What Is Shockwave Therapy — And Why Does the Name Scare Everyone?
Shockwave therapy (formally called extracorporeal shockwave therapy, or ESWT) is a non-invasive treatment that 
uses acoustic pressure waves — not electricity — to stimulate healing in damaged foot and ankle tissue. "Extracorporeal" simply means outside the body. Nothing goes inside you. No cuts, no needles, no electrical current of any kind.
A handheld device is pressed against your skin, and pulses of sound energy pass through the tissue underneath.
Here's the thing: the word "shock" in shockwave comes from physics, not from anything you'd recognize as a shock. These are the same pressure wave mechanics used in diagnostic ultrasound — just applied at therapeutic intensities to trigger a healing response. Most people describe the sensation as a tapping or pulsing feeling. But electric shock? Not even close.
The reason it works comes down to four things happening at once. The pressure waves increase blood vessel formation in tissue that's been starved of circulation. They break up calcium deposits and scar tissue in chronically injured tendons. They trigger the release of growth factors — proteins your body uses to signal repair.
And they create what we call controlled microtrauma, which restarts a healing process that stalled out long ago. Think of it like aerating a lawn. Compacted soil blocks water and nutrients from reaching the roots. Shockwave creates channels in damaged tissue so healing factors can finally get through.
It's FDA-cleared, backed by decades of peer-reviewed research, and used by institutions like Mayo Clinic and UT Southwestern. A 2015 randomized controlled trial in the Journal of Bone and Joint Surgery confirmed ESWT as an effective, evidence-based treatment for chronic plantar fasciitis. The reason your insurance doesn't cover it has nothing to do with whether it works. It's a billing classification decision, not a clinical one.
What Conditions Does Shockwave Therapy Treat?
The short answer: any condition where poor blood supply has left your body unable to finish what it started. That's the 
common thread — chronically damaged tissue where the normal repair process stalled before the job got done.
Chronic plantar fasciitis is the most common application, and for good reason. The plantar fascia has relatively poor blood supply to begin with. When it gets injured and that healing process stalls, you end up with what we call post-static dyskinesia — that sharp, stabbing heel pain when you take your first steps in the morning.
What's actually happening: the fascia contracts overnight while you sleep, and when you stand up, those first steps tear apart whatever partial repair your body managed to do. Shockwave interrupts that cycle by forcing new blood vessel growth and restarting a repair response the tissue couldn't sustain on its own. According to ACFAS clinical guidelines, approximately 95% of plantar fasciitis cases resolve without surgery — and shockwave is a major reason why.
Achilles tendinopathy responds extremely well for the same reason. Tendons in general have poor vascularity, and the Achilles is particularly stubborn in chronic cases. Once it progresses past simple inflammation into actual tissue degeneration, anti-inflammatories stop addressing the real problem. There's degenerated tissue that needs rebuilding — and that's exactly what shockwave is designed to do.
A 2021 systematic review published in Journal of Orthopaedic Surgery and Research found ESWT produced significant improvements in pain and function for insertional Achilles tendinopathy compared to conservative treatment alone.
Beyond those two, I regularly use shockwave for Morton's neuroma, peroneal tendinitis, and stress injuries in active patients. In Houston, I see this pattern constantly — runners training on Memorial Park trails, nurses and teachers logging 10-hour days on hard floors, people who work in the Texas Medical Center standing through long shifts. The hard surfaces, the heat, the humidity that makes every outdoor activity feel twice as demanding — Houston is not an easy city on feet.
Here's what most people don't realize: if you've been told you have "chronic" foot pain, that word "chronic" describes the exact mechanism shockwave is designed to fix.
The Truth About Shockwave Therapy (Three Myths Worth Clearing Up)
Myth #1: "It's experimental — nobody's proven it works."
This one frustrates me, because it's completely backwards. ESWT has FDA clearance and a research record going back decades. The confusion comes from insurance coverage — since most plans don't cover it, people assume that means it's unproven. That's not how it works.
Insurance decisions are financial and administrative. The clinical evidence is solid, and it's used by professional sports teams, academic medical centers, and podiatrists across the country. After treating thousands of patients with shockwave therapy, I can tell you: the hesitation is almost always about the name and the insurance gap — not the outcomes.
