Radial and focused shockwave, compared by depth, feel, and target tissue

The decision is geometric. You are choosing the shape of an acoustic field, not a logo and not a louder version of the same tap. Radial pressure waves and focused shockwaves are both extracorporeal shock wave therapy, delivered through a handpiece and coupling gel, with the person awake. The peak of the wave does not sit in the same place. If the tissue you can reproduce is broad and close to the surface, a diverging field may cover it. If the tissue is a small spot at a depth the exam can estimate, a concentrated peak is the more precise instrument. An office that owns only one applicator has already made that choice in the purchasing department.

How a radial field is built

A radial pressure wave starts at the cap. Inside a Storz radial handpiece, a projectile strikes a transmitter. The strike launches a pressure front that is highest where the cap meets skin and then spreads. Picture a circular ripple losing height as it leaves the point where a stone entered a pond. The treated volume is relatively wide and relatively shallow. Muscle bellies, fascia just under the skin, and broad tendon surfaces live in that kind of volume. The clinician covers a region by moving the cap. There is no buried focal point to dial the way a camera dials a focal plane. Apparent depth changes with how fast the wave decays in that tissue and with how firmly the cap is coupled, not with a focus control.

That geometry has a clinical personality. It is forgiving of a target that is an area rather than a dot. It is a poor match for a problem that exists only in a deep, narrow pocket, because so much of the energy has already been spent nearer the surface. It is also the reason radial sessions can feel busy at the skin: the peak is right there, under the transmitter, ticking through whatever is already irritable.

How a focused field is built

A focused shockwave delays parts of the wave, with a reflector or an acoustic lens, so those parts arrive together at a selected depth. The highest pressure is intended to sit inside the tissue rather than on the surface. The focal volume is tighter. That suits a small insertion, a calcification the exam can actually find, or a tendon zone deeper than a radial cap reliably bathes. Miss the spot and the machine has precisely addressed the wrong cubic centimeter. A focused session therefore starts with palpation and a mark. Sweeping the applicator around a general neighborhood wastes the thing the device is for.

The tradeoff is aim, not prestige. A tighter peak is not a more advanced patient and a wider field is not a beginner setting. They are different maps. MedlinePlus describes tendinitis as irritation and, often in chronic cases, degeneration of the tendon and its anchor. Those anchors are not all the same distance from the skin. The map has to be drawn on the person, not on a stock photo of a handpiece.

Question	Radial pressure wave	Focused shockwave
Where the peak is designed to sit	At or near the transmitter, then decaying outward	At a selected depth inside the tissue
Shape of the field	Wider and shallower	A tighter focal volume
How a region gets covered	The clinician moves the cap	The focus is placed, then confirmed
Coupling	Gel and skin contact	Gel and skin contact
Problem the shape fits, in principle	A broad, superficial soft-tissue band	A small target at a known depth
Heel trial that used this geometry	Gerdesmeyer 2008, radial, sham-controlled	Gollwitzer 2015, focused, sham-controlled
Anesthetic in that trial	Not used	Not used

What the heel trials can say about the machines

The rows above are research recipes, not this office's dose card. Gerdesmeyer and colleagues (opens in a new tab) enrolled 245 people with chronic recalcitrant plantar fasciitis. Radial sessions used 0.16 mJ/mm2 and 2,000 impulses, three times. At 12 weeks the composite pain score had fallen 72.1 percent with radial treatment and 44.7 percent with sham. Success was 61 percent versus 42.2 percent. The write-up recorded no relevant side effects. Gollwitzer and colleagues (opens in a new tab) randomized about 250 people to focused shockwave at 0.25 mJ/mm2 or to sham, three weekly sessions of 2,000 impulses, again without local anesthesia. Composite pain fell 69.2 percent versus 34.5 percent. Success sat between 50 and 65 percent. Device-related events were temporary pain and swelling.

Read as a comparison of geometries, the papers show that each field can beat a sham on a chronic heel. They were not a head-to-head contest. The flux numbers do not share one ruler. A millijoule per square millimeter describes intensity at a defined point in that device's field. Setting 0.16 beside 0.25 and declaring a winner is like comparing two lenses by the number printed on the barrel. A higher flux figure does not automatically mean a harsher minute for the patient. A lower figure does not mean the session is optional. The full heel-by-heel reading of those trials lives on /shockwave-therapy-for-plantar-fasciitis. This page borrows them only as the cleanest allowed evidence that the two shapes are both real treatments, studied separately.

