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When are you NOT a canidate for EWST?

Posted by Beverly on 11/17/00 at 23:32 (032985)

I'm still trying to understand when someone is NOT a good canidate for EWST?
Dr. Z. keeps talking about 'pain at the insertion point.' In plain English, where is that? For those of us who have pain and inflammation in mulitple places on the feet and ankles/calves, I'm just trying to understand what would cause someone not to be a good canidate.

Thank,
Beverly

Re: When are you NOT a canidate for EWST?

Kate on 11/18/00 at 09:07 (032996)

>
Bev,
Determining whether one is or is not a candidate cn be very subjective, but important. It's very important first and foremost to rule out a fracture, that can be done easily with an MRI. Also, we are finding that ESWT works best on chronic (long-term) calcifications, as opposed to softer or more acute calcifications.
When Dr.Z refers to the 'insertional point' he is referring to that spot at the calcaneal (heel) where the achilles tendon and or plantar fascia attach. That is the 'hot-spot' on the heel where treatment would most likely be focused upon. However, ESWT is also indicated for patients suffering from pain caused by PF, and achilles tendonitis that is more diffuse and not centered directly at the insertion point (or hot spot).
One case in particular that ESWT may not be an ideal treatment is in cases of post-tibial tendonitis. Tendonitis that is higher up, and more distal from the insertion point.
When we speak to patients prior to scheduling, we try our best to determine these things, so as not to waste any unnecessary frequent flyer miles. We have had a few patients, who, on the surface, appeared to be ideal candidates for the treatment, but with further examination, they turned out not to be candidates at all. And Dr.Z will not treat anyone with ESWT who he knows cannot or will not benefit with optimal results.

If you ever need any plain english translations, just yell.

Katie

Re: What if you have PF and PTT?

Beverly on 11/18/00 at 14:35 (033020)

Kate,

I have both PF and PTT. The PF came many months before the PTT. The PTT came after my PF started to get a wee bit better and I was on my feet too much, and boom, not only did the PF go back to being real bad again but the PTT came along too. I have both conditions in both feet.

So, does this mean I'm not a good canidate? I feel like the PTT is a byproduct of the PF. If I could clear up one, perhaps I could clear up the other, and yet it often feels like they are feeding off of each other.
You will see very little visual inflammation in my ankles and none in my feet. X-rays did not show a spur. I'm getting an MRI next week and hopefully that will shed more light.

Thanks,
Beverly

Re: Re:One more info...

Beverly on 11/18/00 at 14:37 (033021)

But despite not seeing much inflammation in my ankles, my PT says they are very squishy... the PTT tendons that is. Squishy all the way up to my calf.
Beverly

Re: Re:One more info...

Dr. Zuckerman on 11/19/00 at 16:13 (033082)

Beverly,

The posterior tibial tibial dysfunction or if there is something going on with it could be a major factor in all of your foot, ankle and lower extremity pain. When you get the MRI done . Would you mind if i could have a report and maybe a copy of the films. i have two great foot and ankle surgeons who have three addtional years in the surgical treatment of the foot and ankle. I have read alot mri's but these guys taught me how to read them i would like to have them. I hope that this isn't too forward .We are pf family. i really mean this. My fax number is 1-856-848-5122

Re: Re:Dr. Z., They're only doing the foot. Am I getting short-changed?

Beverly on 11/19/00 at 16:51 (033086)

Dr. Z.,

I would be happy to send you the report, and I'll see about getting copies of the films. I am disappointed that this MRI is only going to be to the feet. Since I have PTT that has not gone away (still have it two months later although very little visible inflammation), am I getting short-changed on my MRI? I asked for an MRI to both the feet and ankles, and I was told that is too much to do at once. I found this hard to believe, because I've had MRI's to other area's of the body in the past that covered more territory than the feet. Mind you, the original injury and pain was to the feet and the ankles came later.
Thanks for your interest,
Beverly

Re: Re:Dr. Z., They're only doing the foot. Am I getting short-changed?

Dr. Zuckerman on 11/19/00 at 17:23 (033088)

Hi,

We always get the feet and ankles. They can always set up two appointments

if you are getting the posterior tibial tendon evaluated it goes right past the ankle joint. All the mri's that i get always include the ankle and foot joint especially the heels . So if i had a choice this is what parts of the foot and ankle I would want to take a look at.