Myth #2: "Cortisone didn't work, so nothing non-surgical will."
This is the one I hear most often — and it gets the logic exactly backwards. Cortisone is the fire extinguisher. It puts out the fire fast. But once the fire's out, there's still a burned building.
It doesn't rebuild damaged tissue, form new blood vessels, or restart a stalled repair process. Research published in the British Journal of Sports Medicine confirms that repeated corticosteroid injections are associated with tendon weakening over time — the last thing you want when the problem is already a failed healing response. Failing cortisone doesn't mean you've run out of options. In many cases, it actually makes you a better shockwave candidate.
Myth #3: "It's going to hurt."
Most people rate the sensation around a 3 or 4 out of 10 during treatment. Some spots are more sensitive than others — and that's actually useful diagnostic information about where the damage is concentrated. Mild soreness in the 24 hours after? That's a good sign. It means the tissue responded.
The fear of the treatment is almost always worse than the treatment itself. Every time.
How Houston Podiatrist Dr. Andrew Schneider Uses Shockwave Therapy — And When
My job isn't to recommend a single treatment. It's to find the right intervention for where you are right now — and to be honest with you about what each step can and can't do. I use a five-level approach with every patient. The goal is always to use the least invasive option that actually gets the job done.
Level 1: Lifestyle Changes
Start here, even if you feel like you've already been here. Footwear is foundational — supportive shoes from your first step in the morning to your last step at night, and no barefoot padding across hard tile or hardwood. Sometimes that single change, paired with activity modification, is enough to let a mild case resolve. Not often when you're dealing with chronic pain. But always worth establishing first.
Level 2: At-Home Care
Icing consistently — 20 minutes on, 40 minutes off — helps manage inflammation, especially after activity. Not heat. Heat feels good but drives more blood flow to an already-irritated area. Skip it.
A 60-second morning stretching sequence makes a real difference: mid-back first, then hips, then calf. That order matters, because tightness higher up the chain loads the foot structures below. OTC anti-inflammatories can take the edge off short-term.
Now, for some of you, this may be enough — especially if you're catching this early. But I'll be honest: if you've been in pain for three or more months and you're still managing with home care, you've hit the ceiling. Your body needed help it didn't get, and no amount of additional icing is going to change that.
Level 3: Conservative In-Office Treatment
When lifestyle changes aren't enough, custom orthotics to correct your foot mechanics are usually my first in-office move. Think of them like prescription eyeglasses for your feet — they compensate for the structural issue so your tissue isn't constantly fighting your own biomechanics. Custom orthotics run about $700, and for the right patient, they're one of the most cost-effective long-term investments I can recommend.
Cortisone injections ($120) have their place — with the right expectations. It's the fire extinguisher, not the construction crew. Great for acute flares. But for chronic tendon degeneration, repeated cortisone shots actually weaken tendon tissue over time. Physical therapy and taping round out this level and work well alongside other interventions.
If you're still in pain after working through all of this, it's time for a different approach.
Level 4: The Third Option — Shockwave, PRP, and Regenerative Medicine
Here's where it gets interesting. We now have regenerative medicine options that address the actual biological problem — not just the symptoms. For most of my chronic pain patients, these treatments sit squarely between conservative care and surgery. That gap is real, and most people don't know it exists.
Shockwave therapy for heel and foot pain is $300 per session, or $750 for a package of three. The three-session package is what I recommend for most chronic plantar fasciitis and Achilles tendinopathy cases — that's the protocol backed by an 82% success rate in the peer-reviewed literature. And I'll tell you something I don't always lead with: I've used shockwave on my own heel. I know what it feels like, I know the timeline, and I know what results look like from the inside.
Your body started trying to repair the injury — but that process stalled. Think of it like a construction crew that showed up, started the job, and then quit. Shockwave gets that crew moving again.
