{"id":11649,"date":"2025-10-24T16:26:48","date_gmt":"2025-10-24T20:26:48","guid":{"rendered":"https:\/\/funcphysio.com\/?p=11649"},"modified":"2025-10-24T16:26:50","modified_gmt":"2025-10-24T20:26:50","slug":"case-study-extracorporeal-shockwave-therapy-for-chronic-posterior-tibialis-tendon-dysfunction","status":"publish","type":"post","link":"https:\/\/funcphysio.com\/zh-hant\/2025\/10\/24\/case-study-extracorporeal-shockwave-therapy-for-chronic-posterior-tibialis-tendon-dysfunction\/","title":{"rendered":"Case Study: Extracorporeal Shockwave\u00a0 Therapy for Chronic Posterior Tibialis\u00a0 Tendon Dysfunction\u00a0"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"h-patient-presentation-and-history\">Patient Presentation and History<\/h2>\n\n\n\n<p>A <strong>25-year-old male <\/strong>presented with chronic pain and dysfunction associated with <strong>Posterior&nbsp; Tibialis Tendon Dysfunction (PTTD)<\/strong>. The initial injury occurred in <strong>2023 <\/strong>while running,&nbsp; consistent with an overuse injury. The patient had been actively engaged in <strong>physical therapy&nbsp; (PT) <\/strong>since the onset of symptoms, achieving consistent, measurable improvement.&nbsp;<\/p>\n\n\n\n<p>However, the patient experienced a significant <strong>plateau in recovery starting in April 2025<\/strong>,&nbsp; indicating that the current conservative management was no longer sufficient to resolve the&nbsp; persistent symptoms and restore full function. Due to this refractory nature of the condition,&nbsp; <strong>Shockwave Therapy <\/strong>was introduced as an adjunctive treatment.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-treatment-protocol-extracorporeal-shockwave-therapy-nbsp-eswt-nbsp\"><strong>Treatment Protocol: Extracorporeal Shockwave Therapy&nbsp; (ESWT)&nbsp;<\/strong><\/h2>\n\n\n\n<p>The patient received a total of <strong>five ESWT sessions <\/strong>over a period of <strong>one month<\/strong>. The treatment&nbsp; protocol for each session was multifaceted, utilizing various modes of shockwave application:&nbsp;<\/p>\n\n\n\n<p>1. <strong>Muscle Smoothing: <\/strong>Applied to the surrounding musculature for broader myofascial&nbsp; relief.&nbsp;<\/p>\n\n\n\n<p>2. <strong>Pain Zone Treatment: <\/strong>Focused application on the area of maximum patient-reported&nbsp; tenderness.&nbsp;<\/p>\n\n\n\n<p>3. <strong>Direct Posterior Tibialis Treatment: <\/strong>Targeted application along the anatomical course&nbsp; of the muscle and tendon.&nbsp;<\/p>\n\n\n\n<p>The treatment was delivered to multiple anatomical locations associated with the PTT complex:&nbsp; the <strong>fascial layer around the tibia<\/strong>, the <strong>posterior tibialis muscle belly<\/strong>, the <strong>tendon proper<\/strong>, the&nbsp; <strong>origin<\/strong>, and the <strong>insertion <\/strong>(navicular\/cuneiforms).&nbsp;<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img fetchpriority=\"high\" decoding=\"async\" width=\"528\" height=\"370\" src=\"https:\/\/funcphysio.com\/wp-content\/uploads\/\/2025\/10\/image-1.png\" alt=\"\" class=\"wp-image-11652\" style=\"width:391px;height:auto\" srcset=\"https:\/\/funcphysio.com\/wp-content\/uploads\/2025\/10\/image-1.png 528w, https:\/\/funcphysio.com\/wp-content\/uploads\/2025\/10\/image-1-300x210.png 300w\" sizes=\"(max-width: 528px) 100vw, 528px\" \/><\/figure>\n<\/div>\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"RPW therapy\" width=\"750\" height=\"422\" src=\"https:\/\/www.youtube.com\/embed\/gvF66fIJPGc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-session-by-session-clinical-response\"><strong>Session-by-Session Clinical Response<\/strong><\/h2>\n\n\n\n<p>The patient&#8217;s response was monitored both immediately post-treatment and in the days following. The discomfort level was tracked using a numeric rating scale (NRS) for pain\/discomfort, where 0 represents no discomfort and 10 represents the worst imaginable discomfort.<\/p>\n\n\n\n<p><strong>Session 1.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-regular\"><table><tbody><tr><td>Metric<\/td><td>Pre-Treatment<\/td><td>Post-Treatment<\/td><td>Post-Treatment Change<\/td><td>Notes<\/td><\/tr><tr><td>Discomfort (NRS)<\/td><td>4\/10<\/td><td>1\/10<\/td><td>Immediate Reduction<\/td><td>Patient felt an immediate and significant difference, suggesting an initial analgesic anddesensitization effect.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Session 2.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Metric<\/td><td>Pre-Treatment<\/td><td>Post-Treatment<\/td><td>Interval Symptom Change<\/td><td>Notes<\/td><\/tr><tr><td>Discomfort (NRS)<\/td><td>Mild<\/td><td>No significant difference<\/td><td>Soreness for 2 days<\/td><td>Patient reported typical post-ESWT soreness for two days, which did not limit functional activity. The initial analgesic effect was not as pronounced as Session 1.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Session 3.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Metric<\/td><td>Pre-Treatment<\/td><td>Post-Treatment<\/td><td>Interval Symptom Change<\/td><td>Notes<\/td><\/tr><tr><td>Discomfort (NRS)<\/td><td>Mild<\/td><td>Improved symptoms<\/td><td>Able to run short distances<\/td><td>Patient was able to complete short runs as usual without experiencing any post-activity aggravation of symptoms, marking an important functional milestone. Subjective symptoms improved following the treatment.