Can Broad-Focused ESWT Help Heal DFUs?

© 2025 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Podiatry Today or HMP Global, their employees, and affiliates. 

Delivering targeted extracorporeal shockwave therapy (ESWT) in a wider area can enhance wound healing and help salvage limbs, according to a case study presented at the Symposium on Advanced Wound Care (SAWC) Fall.¹
 
Researchers focused on 10 patients with chronic diabetic foot ulcers (DFUs) graded at Wagner grade 1–3 and persisting for 10–24 weeks.¹ Patients received 6–10 sessions of broad-focused ESWT consisting of 0.15–0.25 mJ/mm² energy flux density over 8–12 weeks in addition to conventional therapy. 
 
The study notes 9 of 10 patients achieved complete wound closure in 12 weeks, with a mean healing time of 9.6 weeks, while the remaining patient experienced a 90% reduction in ulcer area.¹ In addition, pain scores measured on a visual analogue scale decreased by 60%, and patients experienced no adverse events. 
 
“Broad-focused ESWT has in my opinion revolutionized DFU care by addressing a larger tissue volume more comfortably and efficiently than older methods, providing increased healing rates in a quicker timeframe,” says study author Richard Kaufman, DPM, FACFAS, CWSP. 
 
Compared to older ESWT methods such as focused or radial, Dr. Kaufman notes since broad-focused shockwave treats larger wound areas more uniformly. He says this makes broad ESWT ideal for extensive or irregularly shaped ulcers, unlike the pinpoint precision of focused ESWT, which he notes may miss parts of the wound, and unlike the more superficial action of radial waves. 
 
Dr. Kaufman emphasizes that broad-focused ESWT is painless, requiring no anesthesia, in contrast older broad-focused shockwave, which can be “incredibly painful,” even for those with neuropathy, and requires anesthesia. 
 
Broad-focused ESWT also stimulates a more extensive regenerative process, notes Dr. Kaufman, saying it reduces patient dependency on medications and improves mobility. He calls this “particularly beneficial for DFUs where infection rates remain similar to standard care but healing is accelerated.”
 
After using broad-focused ESWT to treat hundreds of patients with DFUs or other chronic wounds over the last several years, Dr. Kaufman says none of his patients have experienced side effects. He does advise against using shockwave on patients with active infection or malignancy. 
 
“If you are treating DFUs or chronic wounds in clinic, broad-focused shockwave should be a modality which you highly consider utilizing to improve epithelialization rates and help your patients achieve fast wound closure,” says Dr. Kaufman. “I have found this an amazing addition to my practice, and a major benefit to my patients.” 
 
Reference
 
1.    Kaufman R. Efficacy of broad-focused extracorporeal shockwave therapy for wound healing and closure in diabetic foot ulcers: a case study of 10 patients. Presented at the Symposium on Advanced Wound Care (SAWC) Fall, Las Vegas, NV, Sept. 4–7, 2025.