Extracorporeal shockwave therapy for Achilles tendinopathy

The procedure

In extracorporeal shockwave therapy, a device is used to pass acoustic (sound) shockwaves through the skin to the affected area. This is thought to stimulate healing, but it is not known how this works.

There are low-energy and high-energy devices available. High-energy devices may cause more pain, needing local anaesthetic. There is some evidence that local anaesthetic may reduce the benefit of the procedure. Low-energy devices cause less pain, can be used repeatedly and doesn't need local anaesthetic. Many patients have a series of treatments but it may be a single session. Ultrasound guidance may be used to help position the device.