At Sonopodiatry practice, we offer Focused shock-wave therapy, a form of Extracorporeal Shock Wave Therapy (ESWT)provided with the machine Richard Wolf® Focused Shock Wave Therapy . This is a non-invasive treatment used to repair damaged or degenerative soft tissues, including muscles, tendons, ligaments, and joints. By delivering focused energy waves to specific areas, ESWT promotes the regeneration of tissue, reduces pain, and accelerates healing.
However, There are two main types of extracorporeal shock wave therapy:
- Focused Shock Wave Therapy
- Radial Shock Wave Therapy
| Focused Shock waves therapy | Radial Shock waves therapy | |
| Waves type | Focused (converging acoustic energy) | Radial (diverging pressure waves) |
| Penetration depth | Up to 17cm (distal end of the 5 Mpa-Zone)/Alternatively: can be treated accurately and precisely according to the specific disease/injured tissue in 0-100mm increments (focus-central) | ~2 cm / alternatively.: energy scatters and can only reach a maximum depth of 2 cm |
| Energy Focus | High precision at a focal point | Dispersed energy over a wider area |
| tissue targeting | Superficial and deep soft tissues, bones, tendons,ligaments | Superficial soft tissues, muscles |
| Pain tolerance | Often better tolerated (less skin irritation); can precisely reproduce the “known” pain and is therefore even able to treat the cause | Can cause discomfort, haematomas due to skin impact |
| Indicated conditions | Chronic tendinopathies (e.g., Achilles tendinopathy, plantar heel pain, etc.) , calcific tendinopathy of the shoulder, pseudarthrosis, enthesopathies, frozen shoulder, impingement syndrome of the shoulder, myofascial pain syndrome | Muscle relaxation, mild tendinopathies |
| Clinical effectiveness | Higher for chronic/deep-lying pathologies. All the first and pioneering basic studies were carried out exclusively with focussed devices. | Moderate for superficial/acute conditions |
| Device example | Richard Wolf®PiezoWave2T | BTL radial shockwaves, EMS swiss Dolorclast |
| Treatment precision | Very high (focused zone). Focus point can be placed directly on the affected area. | Low to moderate. Difficult to impossible to localise the patient’s known pain. |
. WHAT’S THE DIFFERENCE?
Why Choose Focused Shock Wave Therapy?
There are several important reasons why a patient might choose Focused Shock Wave Therapy over Radial Shock Wave Therapy. While both are used for musculoskeletal disorders and pain management, they differ significantly in their mechanism, precision, depth of penetration, and therapeutic applications.
Key Advantages of Richard Wolf® Focused Shock Wave Therapy:
1. Greater Depth of Penetration
Focused shock waves can reach deeper tissues, making them ideal for treating deep-seated conditions like:
- Chronic tendinopathies (Achilles tendinopathy, Plantar heel pain; Tennis / Golfer elbow)
- Deep muscle trigger points (e.g., low back pain -> M. quadratus lumborum, M. piriformis, etc.)
- Bone conditions (e.g., delayed fracture healing, bone marrow oedema)
In contrast, radial shock waves have a shallower effect, mostly limited to 2 cm, and are better for superficial conditions.
2. Higher Energy Precision
Focused shock waves deliver energy to a precise focal point, minimizing trauma to surrounding tissues.
Radial waves spread energy more diffusely, leading to a less targeted and sometimes less effective treatment for certain pathologies.
3. Evidence-Based Clinical Applications
Basic information: All the first and pioneering basic studies (in the 80s and 90s) were carried out exclusively with focused devices. When radial devices came onto the market at the beginning of the 2000s, they proclaimed these findings of focused devices on their radial devices.
Focused shock wave therapy has stronger clinical evidence for use in:
- Plantar fasciitis/fasciopathy
- Non-union fractures
- Trigger point
- Achilles enthesopathy/tendinopathy
- Tibialis Posterior tendinopathy
- Patellar tendinopathy
- Shoulder impingement
- Frozen shoulder
- Golfer / Tennis Elbow
4. Less Painful for Sensitive Patients
Because energy is focused deeper, skin and superficial tissues are less irritated, often making focused therapy better tolerated, especially in sensitive areas.
When Radial Shock Wave Therapy Might be a good option?
- For larger treatment areas (e.g., muscle relaxation in sports therapy/recovery)
- When targeting superficial structures
- For lower-cost, less invasive sessions
- In early-stage or mild conditions.
How is the treatment delivered?
We usually recommend 1 session per week over 3-6 weeks, each session lasts about 20-30 minutes, but the delivery of shockwaves is considerably shorter. The appointment time is also used to assess your injury, determine the location of the treatment and screen your response to previous session if you are attending your follow up appointment. The outcomes has to be reviewed after
Summary:
A patient should opt for Focused Shock Wave Therapy when a precise, deeper, and more powerful treatment is needed, especially for chronic, deep. Itis a more advanced technology, offering higher efficacy in many clinical applications compared to radial therapy.
Post treatment: Cease of sport activity is strongly recommended during the treatment sessions or a sport activity maybe adapt for each patient (such as swimming, cycling, or cross-training are generally considered safe). You may modify your activity routine, but it’s important to seek advice from a trained healthcare or exercise professional.
In addition to Focused shockwave therapy, you should follow an individualized rehabilitation program. Focused Shockwave therapy should not be relied upon as a standalone treatment. A podiatrist, physiotherapist, sport and exercise medicine consultant, or strength & conditioning coach can help guide you through this process.
Still not sure:
For more information or to book an appointment, please contact our practice at 07714792424 or info@sonopodiatry.co.uk
Acknowledge:
Many thanks for the information about the Richard Wolf® machine ESWT provided by the Elvation medical GmbH® product specialist team, physiotherapist Mr Jakub Buenczak and Physiquipe®.