Use of extracorporeal shock wave therapy for children’s foot, ankle and leg concerns

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Position statement:
Australian Podiatry Association, Ontario Society of Chiropodists, Royal College of Podiatry

Use of extracorporeal shock wave therapy for children’s foot, ankle and leg concerns
Position Statement Summary
• Children and teenagers are vulnerable due to future health being dependent on current health, their behaviours, development, and the overall environmental impact on wellbeing; vulnerability is especially due to their physiological and psychosocial needs
• Foot, ankle or leg conditions in children and teenagers can change body function, participation in care, family, and education settings, or how much activity can be performed compared to children without these conditions • There are many established high value treatments for children who have pain, body limitations, activity, and participation limitations because of conditions relating to the foot, ankle, and leg
• Interventions that induce pain, or treatments that have a cost implication over that of alternatively effective high-value care, have limited use in health care, particularly in paediatric health care. These treatments are known as low-value care.
• There is increasing interest in the use of extracorporeal shock wave therapy (ESWT) for the treatment of foot, ankle, and leg conditions
• The majority of ESWT equipment technical manuals provide a list of contradictions or warnings that this technology should not be used on children or teenagers with growth plates, with some manufacturers providing condition-based exceptions or cautions.
• Despite these warnings, there is evidence this equipment is being promoted for use in clinical practice with children and teenagers
• A systematic review and risk of bias assessment of evidence relating to the use of ESWT in children informed this position statement. There were very few well-designed clinical trials assessing the efficacy of this treatment
• From the few trials that do exist, our review findings show that ESWT does not offer an advantage over other treatment for any outcomes relating to foot, ankle, or leg pathologies in children or teenagers
• There are unknown harms associated with the use of any technology that may induce a pain response during its use, or have limited, or no benefit compared to no treatment, or a treatment currently embedded in practice • This means there is no evidence supporting the use of ESWT in children and teenagers’ foot, ankle, or leg conditions. These statements are based on the body of evidence using ESWT as a treatment in these age groups and with a variety of health conditions
• Our review also found that where there was evidence for efficacy, it was associated with concerns about the risk of bias. This limits the generalisability of these findings in clinical practice
• Podiatrists intending to use ESWT on children and teenagers, should only do so within the confines of an ethically approved and well-designed clinical trial that also considers comparative effectiveness and cost within its design.

Link to policy document

 

Focused extracorporeal shockwave therapy for youth sports-related apophyseal injuries: case series
Tarek Shafshak & Marwa Abdullah Amer
Journal of Orthopaedic Surgery and Research volume 18, Article number: 616 (2023)