🦶 Extracorporeal Shockwave Therapy Simulator

Chronic Plantar Fasciitis Baseline

Repeated strain thickens and inflames the plantar fascia at the heel.

• >4mm: Fascia thickness (vs ~2mm healthy)
• ~50%: Heel-spur prevalence (of chronic cases)
• >6 mo: Pain duration (defines chronic stage)
• Low: Blood flow (degenerative tissue)

Degenerative fascia changes

Collagen fibers disorganize and microtears accumulate over time.

Chronic cases show degeneration, not just inflammation.

Why conservative care stalls

Poor local blood supply limits the fascia's own repair capacity.

Rationale for shockwave therapy

Mechanical stimulation aims to restart a stalled healing response.

Shockwave Probe Application

A handheld probe couples to the heel and fires focused pulses.

• 2000-3000: Pulses per session (typical protocol)
• 0.1-0.4: Energy range (mJ/mm²)
• ~10 min: Session length (outpatient)
• Gel: Coupling medium (transmits acoustic energy)

Focused vs radial waves

Focused probes concentrate energy at a defined tissue depth.

Energy titration

Energy level is tuned to patient tolerance and target depth.

Higher energy reaches deeper but increases discomfort.

Pulse propagation

Pressure waves ripple through tissue as concentric rings.

Controlled Microtrauma Induction

Pulses create tiny, deliberate injury points within the fascia.

• Dozens: Microtrauma sites (per session)
• Micro: Injury scale (sub-millimeter)
• ↑: Cytokine release (growth factor signaling)
• Transient: Pain flare (resolves in days)

Purposeful micro-injury

Small controlled trauma reactivates the tissue repair cascade.

Growth factor release

Damaged cells release signals that summon repair machinery.

Microtrauma is the trigger, not the treatment itself.

Dose dependency

More sessions and energy generate broader microtrauma coverage.

Neovascularization Stimulation

New capillary sprouts grow into the injured fascia over sessions.

• ↑↑: VEGF expression (angiogenic signaling)
• Growing: New capillaries (per treated site)
• Progressive: Blood flow gain (across sessions)
• Weeks: Peak effect (after final session)

Angiogenesis cascade

VEGF and related factors drive sprouting of new vessels.

Neovascularization restores nutrient supply to healing tissue.

Capillary network growth

New vessels branch toward microtrauma sites over time.

Session dependency

Vascular response scales with number of completed sessions.

Tissue Repair & Pain Reduction

Collagen remodels and heel pain gradually resolves over months.

• ~70-80%: Success rate (symptom improvement)
• Progressive: Pain reduction (weeks to months)
• Restored: Collagen realignment (organized fibers)
• 3 months: Outcome window (typical assessment)

Collagen remodeling

Fibers reorganize into a stronger, aligned structure.

Symptom resolution

Pain and stiffness decline as repair progresses.

Full benefit typically appears weeks after therapy ends.

Long-term outlook

Most patients avoid surgery after a full ESWT course.