Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy

New Options for Heel Pain Sufferers
Studies demonstrate that 15-20% of new patients seeking care by foot and ankle specialists present with the complaint of heel pain. Plantar fasciitis, heel spur syndrome, heel bursitis, nerve entrapment, stress fracture, gout, and systemic inflammatory conditions are just some of the possible causes, The vast majority (70-90%) of Individuals diagnosed with heel spur syndrome/planter fasciitis, respond to non-operative treatment. Until recently the only remaining treatment option for those individuals who failed to improve was surgical intervention, ESWT (extracorporeal shock wave therapy) now offers heel pain sufferers new treatment choices.

What is ESWT?
Extracorporeal shock wave therapy is a new non-Invasive alternative to surgery. Similar technology has been used to successfully treat kidney stones since the 1980's, In this new application, the ultrasound device applies sound waves to the foot, aimed at the inflamed plantar fascia. While the spur is not removed, It is believed that micro trauma to the tissue results in the ingrowth of new blood vessels to repair and heal the chronically irritated fascia.

Who Qualifies?
Generally, an individual who has failed to improve after six months of conservative management would be considered a suitable candidate. This includes stretching, shoe inserts/orthotic devices, cortisone injections, non-steroidal anti-inflammatory drugs, physical therapy, night splints, CAM walkers, weight loss, and rest.

Expected Results
A study by Weil, Roukis and Welt et. al., in The Journal of Foot and Ankle Surgery (Volume 41, No. 2) found that at an average of 8,4 months following treatment, 82% of the patients treated with ESWT were very satisfied or satisfied. This compares with 83% of patients that had undergone surgical release of the fascia.

What About Risks?
Adverse effects that have been reported from treatment seem to parallel the risks associated with the infiltration of local anesthetics, such as nerve injury or irritation, hematoma, bruising, and skin rash.

Post Treatment Care
Patients who have undergone ESWT may return to their pre-treatment level of function immediately following the procedure, providing they are wearing supportive foot gear, preferably in combination with orthotic devices/shoe inserts. Application of ice and the use of anti-inflammatory medication for the first several days may prove helpful. One may expect an increased level of discomfort three to seven days post treatment as the local inflammatory response ensues. Athletic and strenuous weight bearing activities should be avoided for at least the initial two to three weeks.

Long Term Effects
Sufferers of heel pain must consider their symptoms as a condition which should be managed by continued compliance with stretching, supportive foot gear and avoidance of barefoot activities as well as positions which place excessive load on the forefoot (i,e., standing on ladders, squatting, walking uphill, etc.)

Fees/insurance
Since ESVVT is a new application for heel pain, some insurance companies have not yet developed payment guidelines. Others have fee schedules which include coverage. Our staff will assist you with determining your share of the financial obligation.

Summary
As with any treatment option there are no guarantees or assurance. No single treatment should be considered a panacea, Clinical studies have shown ESWT to be safe and effective in treating heel pain in individuals who have not responded to traditional conservative therapies such as stretching, shoe inserts, cortisone injections, non-steroidal anti-inflammatory drugs, physical therapy, night splints, CAM walkers, rest, and weight loss. However, it appears that ESWT offers a clinical response similar to percutaneous plantar fascial release without the risks and loss of wages
associated with surgery.

In the study by Well et, al., patients reported improvement on the visual analog scale from 7.9 down to 3.1 at the 3 month follow-up.

This modality is FDA approved, and the treatment can be administered In your doctor's office tinder local anesthesia, The entire treatment takes approximately a half hour, Ask your doctor for more information to find out if ESWT is right for you. If you are qualified, your doctor will schedule treatment.

The Dornier Epos Ultra a uses ultrasound targeting to precisely aim the shock waves. This feature Is unique among those devices approved by the FDA.