Sham groups improved too. Some people in the active groups did not. The enrollments were chronic cases, not tissue that had been angry since Tuesday. Nothing in either paper retires load management. A wave can change a pain score and leave the training error, the dead shoe, or the weak calf exactly where it was.

Sensation, and why the trials stayed awake

Feel is part of the match, and it is why these protocols did not numb the target. Radial treatment is commonly a fast, somewhat loud tapping spread under the cap, sharpest on the tender line. Focused treatment is commonly a more localized thud or sting at the depth being aimed. Sometimes the skin is quieter than people expect, and sometimes it is not. Neither sentence is a comfort guarantee. The person talks. Energy comes down when the dose crosses from a tolerable provocation into bracing and breath-holding. A session that only works if the tissue is anesthetized is a different philosophy from the trials in the table.

Side-effect language stays tied to the paper it came from. One report found no relevant adverse effects. The other named temporary pain and swelling. Redness, a passing bruise, or a sore day show up often enough in ordinary consent conversations that they should be mentioned. This page will not invent a percentage for them. A blood-clotting disorder is already outside the practice's published shockwave screen, which is one reason a bruise is not a trivial aside for every body.

How both devices change the visit, not the biology

Richter Family Chiropractic has a Storz radial unit and a Storz focused unit. The technology inventory is the main-site list of that hardware alongside the other machines. The shockwave page is the practice describing the service in its own words. Hardware does not pick the patient. The examination has to reproduce the pain, judge whether the sore tissue is an area or a point, and decide whether an acoustic wave belongs in the plan at all.

Dr. William Choi, DC, came through kinesiology at San Diego State University and uses Diversified technique. That matters here because load and joint motion change which tissue is under the applicator. Dr. Matthew Richter, DC, graduated from Los Angeles College of Chiropractic in 1997 and is certified in Class IV laser and in spinal decompression. Those certificates describe other tools in the same building. Both of them practice as chiropractors. A wave aimed at a tendon, while a stiff joint above it keeps dumping force into the same fibers, is an unfinished plan, whichever cap is on the cart.

There is a third device people mix into this choice. Extracorporeal magnetotransduction therapy, delivered on a Storz Magnetolith, does not send an acoustic shock at all. It is a contact-free pulsed electromagnetic field. The comparison, including why a low-back trial must not be narrated as a heel trial, is on /emtt-therapy. Scheduling both technologies in one season of care is a clinical decision. It is not evidence that they are interchangeable names.

Screens that apply before either cap is lifted

The practice's published shockwave exclusions are pregnancy, a field that sits over infection, a field that sits over tumor, and a known blood-clotting disorder. Treat that list as what the clinic has already said in public, then confirm it against the current device manual. The manual check is still open. A pacemaker or defibrillator question belongs to EMTT screening. It should not be shrugged off because the appointment was booked under the word shockwave. An open wound, a limb that is hot and the person febrile, or pain after a fall that will not accept weight needs a diagnosis first. Acoustic geometry is a poor substitute for finding a fracture, an infection, or a systemic disease. Heel pain in particular has a wide differential, which is why MedlinePlus groups heel injuries and disorders (opens in a new tab) instead of offering one label.

Price is not a column in the table

No public fee says the radial applicator costs one number and the focused applicator another. Writing a range here before the practice approves it would be fiction, which is why price remains an open item. The quote belongs with the plan, once the exam has decided whether either wave is useful. Payment methods the office already names, including HSA or FSA cards, CareCredit, and Cherry, are ways to pay. They are not indications. Most PPO and HMO plans and Medicare are described as accepted, with coverage that still varies by plan. That is not a statement that an acoustic series is a covered code. The desk has to look at the card. Attorney liens are a personal-injury arrangement, not a tendon protocol.

What neither geometry will rewrite

A radial field can bathe a sore superficial band. A focused peak can sit on a tiny insertion. The person can still return to the same sudden mileage jump, the same unconditioned tendon, or the same task that started the overload. Group scores in chronic plantar fasciitis moved more than sham. They did not close the case on strengthening, activity edits, or the joints that steer load. If a clinic sells the handpiece as the entire plan, the geometry discussion has been used as theater.

Arrive with a map, not a machine request. Is the pain a broad ache or a fingertip spot? Does it sit just under the skin or deep to a bony ledge? What have you already loaded, and what are you unwilling to stop? Which treatments have had a fair trial? The applicator is an answer to that map. It is not the greeting at the door, and it is not a cure stamped onto whatever hurts.