What has been published?

The Use of extracorporeal shock wave therapy for children’s foot, ankle and leg concerns was created by an international working group.

The working group considered focused and/or radial extracorporeal shock wave therapy (ESWT) applied to the lower limb, of any dose (single or multiple), and any frequency. All working group members contributed to gathering, critically evaluating and summarising the evidence, and this work was unfunded.

Who was in the working group?

The working group consisted of the following Australian authors, alongside Canadian authors and authors from the United Kingdom who are detailed in full in the soon-to-be-released position statement: 

  • A/Prof Cylie Williams Associate Professor – Monash University and private practitioner  
  • Dr Antoni Caserta Senior Clinician – Monash Health, and private practitioner  
  • Dr Alicia James Head of Podiatry – Monash Health, private practitioner, Chair of the Australian Podiatry Association Paediatric Podiatry Special Interest Group  
  • A/Prof Kade Paterson Senior Research Fellow – The University of Melbourne, President – Sports and Exercise Podiatry Australia, private practitioner.  

Why was this statement developed?

This position statement was developed to guide the use of ESWT in children and teenagers for podiatrists who have access to ESWT, or who refer for its use.


What did the process involve?

Underpinning this statement is a registered systematic review.The Cochrane Risk-of-Bias tool for randomized trials (RoB – 2) was used, and the Risk Of Bias In Non-randomised Studies – of Interventions (ROBINS-I) tools were also used to describe any risk of bias regarding included studies.

What does the position statement recommend?

It states that 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. Children or teenagers should not have shockwave treatment for foot, ankle, or leg problems. The reasoning behind this statement will be explored further when it is released at the upcoming Australian Podiatry Conference and shared more widely once published. These statements are based on the body of evidence and manufacturer guidelines informing the use of ESWT as a treatment in these age groups and with a variety of health conditions. 


Additional reflections

A/Prof Cylie Williams had the following to share about the process and the conclusions drawn in the Position Statement. Co-author Dr Antoni Caserta, PhD will expand upon these insights at the upcoming Australian Podiatry Conference 

“Children and teenagers are vulnerable for several reasons, including factors such as their future health being dependent on current health, their behaviours, development, and the overall environmental impact on wellbeing.  Their vulnerability is especially pronounced, given their physiological and psychosocial needs. This means it is important we consider the impact of the use of new technologies and always weigh the risks and benefits. There are many established high-value treatments for children who experience limitations in their body, mobility, participation or activity levels owing to causes such as pain that can result from foot, ankle, and leg conditions. We hope this position statement helps inform clinical decision making when unsure of the suitability of this treatment modality in paediatric practice.”

More information

For more information, check the Australian Podiatry Association’s website at the end of June for a full copy of the position statement.