Are all Achilles tendon problems the same?

No. Location, duration, severity and differential diagnoses influence the treatment pathway.

Is exercise still relevant?

A clinician may combine appropriate loading exercises with other interventions according to the individual case.

Can acute tendon rupture be treated this way?

Suspected rupture or severe injury requires prompt medical assessment and is not a routine shockwave application.

SHOCKIS / CLINICAL APPLICATION

Achilles Tendinopathy

Achilles tendinopathy is a common overuse condition characterized by Achilles tendon pain, swelling, and impaired function.

Disease Overview

Achilles tendinopathy is a common overuse condition characterized by Achilles tendon pain, swelling, and impaired function. It is classified into insertional type (at the bone-tendon junction) and midportion type (more than 2 cm proximal to the insertion point). Repetitive loading with insufficient recovery leads to degenerative changes in the tendon matrix.

Typical Symptoms and Associated Factors

Symptoms include posterior heel pain that worsens with physical activity.

Clinician palpating a patient's Achilles tendon and posterior heel

Professional Evaluation

The diagnosis is primarily clinical, based on localized symptoms provoked by tendon-loading activities and focal tenderness on palpation. Current clinical practice guidelines do not recommend imaging as an aid for routine diagnosis; imaging studies may be considered when the diagnosis is uncertain or alternative pathologies need to be excluded.

Clinical examination of the Achilles tendon, including focal palpation and loading tests

Conservative Management

For midportion Achilles tendinopathy, clinical practice guidelines recommend progressive tendon-loading exercises and patient education as first-line treatment. Exercises should be individualized according to the patient's symptoms, functional capacity, and response to loading. Clinicians should avoid complete rest and encourage maintaining activity within pain tolerance. Other measures may include heel lifts, orthoses, and non-steroidal anti-inflammatory drugs.

Applying coupling gel to the Achilles tendon area

ESWT: Potential Mechanisms and Limitations of Evidence

Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment that uses a device to deliver shock waves through the skin to the affected area. The exact mechanisms by which this therapy may exert effects on tendinopathy have not been fully elucidated. The evidence base for ESWT in Achilles tendinopathy is inconsistent.

Extracorporeal shock wave therapy being applied to the Achilles tendon

Safety Considerations

Within the scope of the reviewed evidence, according to NICE, ESWT for Achilles tendinopathy does not raise major safety concerns. One systematic review reported 2 cases of Achilles tendon rupture after focused shock wave therapy; however, these cases were only reported as temporal associations after treatment, and no causal relationship can be established. These findings should be interpreted in the context of the limitations of the reviewed studies. Appropriate screening for patient contraindications, adherence to device-specific instructions for use, and sound professional clinical judgment remain essential.

Contact with SHOCKIS

Clinicians and procurement professionals evaluating shock wave therapy systems for Achilles tendinopathy should consider device-specific characteristics and the applicable regulatory status in their respective regions. The evidence summarized above reflects the broader ESWT literature and does not constitute validation of any specific SHOCKIS product for any particular indication. If you wish to discuss how SHOCKIS can support your clinical or procurement needs, our team is welcome to hear from you.

Clinical Workflow Checklist

01CLINICAL ASSESSMENT
Review patient history, symptoms, and contraindications.
02TARGET AREA IDENTIFICATION
Identify the treatment area through clinical examination and appropriate imaging when needed.
03TREATMENT SETUP
Select treatment parameters according to clinical assessment, device instructions, and patient tolerance.
04SHOCKWAVE APPLICATION
Apply coupling gel and deliver treatment while monitoring patient response.
05POST-TREATMENT CARE
Clean the treatment area and applicator, and provide appropriate aftercare guidance.

Safety Information

The information below describes conditions and reactions generally associated with extracorporeal shock wave therapy. It does not replace the instructions for use of the specific SHOCKIS device. Clinicians must verify applicability against the current device labeling and their own clinical judgment.

Contraindications & Precautions

Shock wave therapy should not be applied, or should be applied only with particular caution, in the following situations:

Known hemorrhagic disorders or coagulation dysfunction
Thrombosis in or adjacent to the intended treatment area
Severe cognitive impairment or psychiatric illness
Implanted pacemakers or other active electronic implants
Tumors located in the treatment area
Pregnancy, particularly the lower abdominal region
Ruptured or severely injured tendons and fasciae, as well as regions containing the brain, spinal cord, large blood vessels, or major nerve trunks
Regions containing abdominal organs, especially lung tissue
Bone defects exceeding 2 cm
Joint fluid leakage
Growing pains in pediatric patients

Any other condition deemed unsuitable by the treating physician.

Potential Adverse Reactions

The following reactions may occur at or near the treatment site:

Local hematoma, ecchymosis, or petechiae
Temporary intensification of pain shortly after treatment
Local numbness, needle-like sensation, or hypoesthesia
High-energy extracorporeal shock wave therapy may cause local nerve or vascular injury

These reactions are generally transient and typically resolve within approximately one week without special treatment.

References