| FAQ's
Having daily pain is no way to live, especially when he pain is avoidable. When you have chronic pain everything you do in life is affected.
We take pleasure in sharing with information about this state of the art solution to common painful conditions. Extracorporeal Shock Wave Therapy or ESWT can give you a pain free life with one simple 25 minute procedure.
Below the following questions are answered:
- What are the causes of heel pain?
- What is Plantar Fasciitis?
- What can I do?
- I still have heel pain what’s next?
- I don’t want surgery!
- What is ESWT for Plantar Fasciitis?
- Is it FDA approved?
- Am I a Candidate for ESWT?
- What can I expect with ESWT?
- When can I return to normal activities?
- After the ESWT?
- What if it doesn’t work?
- What is the Future of ESWT?
What are the causes of heel pain?
Heel pain can be Plantar Fasciitis, Bursitis, Tendonitis, Arthritis, a Stress Fracture or even a Cyst. A qualified physician will provide you with a proper diagnosis.
What is Plantar Fasciitis?
Plantar Fasciitis is inflammation of the plantar fascia. The plantar fascia is a tight band of fibrous tissue which begins at the heel, travels across the arch, and fans forward toward the toes. The plantar fascia acts like a bowstring to maintain the arch of the foot. Heel pain generally occurs when the inflexible fascia is repeatedly stressed causing inflammation where the fascia attaches to the heel bone (calcaneus). This inflammation often results in a calcification (bone formation) of the fascia at the attachment to the heel bone which may create a bone spur. Bone spurs are not the problem but a symptom of the problem.
It is natural to procrastinate, but it is not a good idea for tendonosis conditions, since continuously using degenerative tendon tissue can cause further damage to the tendon, even progressing to a rupture. ESWT is no longer an option if a rupture has occurred and your only alternative is invasive surgery.
What can I do?
The longer the problem persists the harder it is to get rid of. There are things you can do that may alleviate the problem. First, wear shoes with good arch supports. Reduce the activities that cause stress to your heel. Ice the sore area for 30 to 60 minutes several times a day. Take an over the counter anti-inflammatory. Finally exercise, stretch the fascia three times per day. If this doesn’t work and the pain lasts for more than two weeks, its time to see a podiatrist or other qualified physician. A proper diagnosis is critical to a successful outcome. Heel pain can be Plantar Fasciitis, Bursitis, Tendonitis, Arthritis, a Stress Fracture or even a Cyst. A diagnosis is critical.
I still have heel pain what’s next?
Once you have a diagnosis your physician will lay out a treatment plan. It will include some of the things you are already doing such as exercise, icing and medication. Your physician may suggest custom orthotics (arch supports), taping or even cortisone injections. Great news! At this point you should be better. Actually 85% of the patients respond favorably to this protocol. Sadly 15% do not!
I don’t want surgery!
If you happen to be one of the 15% that do not respond to conservative treatment we still have another option before surgery Extracorporeal Shockwave Therapy (ESWT) don’t let the big name scare you. It is simply acoustic or sound waves applied to the heel tissue. It’s exactly the same principle as lithotripsy (used to break up kidney stones). In treating the Plantar Fasciitis the sound waves make microscopic tears in the fascia and the scar tissue that has formed around the fascia. The objective is to create healthy tissue where the scar tissue and thickened fascia once were. There are few side effects and the FDA studies show an 80% success rate.
The procedure takes about 25 minutes. The FDA studies were done with “No anesthesia allowed”. You can choose no anesthesia, an ankle block which is “mildly uncomfortable” or you can choose a “twilighty anesthesia” (MAC), that is quite a pleasant experience. Most patients return to normal activities the next day. Many patients feel relief the next day but the entire process of creating a new blood supply for the affected area is six weeks to three months. It is important to continue your stretching exercises during this critical period.
What is ESWT for Plantar Fasciitis?
ESWT is a safe and proven, non-invasive therapy that relieves pain by directing sound waves into the pain location. Perhaps the technology is best known for its use in treating kidney stones (Lithotripsy). The procedure is done with the Orthospec or Dornier devise. Both are high energy devises that direct acoustic or sound waves into the heel tissue. Studies have shown high energy devices to have a better success rate than their low energy counter parts. This simple procedure takes only 25 minutes and has an 85% success rate.
ESWT has been shown to be very beneficial in the treatment patients who have suffered from chronic pain caused by Proximal Plantar Fasciitis. In treating the Plantar Fascia the sound waves make microscopic tears in the fascia and the scar tissue that has formed around the fascia. This will trigger your individual repair mechanisms to reactivate healing and encourage revascularization and other elements necessary to advance normal tissue healing. In addition the over stimulation of pain transmission nerves by the shockwaves may lead to a reduction in sensitivity and pain.
Internationally ESWT has been used for all types of conditions including Achilles Tendonitis, Tennis Elbow, Patella Tendonitis as well as Shoulder Tendonitis.
Is it FDA approved?
Yes the FDA has approved ESWT for the treatment of chronic heel pain syndrome (Plantar Fasciitis).
Click here for FDA approval
Am I a Candidate for ESWT?
