Ultrasound & biofeedback
Extracorporeal Shockwave Therapy (ESWT)
Graded on: chronic plantar heel pain (plantar fasciitis), self-report.
Compare this record with another, side by side →
How this letter has changedLatest: September 2026 · Added.
New device record, graded for one use. Two large sham-controlled trials, Gollwitzer et al. (J Bone Joint Surg Am 2015; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 25948515) and Gerdesmeyer et al. (Am J Sports Med 2008; PMID 18832341), found less heel pain at 12 weeks, and two meta-analyses A study that pools the numbers from several trials into one combined estimate. of sham-controlled trials, Aqil et al. (Clin Orthop Relat Res 2013; PMID 23813184) and Sun et al. (Medicine 2017; PMID 28403111), agree. An independent trial, Buchbinder et al. (JAMA 2002; PMID 12234230), found no benefit and is cited on the record. Self-reported pain caps the letter at B. Shoulder, elbow, sexual function and regeneration uses are not covered.PMID 25948515 PMID 18832341 PMID 23813184 PMID 28403111 PMID 12234230
Every change to a letter on this site is dated and published. The full evidence log →
Shockwave therapy is a device treatment that sends shock waves into a painful area. In people with long-lasting heel pain from plantar fasciitis, two large trials against a fake treatment found less pain after three sessions, still seen at 12 weeks. Both were run by device makers. A trial by an outside team found no benefit, and results varied with the device and dose. People rated their own pain. Uses for shoulders, elbows, sexual problems, cellulite or aging were not tested here. Temporary pain and swelling at the treated spot were reported.
A letter describes the human evidence, not the product, the manufacturer, or the intervention's worth.
See the full evidence record →Graded on Chronic plantar heel pain (plantar fasciitis), self-report.
Why this gradeThe reasoning, and what the grade does not cover.
Grade B for chronic plantar fasciitis. Two large sham-controlled trials and two meta-analyses of sham-controlled trials show less heel pain after three sessions given one to two weeks apart, and the benefit held at 12 weeks. Both large trials were device-maker trials run for FDA approval, which the record flags as sponsored. Self-reported pain is the endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score., which caps the letter at B. It is not an A for two reasons as well as the endpoint: an independent sham-controlled trial published in JAMA found no benefit, and the pooled analyses report high heterogeneity How much the results of the pooled trials differ from each other. High heterogeneity makes a combined estimate less reliable., so the size of the effect varies with the device, the dose and the patient.
WHAT THIS GRADE DOES NOT COVERshoulder, elbow and other tendon conditions, erectile dysfunction and pelvic floor uses, cellulite, and general regeneration or longevity claims. None of those is graded by this letter, and clinics that own a shockwave device commonly market it for all of them. It also does not cover acute heel pain, since the trials enrolled people whose pain had lasted for months despite other care.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Temporary pain and swelling at the treated site were the adverse events reported in the trials. People with a bleeding disorder or on anticoagulants, and anyone pregnant, were not the populations studied.
The evidence, in fullFive papers, each linked to its PubMed record.
Gollwitzer et al. (J Bone Joint Surg Am, 2015; PMID 25948515): 250 adults with chronic plantar fasciitis randomized, double-blind Neither the participants nor the people assessing them know who received the real treatment until the trial ends., to focused shockwave (0.25 mJ/mm2, three weekly sessions of 2,000 impulses) or placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received.; heel pain fell 69.2% versus 34.5% at 12 weeks. This was the pivotal trial for FDA approval of the Storz Medical Duolith SD1 (PMA P080028). Gerdesmeyer et al. (Am J Sports Med, 2008; PMID 18832341): 245 adults randomized to radial shockwave (0.16 mJ/mm2, three sessions two weeks apart) or placebo; pain fell 72.1% versus 44.7% at 12 weeks. This was the pivotal trial for FDA approval of the EMS Swiss DolorClast, and both trials share a senior investigator (Gerdesmeyer). Aqil et al. (Clin Orthop Relat Res, 2013; PMID 23813184): meta-analysis of 7 sham-controlled trials (663 participants) favoring shockwave. Sun et al. (Medicine, 2017; PMID 28403111): meta-analysis of 9 trials (935 participants), odds ratio 2.58 for improvement, with high heterogeneity. Buchbinder et al. (JAMA, 2002; PMID 12234230): 166 adults randomized to ultrasound-guided shockwave or placebo, no benefit. Grade B: replicated The same finding reproduced by a separate research group. A result seen once can be chance or bias; a replicated one is harder to explain away. benefit on self-reported pain, with one well-run null trial.
Heel pain on first steps in the morning, on a 0 to 10 scale, at baseline and 12 weeks after the last session, the timepoint the trials used.
Evidence notes: randomized trial, meta-analysis, industry-sponsored
Endpoint graded: Chronic plantar heel pain (plantar fasciitis), self-report (self_report)
Last reviewed: September 2026
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
As studiedDose, form, population and duration for every use.
Clinic shockwave devices are marketed for many conditions and for general regeneration. The trials support one use at a stated energy and session count; device makers often do not publish their energy settings.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
Primary evidenceFive papers, each linked to its PubMed record.
Gollwitzer et al. (J Bone Joint Surg Am, 2015; PMID 25948515): 250 adults with chronic plantar fasciitis randomized, double-blind, to focused shockwave (0.25 mJ/mm2, three weekly sessions of 2,000 impulses) or placebo; heel pain fell 69.2% versus 34.5% at 12 weeks. This was the pivotal trial for FDA approval of the Storz Medical Duolith SD1 (PMA P080028). Gerdesmeyer et al. (Am J Sports Med, 2008; PMID 18832341): 245 adults randomized to radial shockwave (0.16 mJ/mm2, three sessions two weeks apart) or placebo; pain fell 72.1% versus 44.7% at 12 weeks. This was the pivotal trial for FDA approval of the EMS Swiss DolorClast, and both trials share a senior investigator (Gerdesmeyer). Aqil et al. (Clin Orthop Relat Res, 2013; PMID 23813184): meta-analysis of 7 sham-controlled trials (663 participants) favoring shockwave. Sun et al. (Medicine, 2017; PMID 28403111): meta-analysis of 9 trials (935 participants), odds ratio 2.58 for improvement, with high heterogeneity. Buchbinder et al. (JAMA, 2002; PMID 12234230): 166 adults randomized to ultrasound-guided shockwave or placebo, no benefit. Grade B: replicated benefit on self-reported pain, with one well-run null trial.
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Products carry no letter. The letter belongs to the therapy as the trials studied it, and no trial tested these products unless the entry says so. Listed alphabetically; payment does not affect order.
Electromagnetic focused shockwave device for clinics. No trial has tested this device; the modality grade covers chronic plantar fasciitis only.
Clinic device sold to practitioners. The company states it is an electromagnetic focused shockwave device and FDA-registered; it does not publish its energy flux density, so a match to the 0.16 to 0.25 mJ/mm2 used in the trials cannot be confirmed.
Electrohydraulic shockwave device for clinics, marketed for temporary relief of minor aches and pains. The company itself describes sexual-function uses as investigational. No trial has tested this device; the modality grade covers chronic plantar fasciitis only.
Clinic device sold to practitioners. The company states it uses electrohydraulic technology and is registered and listed with the FDA as a class 1 device; it does not publish its energy flux density.
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