoes.
  • If you are running, replace running with other sports that will not cause heel pain.
  • Wear supportive shoes as soon as you get out of bed. Walking barefoot or wearing hard-soled slippers can put pressure on your feet.
  • If you are doing sports, warm up and physical endurance to prevent pain from occurring.

You can consult your physiotherapist about increasing exercises.