Chronic Wounds & Ulcers
Chronic wounds — including diabetic foot ulcers, pressure (decubitus) ulcers, venous leg ulcers, and other wounds that fail to heal within the expected timeframe — require comprehensive medical management, typically involving wound care specialists, and often a broader care team addressing underlying contributors like diabetes control, vascular status, and pressure offloading. Shockwave therapy has been studied as a possible adjunct in this space; it is never a substitute for that comprehensive medical management.
Common Symptoms
- A wound that has not progressed toward healing within the expected timeframe (often defined as 4-12 weeks depending on wound type)
- Signs of poor healing: minimal new tissue growth, persistent drainage, or a wound bed that isn't improving
- Pain, odor, or signs of infection
- Surrounding skin changes (swelling, discoloration) depending on the underlying cause
Why It Happens
Chronic wounds fail to progress through the normal healing process for many possible reasons: inadequate blood supply (common in diabetic foot ulcers and some pressure ulcers), ongoing pressure or friction, uncontrolled blood sugar, venous insufficiency, infection, or a combination of these. The underlying cause has to be identified and addressed, or the wound will tend to persist or recur even if it's temporarily treated locally.
Why It Can Become Persistent
Chronic wounds are, by definition, ones where the normal healing process has stalled — which is exactly why they require a dedicated wound care evaluation rather than expecting standard first-aid measures to be sufficient.
Who Commonly Gets It
Diabetic foot ulcers affect people with diabetes, particularly with peripheral neuropathy or reduced blood flow; pressure ulcers most often affect people with reduced mobility; venous ulcers are associated with chronic venous insufficiency, most common in the lower legs.
How It Is Usually Diagnosed
Wound care specialists assess wound characteristics, blood supply (sometimes with vascular studies), infection status, and contributing medical conditions to guide a comprehensive treatment plan.
Traditional Treatment Options
- Debridement: Removal of non-viable tissue to promote healing, performed by a wound care provider.
- Offloading and pressure management: Reducing pressure on the wound (special footwear, positioning, support surfaces) depending on wound location and type.
- Addressing underlying medical factors: Blood sugar control, vascular assessment and treatment, and infection management.
- Advanced wound care therapies: Specialized dressings, compression therapy (for venous ulcers), or other advanced modalities as determined by the wound care team.
Why Someone Might Start Looking for Another Option
Chronic wounds that don't respond to standard care are a significant clinical challenge, and researchers have explored several adjunct technologies — including shockwave therapy — to see whether they can help stalled wounds resume healing.
Where Shockwave Therapy May Fit
Multiple studies — including randomized trials on diabetic foot ulcers and pressure ulcers, laboratory research on how shockwave therapy affects wound-healing immune cells, and an independent 2023 systematic review from a UK academic research group — have investigated shockwave therapy as an adjunct for chronic wound healing. This is a genuinely researched area, though we were not able to independently confirm the specific outcome statistics of several of the older individual trials cited here beyond their bibliographic record (see each study's citation for exactly what was and wasn't independently confirmed). It would only be considered as one component of a comprehensive wound care plan, never as a stand-alone treatment.
How Shockwave Treatment Works for This Area
This practice does not independently manage chronic wounds. If a wound care specialist or referring physician identifies shockwave therapy as an appropriate adjunct within a comprehensive treatment plan, care would be coordinated accordingly.
What the Treatment Feels Like
Not applicable outside of a coordinated wound care plan; sensation and protocol would depend entirely on the specific clinical situation and wound characteristics.
What Happens During Your First Visit
Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.
New Patient Offer
New Patient Exam + First Treatment — $99
First treatment provided when clinically appropriate following your examination.
Who May Not Be Appropriate
- Anyone with a chronic wound who has not yet had a comprehensive wound care evaluation
- Active, untreated infection at the wound site
- Wounds with significantly compromised blood supply that need vascular evaluation and treatment first
- Anyone for whom this would delay necessary medical management of an underlying condition (uncontrolled diabetes, untreated vascular disease)
This list is not exhaustive. Your provider will screen for contraindications during your evaluation.
