Extracorporeal Shock Wave Therapy (ESWT) for Non-Union and Delayed Union of the Medial Malleolus: Worth the Investment?

Extracorporeal Shock Wave Therapy (ESWT) is a novel treatment modality gaining popularity for various orthopedic conditions. As a physician, particularly in the realm of orthopedics, I often find myself fielding questions regarding the effectiveness of ESWT for non-union and delayed union of the medial malleolus. Let's dive into the evidence and consider the potential benefits and limitations of ESWT.

Potential Benefits of ESWT

ESWT is primarily known for its ability to stimulate tissue regeneration and anti-fibrosis. The main outcomes of this therapy are fast pain relief and mobility restoration. Additionally, it offers a non-surgical approach, making it an ideal therapy for those seeking to avoid surgery and painkillers. It is commonly used to treat conditions such as calcifications, jumper's knee, painful shoulder, tennis elbow, heel spur, insertional pain, hip pain, chronic tendinopathy, and medial tibial stress syndrome.

Current Evidence for ESWT in Orthopedic Cases

Unfortunately, there are no strong studies to definitively answer whether ESWT is effective for non-union and delayed union of the medial malleolus. However, the clinical usage of this therapy is not widespread in most orthopedic communities within the United States. Over the past few decades, a few studies have suggested a modest benefit from ESWT, but almost all of these studies are relatively weak. The larger studies have not shown significant advantages, either long-term or short-term, compared to surgical interventions.

Considerations for Non-Union and Delayed Union

When it comes to non-union, often the bigger question is whether there are underlying factors contributing to the condition. These factors could include poor bone quality, inadequate blood supply, or incorrect fixation. If these factors are not addressed, non-union or delayed union may persist despite any treatment. In such cases, the focus may shift towards addressing the underlying issues rather than solely relying on ESWT.

Conclusion and Recommendations

While ESWT offers some potential benefits for pain relief and mobility restoration, its efficacy for non-union and delayed union of the medial malleolus remains questionable based on current evidence. The lack of strong clinical support and the absence of widespread use in orthopedic communities suggest that ESWT may not be the most recommended initial treatment option. However, if other conservative measures have failed and surgery is not preferred, ESWT can be considered as a potential alternative.

Ultimately, the decision to invest in ESWT should be made after thorough discussion with a qualified orthopedic surgeon. Patients should be aware of the limitations and potential risks associated with this treatment and explore all available options to find the best course of action for their specific condition.