Ankle
ligaments. all tendons that cross the ankle. Achilles tendon
talus,
navicular
cuboid
Posterior tibial tendon
The enire lateral aspect of the ankle joint which would be the ligaments.
there are three. Anterior Tal-fibular ligament. Posteriot tal-fibular ligaments and last but not least the calcaneal-fibular ligament. On the side of the foot and ankle you have the deltoid lig

On the bottom of the foof the entire plantar fascia.

So in summary do the entire foot and ankle both feet.

Re: Re:Dr. Z.: I'll try.

Beverly on 11/19/00 at 19:20 (033094)

Dr. Z,

Thanks for the info. I will call the doctor's office and try to get the ankles included in the MRI. My script only says, 'both feet.' I wish I had seen the doctor for this. But as you may know, I keep getting shuffled off to the PA. I will remind him that I also have ankle pain, as well as foot pain. I have a bad feeling, they won't expand the script to include the ankles.
Thanks,
Beverly

Re: Re:Dr. Z.: I'll try.

Dr. Zuckerman on 11/19/00 at 20:46 (033099)

When I just write down mri of the feet I will get it for the feet and ankle . If for some reason they avoid the ankle which I don't think they will just tell the techinican doing the mri where the pain is they will usually either include this part or call the Dr. Office. Don't worry I am sure that the ankle is included. I have never seen an MRI of just the foot when we are ruling out heel pain due to plantar fasciitis .For example if i
write mri of the foot rule out stress fracture i alway get the foot and ankle including the achilles tendon and posterior tibial tendon. But just call to make sure if you are concerned. If a patient called my office I would be happy that they have an interest in the test. The doctor should like an informed patient this way he doesn't have to work so hard at teaching and explain the subject of heel pain and plantar fasciitis

Re: Re:One more info...

john h on 11/24/00 at 11:50 (033392)

beverly: what is 'squishy'? some sort of teaxs lingo?

Re: Re:To John on the definition of squishy

Kay S on 11/25/00 at 14:05 (033488)

Beverly--I think your description of the 'squishiness' factor is hysterical! It reminded me of when I first started doing hospital nursing and we had our own lingo for various conditions---one which we could never share with anyone else. I have no idea what any of that means as far as your foot pain, but I wanted you to know you gave me a laugh, and goodness knows I can use that!

Re: When are you NOT a canidate for EWST?

Kate on 11/18/00 at 09:07 (032996)

>
Bev,
Determining whether one is or is not a candidate cn be very subjective, but important. It's very important first and foremost to rule out a fracture, that can be done easily with an MRI. Also, we are finding that ESWT works best on chronic (long-term) calcifications, as opposed to softer or more acute calcifications.
When Dr.Z refers to the 'insertional point' he is referring to that spot at the calcaneal (heel) where the achilles tendon and or plantar fascia attach. That is the 'hot-spot' on the heel where treatment would most likely be focused upon. However, ESWT is also indicated for patients suffering from pain caused by PF, and achilles tendonitis that is more diffuse and not centered directly at the insertion point (or hot spot).
One case in particular that ESWT may not be an ideal treatment is in cases of post-tibial tendonitis. Tendonitis that is higher up, and more distal from the insertion point.
When we speak to patients prior to scheduling, we try our best to determine these things, so as not to waste any unnecessary frequent flyer miles. We have had a few patients, who, on the surface, appeared to be ideal candidates for the treatment, but with further examination, they turned out not to be candidates at all. And Dr.Z will not treat anyone with ESWT who he knows cannot or will not benefit with optimal results.

If you ever need any plain english translations, just yell.

Katie

Re: What if you have PF and PTT?

Beverly on 11/18/00 at 14:35 (033020)

Kate,

I have both PF and PTT. The PF came many months before the PTT. The PTT came after my PF started to get a wee bit better and I was on my feet too much, and boom, not only did the PF go back to being real bad again but the PTT came along too. I have both conditions in both feet.

So, does this mean I'm not a good canidate? I feel like the PTT is a byproduct of the PF. If I could clear up one, perhaps I could clear up the other, and yet it often feels like they are feeding off of each other.
You will see very little visual inflammation in my ankles and none in my feet. X-rays did not show a spur. I'm getting an MRI next week and hopefully that will shed more light.