If you have had your condition for more than six months and have tried three of conservative treatment for Plantar Fasciitis under a physicians care and your heel pain has not been resolved then ESWT is considered a therapeutic option for you. Conservative treatments are considered; anti-inflammatory mediations, steroid injections, ice packs, stretching exercises, orthotic devices (shoe inserts), and physical therapy.
ESWT therapy is not for everyone. There will be no guess work your physician will review your health history with you to determine if this treatment is appropriate for you. Patients that are not considered candidates for ESWT include those with pacemakers or patients taking medications that may prolong or interfere with blood clotting (Coumadin). In addition children, pregnant women and those with acute Plantar Fasciitis are not considered appropriate candidates for ESWT.
If ESWT is right for you don’t delay. The sooner you receive treatment the sooner you can start enjoying your hobbies and active lifestyle again! Additionally, if left untreated, you can experience new problems in your body. When a person’s heel hurts they often compensate by walking on their toes or limping to avoid the pain. These abnormal movements in time cause un-necessary strain on your knees, hips and lower back, or even worse you end up with the same condition in the other foot. Compensation issues occur whenever you have chronic pain and it is left untreated.
What can I expect with ESWT?
The procedure is performed on an outpatient basis, so it does not require a stay in the hospital and in many cases will take place in your physician’s office. Your physician will instruct you to stop taking anti-inflammatory medications (for example ibuprofen) for 5 or more days prior to the procedure. Avoiding medications is important since they are known to prolong bleeding under the surface of the skin and will stop the inflammatory process.
During treatment you will recline comfortable while the area to be treated will be resting against the machine on a soft, water filled membrane. The technician may an ultrasound to view and target the area to be treated. Once the treatment begins you will hear a repetitive clicking sound and the procedure will take about 25 minutes. You may read, watch television, have something to drink or just relax during the procedure. We do advise that you have someone drive you home after the procedure. Since there is no lengthy recovery time in many cases you can return to work as early as the next day. This cannot be said for the surgical treatment of Plantar Fasciitis.
If you feel nervous or anxious about the ESWT treatment, please feel free to call us at 770-418-1395, your doctor or treatment coordinator.
When can I return to normal activities?
Most patients return to normal activities the next day. You will be asked to avoid any stressful activity involving the heel for four weeks after the procedure. “Stressful activity” may include running or jogging, doing heavy housework, yard work, or participating in sports. Many patients feel relief the next day but the entire process of creating a new blood supply for the affected area is six weeks to three months. It is important to continue your stretching exercises during this critical period. New studies show that healing can continue up to one year after the procedure.
ESWT delivers the same positive outcomes as surgery with a minimal risk of infection and a much faster recovery rate.
After the ESWT?
You may experience some pain or discomfort in the treated heel after the anesthesia effects have subsided. You may also continue to experience the same type of heel pain you had prior to treatment for one to two weeks. Pain is manageable by over the counter pain medication (i.e. Tylenol) in most cases. You will be asked not to take anti-inflammatory drugs for 14 days after the procedure.
You should not participate in any stressful activity involving the affected heel for four weeks. “Stressful activity” may include running or jogging, doing heavy housework or yard work, or participating in sports. Following this four-week period, you should be able to resume normal activity.
To avoid re-injury, you should avoid completely flat shoes such as sandals, loafer, moccasins, or house slippers. Continued use of orthotics is encouraged.
Simple Stretching exercises should be performed several times daily and before any sports activity, or before walking long distances. Massage of the affected foot prior to rising after rest may also be beneficial. Stretching for 30 seconds several times a day is recommended.
Maximum healing effect of the procedure cannot be evaluated prior to 6 months after treatment. The healing effect is also dependent upon individual patient response, and improvement may continue beyond evaluation period and up to a year.
- Rest and elevate the foot for the remainder of the day and night.
- Resume gentle stretching exercises the day following the procedure.
- Avoid taking any anti-inflammatory medication, such as ibuprofen or aspirin, for up to 14 days after ESWT.
- Avoid heavy lifting until the surgeon approves resuming this activity.
- You may walk on the foot.
- Avoid running or excessive activity.
- Avoid going barefoot during the healing process.
- Wear supportive shoes.
- In some cases, orthotic devices (shoe inserts) will be prescribed.
Although patients sometimes feel they can return to normal activities right away, the physician will determine when that is appropriate for your situation. It is important to use caution and follow the doctor’s instructions to avoid injuring the treated foot. Because ESWT temporarily reduces or eliminates the sensation of pain, patients sometimes become too active too soon.
What if it doesn’t work?
Although most patients with Plantar Fasciitis respond to non-surgical treatment, a small percentage of the patients may require surgery. If you happen to be one of the (3%) that did not respond to the conservative care or ESWT, surgery is still an option. Your podiatric foot and ankle surgeon will discuss the surgical choices with you and determine which approach is best for you.
What is the Future of ESWT?
Like many other innovative noninvasive therapies, ESWT is an evolving technology. As the body of information on this technique continues to expand, the result will be additional uses for ESWT that will benefit more patients in the future. |
