This document discusses radial extracorporeal shock wave therapy (RSWT) and its applications for podiatry. RSWT was developed to treat kidney stones and has since been used for orthopedic applications. It is now used to treat various tendinopathies and musculoskeletal injuries. RSWT works by generating high-energy sound waves that stimulate the body's healing mechanisms through effects like cavitation bubbles and the release of substances that promote healing. Studies have shown RSWT to be an effective treatment for foot ulcers in diabetics and various tendinopathies when used alongside standard care. It provides pain relief, accelerates healing, and has minimal side effects.

1. SWISS
DOLORCLAST
APPLICATIONS
FOR PODIATRY

2. HISTORY
• EMS/Dolorclast was the first company to
develop Lithotripsy
• Extracorporeal Shockwave Therapy
• (ESWT) was first used to treat kidney stones
• Since 1990 (ESWT) has been used for a
variety of orthopaedic applications.
• More recently, it is used for treating wound
ulcers, lymphodema, burns and cellulite

3. Indications for RSWT®
Tennis elbow
(Epicondilitis
humeri radialis) Subacromial pain
syndrome
Greater trochanteric Golfer‘s elbow
pain syndrome (epicondylitis
humeri ulnaris)
Patellar tip syndrome Medial tibial stress
syndrome
Achilles
Plantar fasciopathy tendinopathy

4. MECHANISMS
• The procedure accelerates the body's own
healing mechanisms by:-
• Generating impulses of high energy, high
pressure sound waves that travel through
skin to stimulate healing.
• It is effectively changing a chronic
condition to an acute condition.

5. Radial extracorporeal shock wave therapy
RSWT®

6. 28.11.2011 Gloria Allery & Val Bryce 6
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7. RSWT®: basic physics (3) - cavitation
• Which part of shock waves mediates their biological efffects on
tissue?
• "A significant tissue effect is cavitation consequent to the
negative phase of the wave propagation."
• (Ogden et al., 2001)

8. RSWT®: see shock waves on high speed movie:
8
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9. RSWT®: basic physics - cavitation
Cavitation bubbles
Wave front
Secondary
Hydrophone shock waves
(used to trigger
a high-speed
camera)
Applicator
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10. SCIENTIFIC BACKGROUND
• ESWL can trigger a variety of effective
actions
• Release more substance P
• Inhibits the COX11 enzyme
• Activates cellular defenses
• Hyper stimulates nerve fibres

11. RSWT RANDOM CONTROL TRIALS WITH POSITIVE
OUTCOMES
Chronic plantar fasciopathy
•Gerdesmeyer et al., Am J Sports Med 2008; 36: 2100-2109
•Chow and Cheing, Clin Rehab 2007;21: 131-141
•Greve et al., Clinics 2009; 64: 97-103
Midportion Achilles tendinopathy:
•Rompe et al., Am J Sports Med 2007;35:374-381
•Rompe et al., Am J Sports Med 2009;37:463-470
Insertion Achilles tendinopathy:
•Rompe et al., Am J Bone Joint Surg 2008;90:52-61
Medial tibial stress syndrome:
•Rompe et al., Am J Sports Med 2009 [Epub Sep 23]
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12. PROBLEMS WITH DIABETIC
FOOT
• Diabetes= Worldwide= over 200million
Qld = over 200,000
• Over 1 million diabetic amputations year
worldwide
• Most common diabetic admissions
Foot ulcers = more than 15%
Amputations = more than 1-3%

13. STANDARD FOOT ULCER
MANAGEMENT
• Control infection
• Improve blood supply
• Optimise wound healing environment
• Protect wound from trauma

14. TREATMENT
ESWT in conjunction with standard
therapies for off loading foot pressure
• Padding
• Insoles
• Orthotics
• Footwear- sandals boots, casts, splints
• Walking aids, crutches, walking sticks,
wheelchairs

15. Case Study
• This patient was treated at a Hairmyres Hospital,
Scotland, and had a large diabetic foot ulcer.
This had been surgically debrided and had also
had larvae therapy. It was not responding to
treatment and there was a real chance that the
patient would need a lower leg amputation.
• The patient was treated with ESWT over a
period of six months during which there was full
healing. On average he was treated once every
2.5 weeks.

16. Large diabetic foot ulcer-
March 2010,prior to treatment

17. 24th AUGUST 2010 5 TH October 2010

18. References
[1] R. Saggini, A. Figus, A. Troccola, V. Cocco, A.
Saggini, and N. Scuderi. Extracorporeal shock wave
therapy for management of chronic ulcers in the lower
extremities. Ultrasound Med Biol, 34(8):1261– 1271,
August 2008.
[2] W. Schaden, R. Thiele, C. Kolpl, M. Pusch, A.
Nissan, C. E. Attinger, M. E. Maniscalco-Theberge, G. E.
Peoples, E. A. Elster, and A. Stojadinovic. Shock wave
therapy for acute and chronic soft tissue wounds: a
feasibility study. J Surg Res, 143(1):1–12, 2007.
[3] A. M. Larking, S. Duport, M. Clinton, M. Hardy, and K.
Andrews. Randomized control of extracorporeal shock
wave therapy versus placebo for chronic decubitus
ulceration. Clin Rehabil, Feb 2010.

19. • [4] J. Dumfarth, D. Zimpfer, M. Vögele-Kadletz,
J. Holfeld, F. Sihorsch, W. Schaden, M. Czerny,
S. Aharinejad, E. Wolner, and M. Grimm.
Prophylactic low-energy shock wave therapy
improves wound healing after vein harvesting for
coronary artery bypass graft surgery: A
prospective, randomized trial. Ann Thorac Surg,
86(6):1909–1913, December 2008.
• [5] C. Wang, Y. Kuo, R. Wu, R. Liu, C. Hsu, F.
Wang, and K. Yang. Extracorporeal shockwave
treatment for chronic diabetic foot ulcers. J Surg
Res, 152, 96–103 (2009).

20. RSWT : summary
®
→Physical mechanisms of action understood
→Wave propagation
→Cavitation
→Molecular and cellular mechanisms of action
understood
→Immediate pain relief by depletion of substance P
→Blockade of neurogenic inflammation
→Change of gene expression in adult stem cells
towards healing
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21. →Happy patients
→Efficacy and safety demonstrated in various
RCTs
→Evidence-Based Medicine Level 1
→Fast (3 x 5 min treatment) with immediate benefit
→Negligible side effects when applied properly (skin
reddening)
→No injections, no cortisone, no surgery!
→No doping!

22. A treatment modality becomes successful when...
∀ →we know how it works
∀ →we know that it works
∀ →we know why it works
→your patients become enthusiastic about it!
Enthusiastic patients – successful practice!