What if shockwave therapy does not relieve heel pain?

Heel pain can arise from the plantar fascia, Achilles tendon, a bursa, a joint, a nerve or a bone, and shockwave therapy is not aimed at every source. Standing for long periods, running, hard surfaces, unsupportive footwear or a sudden training change may continue to stress the area. Pain that is worst with first steps, pain behind the heel, or pain with squeezing the heel gives the clinician useful clues. The original diagnosis may need refining rather than the same treatment being repeated.

Note when pain starts, whether it eases with movement, and which shoes or activities change it. Temporarily reduce the aggravating load while maintaining comfortable movement. Ask about calf and foot exercises, a gradual return to activity, footwear changes or another assessment. Do not increase impact exercise simply because a session has finished. Further information is available under Heel Pain and Shockwave Therapy.

Get prompt care after a fall or forceful landing, sudden inability to push off, a snap, substantial swelling or bruising, or inability to bear weight. A hot, red heel with fever, new numbness, a pale or cold foot, or rapidly increasing pain also needs urgent assessment. These signs can indicate an injury, infection, nerve problem or circulation concern.

Ask which tissue is most likely involved, whether the treatment target was correct, what activity level is suitable now, and whether examination or imaging is needed. Ask how long to trial the revised plan before another review.