Thanks,
Beverly

Re: Re:One more info...

Beverly on 11/18/00 at 14:37 (033021)

But despite not seeing much inflammation in my ankles, my PT says they are very squishy... the PTT tendons that is. Squishy all the way up to my calf.
Beverly

Re: Re:One more info...

Dr. Zuckerman on 11/19/00 at 16:13 (033082)

Beverly,

The posterior tibial tibial dysfunction or if there is something going on with it could be a major factor in all of your foot, ankle and lower extremity pain. When you get the MRI done . Would you mind if i could have a report and maybe a copy of the films. i have two great foot and ankle surgeons who have three addtional years in the surgical treatment of the foot and ankle. I have read alot mri's but these guys taught me how to read them i would like to have them. I hope that this isn't too forward .We are pf family. i really mean this. My fax number is 1-856-848-5122

Re: Re:Dr. Z., They're only doing the foot. Am I getting short-changed?

Beverly on 11/19/00 at 16:51 (033086)

Dr. Z.,

I would be happy to send you the report, and I'll see about getting copies of the films. I am disappointed that this MRI is only going to be to the feet. Since I have PTT that has not gone away (still have it two months later although very little visible inflammation), am I getting short-changed on my MRI? I asked for an MRI to both the feet and ankles, and I was told that is too much to do at once. I found this hard to believe, because I've had MRI's to other area's of the body in the past that covered more territory than the feet. Mind you, the original injury and pain was to the feet and the ankles came later.
Thanks for your interest,
Beverly

Re: Re:Dr. Z., They're only doing the foot. Am I getting short-changed?

Dr. Zuckerman on 11/19/00 at 17:23 (033088)

Hi,

We always get the feet and ankles. They can always set up two appointments

if you are getting the posterior tibial tendon evaluated it goes right past the ankle joint. All the mri's that i get always include the ankle and foot joint especially the heels . So if i had a choice this is what parts of the foot and ankle I would want to take a look at.

Ankle
ligaments. all tendons that cross the ankle. Achilles tendon
talus,
navicular
cuboid
Posterior tibial tendon
The enire lateral aspect of the ankle joint which would be the ligaments.
there are three. Anterior Tal-fibular ligament. Posteriot tal-fibular ligaments and last but not least the calcaneal-fibular ligament. On the side of the foot and ankle you have the deltoid lig

On the bottom of the foof the entire plantar fascia.

So in summary do the entire foot and ankle both feet.

Re: Re:Dr. Z.: I'll try.

Beverly on 11/19/00 at 19:20 (033094)

Dr. Z,

Thanks for the info. I will call the doctor's office and try to get the ankles included in the MRI. My script only says, 'both feet.' I wish I had seen the doctor for this. But as you may know, I keep getting shuffled off to the PA. I will remind him that I also have ankle pain, as well as foot pain. I have a bad feeling, they won't expand the script to include the ankles.
Thanks,
Beverly

Re: Re:Dr. Z.: I'll try.

Dr. Zuckerman on 11/19/00 at 20:46 (033099)

When I just write down mri of the feet I will get it for the feet and ankle . If for some reason they avoid the ankle which I don't think they will just tell the techinican doing the mri where the pain is they will usually either include this part or call the Dr. Office. Don't worry I am sure that the ankle is included. I have never seen an MRI of just the foot when we are ruling out heel pain due to plantar fasciitis .For example if i
write mri of the foot rule out stress fracture i alway get the foot and ankle including the achilles tendon and posterior tibial tendon. But just call to make sure if you are concerned. If a patient called my office I would be happy that they have an interest in the test. The doctor should like an informed patient this way he doesn't have to work so hard at teaching and explain the subject of heel pain and plantar fasciitis

Re: Re:One more info...

john h on 11/24/00 at 11:50 (033392)

beverly: what is 'squishy'? some sort of teaxs lingo?

Re: Re:To John on the definition of squishy

Kay S on 11/25/00 at 14:05 (033488)

Beverly--I think your description of the 'squishiness' factor is hysterical! It reminded me of when I first started doing hospital nursing and we had our own lingo for various conditions---one which we could never share with anyone else. I have no idea what any of that means as far as your foot pain, but I wanted you to know you gave me a laugh, and goodness knows I can use that!