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Session 4.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Metric<\/td><td>Pre-Treatment<\/td><td>Post-Treatment<\/td><td>Interval Symptom Change<\/td><td>Notes<\/td><\/tr><tr><td>Discomfort (NRS)<\/td><td>Exacerbated (Not specified, likely \u2265 4\/10)<\/td><td>Significantly Improved<\/td><td>Exacerbation for 3 days due to travel<\/td><td>Symptoms were aggravated due to an external factor (significantly increased time on feet during travel), providing a stress test. The patient required a session to address thisflare-up, which resulted in significant immediate improvement.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Session 5.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Metric<\/td><td>Pre-Treatment<\/td><td>Post-Treatment<\/td><td>Interval Symptom Change<\/td><td>Notes<\/td><\/tr><tr><td>Discomfort (NRS)<\/td><td>Mild\/Low<\/td><td>N\/A (Focus on long-term outcome)<\/td><td>Able to complete a long run<\/td><td>The patient achieved a major functional goal: completing a long run without experiencing any discomfort afterwards. The patient reported a feeling of steady and consistent improvement, indicating the ESWT course successfully broke the prior treatment plateau.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img decoding=\"async\" width=\"380\" height=\"260\" src=\"https:\/\/funcphysio.com\/wp-content\/uploads\/\/2025\/10\/image-1.jpg\" alt=\"\" class=\"wp-image-11651\" srcset=\"https:\/\/funcphysio.com\/wp-content\/uploads\/2025\/10\/image-1.jpg 380w, https:\/\/funcphysio.com\/wp-content\/uploads\/2025\/10\/image-1-300x205.jpg 300w\" sizes=\"(max-width: 380px) 100vw, 380px\" \/><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\" id=\"h-discussion-and-conclusion-draft-nbsp\"><strong>Discussion and Conclusion (Draft)&nbsp;<\/strong><\/h2>\n\n\n\n<p>This case study illustrates the utility of Extracorporeal Shockwave Therapy (ESWT) as an&nbsp; effective adjunctive treatment for chronic Posterior Tibialis Tendon Dysfunction (PTTD) that had&nbsp; become refractory to standard physical therapy.&nbsp;<\/p>\n\n\n\n<p>Prior to the intervention, the patient had reached a <strong>therapeutic plateau <\/strong>in April 2025. The&nbsp; introduction of the five-session ESWT protocol over one month led to a rapid and consistent&nbsp; reversal of symptoms and functional limitations.&nbsp;<\/p>\n\n\n\n<p><strong>Patient\u2019s comment<\/strong>: \u201cWhen I started shockwave, my 2-3 mile runs would usually take 2-4 days for the inflammation cycle to resolve. This was quite consistent over the past months. A month into the therapy, I was able to go on a 6-miler with almost no symptoms in the following days.While there is still sometimes a slight irritation in the PTTD (close to where it terminates in the foot) sometimes, the improvement is undeniable.\u201d<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-key-observations-nbsp\"><strong>Key Observations:&nbsp;<\/strong><\/h2>\n\n\n\n<p>\u25cf <strong>Immediate Analgesia: <\/strong>Session 1 demonstrated a profound immediate reduction in&nbsp; discomfort (4\/10 to 1\/10), suggesting an initial neurophysiological\/analgesic effect.&nbsp;<br>\u25cf <strong>Functional Progression: <\/strong>The patient progressed from mild soreness (Session 2) and&nbsp; the ability to tolerate short runs (Session 3) to successfully completing a <strong>long run <\/strong>without aggravation (Session 5).<\/p>\n\n\n\n<p>\u25cf <strong>Resilience: <\/strong>The episode of exacerbation due to travel (Session 4) demonstrated that<\/p>\n\n\n\n<p>while the tendon was not fully healed, it was responsive to further ESWT intervention,<\/p>\n\n\n\n<p>with the treatment successfully managing the flare-up and restoring progress.&nbsp;<\/p>\n\n\n\n<p>\u25cf <strong>Breaking the Plateau: <\/strong>The overall success is evidenced by the final reported outcome&nbsp; in<\/p>\n\n\n\n<p>Session 5: the patient felt improvement was <strong>steady and consistently getting better<\/strong>,<\/p>\n\n\n\n<p>successfully moving beyond the chronic plateau.&nbsp;<\/p>\n\n\n\n<p><strong>Conclusion: <\/strong>In this case of chronic PTTD, a five-session course of multi-modal ESWT&nbsp; effectively managed a significant flare-up and enabled the patient to overcome a two-month&nbsp; therapeutic plateau, leading to a meaningful return to running activity. ESWT appears to be a&nbsp; valuable tool for restoring the healing process in chronic tendon pathology when conservative&nbsp; treatments alone become insufficient.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Patient Presentation and History A 25-year-old mal [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":9864,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[128,255,261],"tags":[426,148,236,573,575,136,574],"class_list":["post-11649","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-front-page-2","category-functional-manual-therapy","category-yj-choi","tag-chronic-pain","tag-funcphysio","tag-physical-therapy","tag-posterior-tibialis","tag-shockwave","tag-sports","tag-tendinitis"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.7 (Yoast SEO v26.7) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ 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