What is a heel spur and why is it so annoying?

If you feel a sharp pain in your heel when you get out of bed in the morning, making you momentarily stand on your tiptoes, the culprit might be a heel spur, or plantar fasciitis. This is a condition where the tendon under the sole of the foot (plantar fascia) becomes inflamed, and sometimes a small bony "spur" even forms under the heel. Such a condition can make every step agonizing – especially in the morning or after prolonged sitting, as the inflamed connective tissue has stiffened overnight, and the pain is particularly severe during the first few steps (Khan et al., 2008) (Wang et al., 2013).

What to do if common methods don't help?

Most people first try insoles, stretching exercises, and painkillers. These might help in some cases, but often the pain persists or quickly returns. If common methods don't yield results, you might feel that you just have to endure the heel pain. Fortunately, there are more modern solutions – one of the most effective is shockwave therapy (ESWT), which has found strong scientific evidence in the treatment of chronic plantar fasciitis (Yalcin et al., 2020); (Babaei-Ghazani et al., 2022).

What is shockwave therapy?

Shockwave therapy is nothing scary – it's not an electric shock or anything painful. It's a procedure where a special device sends short and strong "sound waves" to the heel. Imagine someone tapping inside your heel with tiny hammers – these waves cause the body to fight inflammation and pain itself (Kudo et al., 2006); (Chew et al., 2015).

How does it work?

• Improves blood circulation
• Accelerates tissue healing
• Reduces inflammation
• Helps nerve endings to "calm down," so the pain subsides (Babaei-Ghazani et al., 2022); (Yalcin et al., 2020)

What do scientific studies say?

1. Does it really work?

Several randomized studies and reviews confirm that shockwave therapy is very effective for chronic heel spurs. For example, Khan et al. (2008) found that after just three sessions, participants' heel pain was significantly reduced, and the plantar fascia was thinner – indicating a reduction in inflammation and swelling. Pain decreased by 73.2% in the shockwave therapy group, which was 32.7% more than in the placebo group, and no significant side effects occurred.

Kudo et al. (2006) also confirmed that shockwave therapy helps reduce the typical morning "first step" pain, which is one of the most unpleasant symptoms of plantar fasciitis. After three months, the pain was significantly less than in those who received placebo treatment.

2. Is the effect lasting?

Yes, studies confirm that the effect of shockwave therapy is not short-term. For example, Yalcin et al. (2020) studied how heel pain and mobility changed after shockwave therapy not only immediately after treatment but also over a longer period. They assessed patients 3, 6, and 12 weeks after the end of the treatment course and found that the pain remained significantly lower even several weeks later. Daily movement and foot function also improved.

Long-term studies also confirm that ESWT reduces pain and improves quality of life for months after treatment ends (Kapusta et al., 2022).

3. Is it better than injections or other methods?

When comparing shockwave therapy with, for example, cortisone injections, several studies have shown that shockwave therapy can offer longer-lasting relief. For instance, a study by Chew et al. (2015) found that although both treatment methods can quickly reduce pain, the effect of shockwave therapy often lasts longer. This means that the pain does not tend to return as easily, and patients can enjoy a more lasting result. Also, the need for repeat treatment is less than with injections, and the treatment is safe even with long-term use.

Other studies also confirm that shockwave therapy is more effective than corticosteroid injections or other conservative methods, especially for chronic pain (Shockwave Canada, 2024); (Sun et al., 2017).

4. Is it safe?

Shockwave therapy is a safe and well-tolerated treatment method, with side effects that are mostly mild and resolve quickly. Babaei-Ghazani et al. (2022) confirm that after the procedure, the treated area may be slightly sensitive or reddened, but these signs usually disappear within a few days. Most people do not require separate recovery time and can continue their daily activities.

The procedure itself is simple and quick. Usually, 3–6 sessions are performed, each lasting about 10–20 minutes. During the procedure, mild discomfort may be felt, but most patients find it quite tolerable – the sensation is often described as a strong massage. After the procedure, it is recommended to rest the foot a bit, but no special recovery time or restrictions are needed. Many people feel that the pain has reduced and movement becomes easier already after the first sessions (Yalcin et al., 2020). Large reviews also confirm that serious side effects do not occur, and ESWT is safe in the long term (Leão et al., 2020).

Does it help everyone?

Shockwave therapy is particularly suitable for those whose heel pain has lasted for a long time and for whom conventional treatment methods, such as stretches, insoles, or painkillers, have not yielded the desired results (Wang et al., 2013). Studies show that for chronic and persistent pain, shockwave therapy is often the most effective, helping to reduce pain and improve foot mobility and daily functioning (El Molla et al., 2021).

Conclusion: Is it worth trying?

If you have previously encountered a heel spur or plantar fasciitis, you know how stubbornly pain can persist. In the case of shockwave therapy, it is important to understand that this treatment not only alleviates symptoms but also contributes to the actual recovery of the foot's connective tissue (Khan et al., 2008). For example, studies have found that after shockwave therapy, the structure of the plantar fascia becomes more elastic, and signs of inflammation decrease.

Additionally, shockwave therapy is one of the few treatment methods documented to improve foot function – people can return to work and hobbies more quickly (Yalcin et al., 2020). This is particularly important for those whose quality of life has significantly declined due to heel pain. Because the procedure does not require recovery time or surgery, it is well-suited for active individuals who wish to return to their normal life rhythm as quickly as possible (Babaei-Ghazani et al., 2022). Shockwave therapy also does not damage tissues or cause long-term side effects, making it suitable for repeated use if the pain should return over time (Chew et al., 2015).

Modern treatment centers adapt the shockwave therapy protocol according to the patient's needs – whether it's different pain intensity, duration of the disease, or lifestyle. It is precisely the individual approach and scientifically proven effectiveness that make this method a reliable choice for those seeking a long-term solution to chronic heel pain (Kudo et al., 2006).

Cited scientific sources:

1. Khan et al., 2008, DOI: 10.4103/0019-5413.41853
2. Kudo et al., 2006, DOI: 10.1002/jor.20008
3. Yalcin et al., 2020, DOI: 10.1590/1413-785220202801227.190
4. Chew et al., 2015, DOI: 10.1016/j.arthro.2015.05.036
5. Babaei-Ghazani et al., 2022, DOI: 10.3390/medicina58111598
6. Wang et al., 2013, DOI: 10.4103/0019-5413.114932
7. Kapusta et al., 2022, DOI: 10.3390/jcm11236926
8. Sun et al., 2017, DOI: 10.1097/MD.0000000000006621
9. Heide et al., 2020, DOI: 10.1186/s13063-020-04510-z
10. El Molla et al., 2021, DOI: 10.1186/s43166-021-00085-y
11. Leão et al., 2020, DOI: 10.1590/1413-785220202801227402