Focused shock wave therapy (ESWT) and electromagnetic transduction therapy (EMTT) may improve post-operative bone...

Surgical procedures of the foot and ankle commonly involve treatment of bone anatomy and include osteotomies and open reduction with internal fixation. A potential complication of these types of surgeries is delayed or non-union of bones. Delayed osseous healing prolongs post-operative recovery and may result in delayed return to work, increased financial costs and impaired health outcomes. Identifying additional non-invasive therapies that aid in bone healing may improve surgical outcomes. Focused Extracorporeal Shockwave Therapy (ESWT) and Electromagnetic Transduction Therapy (EMTT) are both procedures proposed to improve bone and soft tissue healing.

A matched analysis was conducted on foot and ankle surgeries performed from June 2022 through April 2023. Ten patients (controls) were identified who had surgical management for talar osteochondral defects, foot and ankle fractures, and joint disease who were matched with ten patients who received ESWT and EMTT (ESWT + EMTT patients). The ESWT + EMTT patients received one session of focused ESWT ("Duolith"™, Storz Medical AG, Tägerwilen, CH) applied up to 0.35 mJ.mm² to the surgical site within three weeks post-operation and two sessions of EMTT ("Magnetolith"™, Storz Medical AG, Tägerwilen, CH) set at 6000 pulses each, power level 8, and 8 Hz. The primarily outcome was differences in VAS score at the time of weight-bearing and time to return to activity calculated in weeks for ESWT + EMTT compared to control patients. An exploratory analysis included reviewing radiographs for evidence of radiographic healing on plain film radiographs performed four weeks post-operatively. Statistical analyses were performed using student t-tests and Fisher's Exact tests, with P < 0.05 set as statistically significant.

Twenty patients (15 women and 5 men) of average age 52.1 ± 16.6 years (range 18-73 years-old) were included with similar age and sex between EMTT + ESWT and control patients. On average, ESWT + EMTT had lower post-operative VAS pain scores than control patients (0.2 ± 0.4 vs 3.1 ± 1.3, P = 0.0001). Additionally, the mean return to activity was reduced for ESWT + EMTT patients (13.2 ± 2.9 weeks vs 22.4 ± 9.2 weeks, P = 0.01). A larger portion of ESWT + EMTT patients had evidence of radiographic healing at four weeks post-operatively compared to controls (8 of 10 vs 2 of 10, P = .03).

The combination of ESWT and EMTT post-operatively may improve pain and earlier return to activity, and treatment was well-tolerated after foot and ankle surgeries. These results can be further explored through placebo-controlled randomized clinical trials in surgical management of foot and ankle conditions and other indications.