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ESWT in Reader's Digest

Posted by KenC on 1/01/01 at 22:14 (035782)

I just wanted to let you folks know that I read a small article in the January 2001 issue of Reader's Digest about ESWT and how it was finally approved by the FDA. I thought you might be interested in reading it. I'm still in severe pain with my PF. I watched the video you folks sent me and one thing concerns me. Dr. Z. said that in order for ESWT to be effective a patient had to have experienced a small amount of success with cortizone shots. I had three of them and I don't remember a huge reduction in the amount of pain. Should I still consider ESWT? Thank you and happy new year!
KenC.

Re: ESWT in Reader's Digest

rekha.s on 1/02/01 at 19:44 (035822)

yes, I also read that article few weeks back and posted in the eswt board....I was real excited that a major magazine has an article about this promising new technology!!!

Re: ESWT in Reader's Digest

Dr. Zuckerman on 1/02/01 at 20:22 (035826)

That is an old video. I have expanded my opinion about this. First of if you had steriod injections and you did get relief then that is a good sign that the area is localized and therefore is insertional, due to knowing that the area did get better at one time.

If you didn't get relief from the steriod injection then you need to dig deeper into the reasons for your problem such as stress fx., TTS,

So if there is proof either from physical examination and or mri this is the most important aspect.

When I did the video I was trying to incorporate my experience with heel spur surgery into ESWT. I was wrong to be so general in my explanation.

I should of explained then if you didn't get any relief from steriod injections, meaning no relief at all period not even one minute then you need to investigate the probem in greater detail before any future treatment period. I didn't say this but this is what I was trying to say.

Lack of steriod injection relief could mean wrong diagnosis. We aren't talking about relief and then return of pain. If you got some relief and then return of pain. This is telling me that the area that is causing the problem has been located.

This is what happens when you are interviewed for twenty seconds. I like to hear that you do got relief but no relief doesn't omitt you from ESWT.
It just means you better investigate the cause more closely

Re: ESWT in Reader's Digest

KenC on 1/03/01 at 10:45 (035848)

I didn't get much relief at all from the injections. So basically what you are saying is that in order for me to find out if this really is PF then I should get an MRI. Is that correct? Please let me know. Thank you.
KenC

Re: ESWT in Reader's Digest

Dr. Zuckerman on 1/03/01 at 11:57 (035853)

I would get an mri to completely evaluate the pf, stress fracture and all of the ligaments in the ankle and foot that could contribute to pf. Just last nite I had a patient come in with pf nothing helped in the past.. There was pain and weakness of the posterior tibial tendon function. An mri is going to help me see the complete picture. So mri would be the next step for you.

You have plantar fasciitis without any tendon or ligaments of the foot and ankle contributing to your problem, but along with the mri you need to have an evaluation by a doctor that has alot of experience in treating pf.

Go get an mri

Re: ESWT in Reader's Digest

Dr/. Zuckerman on 1/03/01 at 12:06 (035856)

I don't want to give the impression that an mri is just a test to have when nothing else fails to reveal a reason for the pain.

An mri is done and so are all tests to confirm the impression that the treating doctor has after his physical examination.

The reason I order mri in alot of cases for patients that come a distance is due to not being able to examine them and then they come in for ESWT.
If I had the change to examine that I could avoid a trip for nothing.

I had a patient come in with quote 'heel pain from Atlanta Georgia. Very nice man. Talking to him on the phone sounded like pf. His doctors told him pf.

The examinatino revealed no pain at the pf insertion. He had typical posterior tibial tendonitis. He was very glad to hear I had the correct diagnosis and was glad to travel the distance to finally get the correct diagnosis but I felt bad because I know that the only way that I can correctly diagnosis a foot and or ankle problem is with a good history that is followed by a complete hands on examination. There is no way around this .

Some of the ways to help improve long distance evaluation is to use Scott data history form for plantar fasciitis.

I still patients that come a long distance that it is possible that I may that don't need or still can't have ESWT. This is rare but possible.

Re: ESWT in Reader's Digest

KenC on 1/03/01 at 13:40 (035863)

I left a message for my doctor to call me. When he calls, should I request that an MRI be done. I have pain in the plantar fascia region as well as in the rear of the ankle. However, it only hurts (the ankle) when I apply pressure to it by squeezing it. Please let me know how I should approach my doctor about an MRI? Thank you. KenC.