Frequently Asked Questions
No — it should never be presented as a stand-alone treatment. Chronic wounds need comprehensive care addressing the underlying cause; shockwave therapy, where used, is studied as an adjunct within that broader plan, not a replacement for it.
This practice focuses on musculoskeletal pain. This page exists to give an honest overview of the research in this area, not to represent chronic wound care as a stand-alone service offered independently of appropriate wound care specialists.
What Research Says
Selected sources relevant to chronic wounds & ulcers. See the full Research Center for our complete source registry and methodology.
Clinical Rehabilitation · 2010 · Larking, Duport, Clinton, Hardy, Andrews
This placebo-controlled randomized trial evaluated extracorporeal shockwave therapy for chronic decubitus ulcers (pressure sores) compared with sham treatment.
Limitations: We were not able to independently access this study's specific outcome data during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record. Notably, a published response/critique letter about this trial exists in the medical literature (PMID 21115686), which is worth reading before relying on this study's conclusions.
Journal of Surgical Research · 2009 · Wang, Kuo, Wu, Liu, Hsu, Wang, Yang
This study evaluated extracorporeal shockwave therapy for chronic diabetic foot ulcers, a serious wound-healing complication of diabetes.
Limitations: We were not able to independently access this study's specific outcome data during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record. Diabetic foot ulcers require comprehensive medical management (blood sugar control, offloading, infection monitoring, vascular assessment); shockwave therapy, if used at all, would be one part of a broader care plan, not a replacement for it.
The Annals of Thoracic Surgery · 2008 · Dumfarth, Zimpfer, Vögele-Kadletz, Holfeld, Sihorsch, Schaden, Czerny, Aharinejad, Wolner, Grimm
This randomized trial evaluated whether prophylactic low-energy shockwave therapy improves wound healing at the leg incision site used to harvest a vein for coronary artery bypass graft (heart bypass) surgery.
Limitations: We were not able to independently access this study's specific outcome data during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record. This is a surgical-wound-prevention context, not established chronic wound treatment, so it doesn't directly generalize to non-healing wounds.
Journal of Surgical Research · 2007 · Schaden, Thiele, Kölpl, Pusch, Nissan, Attinger, Maniscalco-Theberge, Peoples, Elster, Stojadinovic
This feasibility study evaluated shockwave therapy for a mix of acute and chronic soft-tissue wounds.
Limitations: Note on citation accuracy: the manufacturer compendium that also references this study lists its first author as 'Pusch,' but the independently indexed record shows Wolfgang Schaden as first author, with Michael Pusch as a co-author — corrected here. We were not able to independently access this study's specific outcome data during our research; as a feasibility study, it's designed to establish that a larger trial is practical, not to prove treatment efficacy.
International Journal of Molecular Sciences · 2021 · Holsapple, Cooper, Berry, Staniszewska, Dickson, Taylor, Bachoo, Wilson
This translational study examined how shockwave therapy affects immune cells (macrophages) involved in wound healing, using tissue samples from patients with chronic venous leg ulcers before and after treatment, alongside laboratory experiments on cultured macrophages. It found shockwave-treated wound tissue showed signs of improved healing activity and reduced inflammatory macrophage density, and shockwave-exposed macrophages in the lab showed increased activity relevant to tissue repair.
Limitations: The clinical portion involved a small number of patients (9 completed the study), a short 2-week follow-up period, and some patients did not respond to treatment for reasons the authors say remain unclear. The laboratory findings help explain a possible biological mechanism but don't by themselves establish clinical effectiveness.
International Wound Journal · 2023 · Hitchman, Totty, Smith, Carradice, Twiddy, Iglesias, Russell, Chetter
This independent systematic review — from a UK academic medical research group (Hull University Teaching Hospitals NHS Trust / University of Hull) with no apparent connection to any shockwave device manufacturer — evaluated the published evidence on extracorporeal shockwave therapy compared with standard wound care for diabetic foot ulcer healing.
Limitations: We were not able to independently access this review's specific pooled results/effect sizes during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record from a genuinely independent academic research group. Diabetic foot ulcers require comprehensive medical management; shockwave therapy is, at most, one component of a broader care plan overseen by a physician.
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First treatment provided when clinically appropriate following your examination.