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Extracorporeal shock wave therapy has been reported to be effective in reducing muscle hypertonia in adults. To evaluate the effect of shock wave treatment of spastic muscles in children with cerebral palsy. Twelve children with spastic equinus foot (6 boys, 6 girls; mean age 8 years (standard deviation (SD) 2.31)) were monitored. Clinical (Ashworth Scale, passive range of motion) and instrumental (pedobarography) examination were performed. This is an open study with one placebo treatment session, followed 6 weeks later by one active shockwave treatment session. Gastrocnemius muscles and soleus muscles were treated. After placebo stimulation no clinical or instrumental effect was seen. After a single active shock wave stimulation a significant decrease in the Ashworth Scale (from 3 to 2), an increase in the range of motion (from 20 degrees to 50 degrees), and an increase in the whole plantar surface area of the treated limb (from 40.3 to 80.2 cm2) were observed in all patients. This effect lasted for 4 weeks in all patients. A single active shock wave stimulation produced a significant long-lasting reduction in hypertonia in the plantar flexors in children with cerebral palsy.