Re: ESWT in Reader's Digest

Kay S on 1/03/01 at 18:52 (035876)

Dr. Z---I never really got any relief with the steroid injections either. Only one time do I remember the pod injected on the inside of the ankle and it was wonderful for about a week, and then back to the same old pain. All the other times (probably about 4 other times over the course of a couple of years) it didn't do a thing. Then when I went to Dr. Kelikian, he did what he called a 'diagnostic block' and that got rid of the pain for the day in that foot, but who would know because it was totally numb. However, he did know exactly where to put that needle, and I think that is the real secret.
I may be the one to prove that it doesn't make any difference about whether the shots work or not.............the ESWT still can. I sure would like to be that person.
Kay

Re: ESWT in Reader's Digest

rekha.s on 1/02/01 at 19:44 (035822)

yes, I also read that article few weeks back and posted in the eswt board....I was real excited that a major magazine has an article about this promising new technology!!!

Re: ESWT in Reader's Digest

Dr. Zuckerman on 1/02/01 at 20:22 (035826)

That is an old video. I have expanded my opinion about this. First of if you had steriod injections and you did get relief then that is a good sign that the area is localized and therefore is insertional, due to knowing that the area did get better at one time.

If you didn't get relief from the steriod injection then you need to dig deeper into the reasons for your problem such as stress fx., TTS,

So if there is proof either from physical examination and or mri this is the most important aspect.

When I did the video I was trying to incorporate my experience with heel spur surgery into ESWT. I was wrong to be so general in my explanation.

I should of explained then if you didn't get any relief from steriod injections, meaning no relief at all period not even one minute then you need to investigate the probem in greater detail before any future treatment period. I didn't say this but this is what I was trying to say.

Lack of steriod injection relief could mean wrong diagnosis. We aren't talking about relief and then return of pain. If you got some relief and then return of pain. This is telling me that the area that is causing the problem has been located.

This is what happens when you are interviewed for twenty seconds. I like to hear that you do got relief but no relief doesn't omitt you from ESWT.
It just means you better investigate the cause more closely

Re: ESWT in Reader's Digest

KenC on 1/03/01 at 10:45 (035848)

I didn't get much relief at all from the injections. So basically what you are saying is that in order for me to find out if this really is PF then I should get an MRI. Is that correct? Please let me know. Thank you.
KenC

Re: ESWT in Reader's Digest

Dr. Zuckerman on 1/03/01 at 11:57 (035853)

I would get an mri to completely evaluate the pf, stress fracture and all of the ligaments in the ankle and foot that could contribute to pf. Just last nite I had a patient come in with pf nothing helped in the past.. There was pain and weakness of the posterior tibial tendon function. An mri is going to help me see the complete picture. So mri would be the next step for you.

You have plantar fasciitis without any tendon or ligaments of the foot and ankle contributing to your problem, but along with the mri you need to have an evaluation by a doctor that has alot of experience in treating pf.

Go get an mri

Re: ESWT in Reader's Digest

Dr/. Zuckerman on 1/03/01 at 12:06 (035856)

I don't want to give the impression that an mri is just a test to have when nothing else fails to reveal a reason for the pain.

An mri is done and so are all tests to confirm the impression that the treating doctor has after his physical examination.

The reason I order mri in alot of cases for patients that come a distance is due to not being able to examine them and then they come in for ESWT.
If I had the change to examine that I could avoid a trip for nothing.

I had a patient come in with quote 'heel pain from Atlanta Georgia. Very nice man. Talking to him on the phone sounded like pf. His doctors told him pf.

The examinatino revealed no pain at the pf insertion. He had typical posterior tibial tendonitis. He was very glad to hear I had the correct diagnosis and was glad to travel the distance to finally get the correct diagnosis but I felt bad because I know that the only way that I can correctly diagnosis a foot and or ankle problem is with a good history that is followed by a complete hands on examination. There is no way around this .

Some of the ways to help improve long distance evaluation is to use Scott data history form for plantar fasciitis.

I still patients that come a long distance that it is possible that I may that don't need or still can't have ESWT. This is rare but possible.

Re: ESWT in Reader's Digest

KenC on 1/03/01 at 13:40 (035863)

I left a message for my doctor to call me. When he calls, should I request that an MRI be done. I have pain in the plantar fascia region as well as in the rear of the ankle. However, it only hurts (the ankle) when I apply pressure to it by squeezing it. Please let me know how I should approach my doctor about an MRI? Thank you. KenC.

Re: ESWT in Reader's Digest

Kay S on 1/03/01 at 18:52 (035876)

Dr. Z---I never really got any relief with the steroid injections either. Only one time do I remember the pod injected on the inside of the ankle and it was wonderful for about a week, and then back to the same old pain. All the other times (probably about 4 other times over the course of a couple of years) it didn't do a thing. Then when I went to Dr. Kelikian, he did what he called a 'diagnostic block' and that got rid of the pain for the day in that foot, but who would know because it was totally numb. However, he did know exactly where to put that needle, and I think that is the real secret.
I may be the one to prove that it doesn't make any difference about whether the shots work or not.............the ESWT still can. I sure would like to be that person.
Kay