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Retro Calcaneal Bursitis

Prior to any Sonocur treatment, care must be taken to be certain that the patient meets the treatment criteria, has no treatment contraindications, has had the necessary pre-treatment imaging studies, and has read and signed the proper informed consent.

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  1. Place patient on treatment table in the lateral position with a pillow under the head and between the legs.

  2. Identify trigger point (sore area along the heel) by palpation and mark with pen if necessary.

  3. Apply transmission gel over trigger point.

  4. Swing Sonocur shock head into place and position over identified trigger point. Retrocalcaneal bursitis is best approached from the medial aspect of the foot where the painful and tender area is almost always located anterior to the Achilles insertion, inferior and posteriorly to the medial malleolus.

  5. Apply shock waves initially at lowest energy level (level 1) at 4Hz.

  6. Move shock head in small increments until patient reports maximal reproduction of discomfort.

  7. Accomplish fine adjustment of shock wave penetration depth by adjusting amount of fluid in bellows, again with patient feedback to identify maximal trigger point stimulation.

  8. Great care must be taken to precisely identify the exact area of pain. It may require the use of several shocks (eg.100) to identify this site.

  9. Depending upon patient tolerance, gradually increase energy levels to the highest level that can be maximally tolerated. Retrocalcaneal bursitis is often very sensitive to treatment and lower energy levels (levels 1 and 2, rarely 3) are generally all that is tolerated. Be certain that the patient does not become too uncomfortable. It is more important to deliver all the shock waves to the correct area at a lower energy level than miss the mark with higher levels because the patient is too uncomfortable.

  10. Readjust the shock head position after every 200-400 shocks to precisely treat the maximal area of tenderness. This is necessary because of the slight positional movements which may occur during treatment.

  11. Deliver a total of 2000 shocks to the affected site after it has been identified.

  12. Remove shock head from the treated area and observe the site of application.

  13. Wipe away the gel.

  14. Supply patient with post treatment instructions and return appointment for additional treatment or physician visit.


  1. If the patient is exquisitely tender or has significant discomfort, it may be helpful to initiate treatment slightly away from the point of maximal tenderness. After 100-200 shocks, slowly readjust the shock head so that the shock waves are focused more progressively toward area of maximal tenderness. Slowly advance to the maximal trigger point and complete the treatment.

  2. Inform the patient that it is usual to have soreness after treatment and that often pain will be worse for a few days until healing begins. Explain that if multiple treatments are necessary, that subsequent treatments can sometimes be more uncomfortable than the initial treatment. In addition, emphasize that healing may take several weeks to occur and that one should not expect maximal improvement until 12 weeks after the last treatment.

  3. Some patients may experience shock wave exit sensations opposite the application site at medium or higher energy settings. This is normal and causes no harm.

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The Sonocur® Orthopedic Extracorporeal Shockwave system is available in Canada and other countries where regulatory approval has been obtained. The Sonocur® Basic is FDA approved in the United States for the treatment of chronic lateral epicondylitis (tennis elbow).

© 2012 Sonorex. All rights reserved. By using this service, you accept the terms of our Visitor Agreement. Please read it. The material is for informational purposes only and is not a substitute for medical advice or treatment for any medical conditions. You should promptly seek professional medical care if you have any concern about your health, and you should always consult your physician before starting a fitness regimen.