For people who want to push those numbers higher, I combine shockwave with platelet-rich plasma (PRP) therapy. PRP ($850) concentrates the growth factors from your own blood — the proteins your body uses to signal tissue repair — and delivers them directly to the damaged area. On its own, PRP delivers 70–80% success rates for chronic tendon conditions. Combined with shockwave, that climbs to 85–95%. The combined protocol runs about $1,600.
A 2017 meta-analysis in the American Journal of Sports Medicine found combined regenerative protocols consistently outperformed either treatment used alone.
PRP plants the seeds. Shockwave prepares the soil. Together they create the healing environment that succeeds where everything else has failed. I also use red light therapy for pain relief as an adjunct in select cases — it adds cellular support to the regenerative process at low cost. None of these are covered by most insurance plans, but FSA and HSA funds apply to all of them.
Level 5: Surgery
The honest number: about 95% of my patients never need it.
And for those who do, modern surgery looks nothing like what you're probably picturing. Minimally invasive foot surgery — specifically the Tenex procedure for chronic tendon conditions — uses ultrasound guidance to precisely target and remove damaged tissue through a tiny incision. No large cuts. No lengthy hospital stay. Most people are bearing weight within days.
Week one and two focus on protection and early healing. Weeks three through six, you're gradually returning to activity. By months two and three, most people are back to full function.
Look, I know that foot surgery sounds scary. But what I do surgically today is a fundamentally different thing than what most people imagine. If we ever get to that conversation, I'll walk you through exactly what it involves — and you'll likely be surprised by how manageable it is.
Not sure which level is right for you? Schedule Your Evaluation →
When You Come In to See Me
When you come in, I'll start by asking you something most doctors skip: what are your goals? Not just where does it hurt — but what do you want to be doing that you can't do right now? Maybe it's running again. Maybe it's getting through a workday without dreading the walk to your car. Maybe it's just waking up in the morning without that first-step dread.
I need to know that, because your goal shapes the treatment plan. A marathon runner and a retiree who wants to walk the neighborhood have different definitions of success, and I treat them differently.
From there, I'll do a full biomechanical exam and watch how you walk. Gait tells me things that an X-ray can't — how load is distributed, where compensation is happening, why a particular structure keeps getting stressed. We have on-site X-rays ($90) when I need to rule out stress fractures or bone involvement.
I also use diagnostic ultrasound to get a real-time look at soft tissue damage right in the exam room. That lets me assess your plantar fascia or Achilles tendon for thickness, tearing, and calcification — live tissue, not a static image. That imaging guides the decision, including exactly where to target shockwave if that's the direction we go.
I want you to know something: I see people who've been managing this for years and felt embarrassed it got this bad. You don't need to feel that way. There's nothing to apologize for. Whatever path brought you here, we're starting from where you are right now.
If you're a good candidate, we can often do shockwave therapy the same day as your first evaluation. Results aren't instant — most people notice initial improvement in the two- to four-week window, with full benefit developing over three to six months as the tissue remodels. I'll set those expectations clearly before we start.
Either way, I need to see you. Even if you've had foot pain for years and tried everything — especially if you've had foot pain for years and tried everything.
Keeping Your Foot Pain from Coming Back
Getting out of pain is step one. Staying out is step two — and it's where a lot of people drop the ball, not out of negligence, but because nobody explained what maintenance actually looks like.
Footwear is the most common culprit for recurrence. Athletic shoes wear out long before they look worn out — support breaks down around 300 to 500 miles, but most Houston patients run them well past that. If you're not tracking mileage, replace them every six months if you're active. Indoors, supportive footwear from your first step in the morning matters just as much as what you wear outside.
Custom orthotics are the most reliable long-term tool I have for keeping people out of pain — particularly for those with structural issues that repeatedly load the same areas. Think of them as ongoing correction, not a one-time fix. And the 60-second morning stretching sequence — mid-back to hips to calf — dramatically cuts reinjury risk when you're consistent.
It takes 60 seconds. It's worth it.
I won't judge you for what got you here. But I will be honest about what keeps people out of pain long-term: consistent habits, the right footwear, and addressing structural issues before they become injuries again. If you're a runner returning to activity after treatment, I'll give you a specific progression protocol so you're not guessing at what your foot can handle.
