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ESWT for Plantar fibromas

Posted by Dr. Marlene Reid on 1/19/01 at 22:21 (036901)

Has anyone heard of ESWT being used for plantar fibomas?? I was asked this recently and haven't had a chance to research it yet. Thanks.

Re: ESWT for Plantar fibromas

Kurt Kaufman on 1/20/01 at 12:35 (036937)

Dr. Reid
Eswt has not been shown to be effective for plantar fibromatosis

Re: ESWT for Plantar fibromas

Dr. Zuckerman on 1/20/01 at 15:27 (036950)

Hi,

I will suggest buying the new book that was published by the International Society for Shockwave treatment. The book talks about plantar fibromas and the lack of reponse. Very small study. There is a women on the ESWT section of this site that talks about her great sucess with ESWT for this condition. I believe the procedure was done in Europe. I would be concerned with the chance of nerve damage. Stay with ESWT for proximal insertional pf and Achilles tendonitis.

Re: ESWT for Plantar fibromas

Dr. Reid on 1/20/01 at 21:23 (036972)

Thanks, actually it was a patient of someone who contacted me. Have you used ESWT on Achilles Tendonitis?? What is your protocol for low energy for anesthesia? I would love to try it. Thanks!

Re: ESWT for Plantar fibromas

Dr. Zuckerman on 1/21/01 at 09:41 (036997)

Yes. According to David Lowery who is the North American director Sieman's medical who make the soncur ESWT. They have done alot of Achilles Tendonitis with calification. He told me that that the following is the order of most sucessful with ESWT.

Elbow
Achilles
Pf

Now low energy can be used in either two ways.
1. Start at low energy. I don't know the joules/mm2 for the ossatron so I can't give you the exact kv,but 12-13 kv is about right .

2. Start the foot out of focus. The surrounding shockwaves are low energy and then work your way into the f2 focal site. You will need to use about
50-75 shockwaves to get the anesthetic effect. If the patient feels some then go out of focus a little longer. The patients are going to feel at times the increase shockwave pressure that goes with the physical properties of a shockwave. It believe this is called the cavitation effect
It is that or the fact that not all shockwaves procdured are created equal

I hope that this is helpful and that i am explaining myself clearly to you

One the most important and only way for us to learn protocol from each other is comparison of generator power at the focal point of treatment.

I use 0.6 joules/mm2 for at the f2 site of treatment. I believe you use 18kv for the ossatron . Do you know what the joules/mm2 are.? This is important for research and for all doctors in the world to be able to compared the actual treatment resutls This is the way the european's think and how they talk to each other about their results. So we have to learn to think and know the joules/mm2 .

Re: ESWT for Plantar fibromas

DR.Kosova on 1/22/01 at 00:17 (037048)

Your Technique for no anesthesia is worth a try and makes sense if we can accomplish the same results. I know you just swicthed to this technique so for the next few cases My patients will still be monitored. This is the FDA protocol that I MUST follow for the time being.

As far as Dr. Eichmeir(sp) You had the podiatry management atricle that you sent me so you know when she stared doing eswt in 1997. Her results are good. I never tell my patients that they will get 100% pain relief for any thing. But I so have many patints for heel pain that state that they are 100% better at the time I evalulte them. Then they might come back for an ingrown nail months or years later and they still admit to being 100% relived of the heel pain. I know Kim used a vas pain scale. How do you evauluate pain. I use a 0-100% scale with 100% means no pain. My patients tend to understand this better then the typical reverse scale.

as far as the other info. go to http://www.digest-ev.de or http://www.ismst.com which we will bve members soon. You know that I am a self admiited eswt neophyte but:

The energy density that I believe you are speaking about is .22mj\mm2 at 18kv. I beleve that the shape of the of the diameter at f2 and size are important. focal size-6db with 5.5X61mm at 20kv and the pressure rise tim of 10ns+\-2ns. And the presuure at focal point of 20MPa to40 Mpa at 14kv to28kv. The generator capacitance is 50nf. The tech. can control the machine with .5,1.0.2.0 4.0 shocks per second. This machine is a different then your machine with a higher impact at f2. That is the point.

I generally post late do to two kids to put to sleep. But Why do you insist that anyone is trying to hide information?

Re: ESWT for Plantar fibromas

Kurt Kaufman on 1/20/01 at 12:35 (036937)

Dr. Reid
Eswt has not been shown to be effective for plantar fibromatosis

Re: ESWT for Plantar fibromas

Dr. Zuckerman on 1/20/01 at 15:27 (036950)

Hi,

I will suggest buying the new book that was published by the International Society for Shockwave treatment. The book talks about plantar fibromas and the lack of reponse. Very small study. There is a women on the ESWT section of this site that talks about her great sucess with ESWT for this condition. I believe the procedure was done in Europe. I would be concerned with the chance of nerve damage. Stay with ESWT for proximal insertional pf and Achilles tendonitis.

Re: ESWT for Plantar fibromas

Dr. Reid on 1/20/01 at 21:23 (036972)

Thanks, actually it was a patient of someone who contacted me. Have you used ESWT on Achilles Tendonitis?? What is your protocol for low energy for anesthesia? I would love to try it. Thanks!

Re: ESWT for Plantar fibromas

Dr. Zuckerman on 1/21/01 at 09:41 (036997)

Yes. According to David Lowery who is the North American director Sieman's medical who make the soncur ESWT. They have done alot of Achilles Tendonitis with calification. He told me that that the following is the order of most sucessful with ESWT.

Elbow
Achilles
Pf

Now low energy can be used in either two ways.
1. Start at low energy. I don't know the joules/mm2 for the ossatron so I can't give you the exact kv,but 12-13 kv is about right .

2. Start the foot out of focus. The surrounding shockwaves are low energy and then work your way into the f2 focal site. You will need to use about
50-75 shockwaves to get the anesthetic effect. If the patient feels some then go out of focus a little longer. The patients are going to feel at times the increase shockwave pressure that goes with the physical properties of a shockwave. It believe this is called the cavitation effect
It is that or the fact that not all shockwaves procdured are created equal

I hope that this is helpful and that i am explaining myself clearly to you

One the most important and only way for us to learn protocol from each other is comparison of generator power at the focal point of treatment.

I use 0.6 joules/mm2 for at the f2 site of treatment. I believe you use 18kv for the ossatron . Do you know what the joules/mm2 are.? This is important for research and for all doctors in the world to be able to compared the actual treatment resutls This is the way the european's think and how they talk to each other about their results. So we have to learn to think and know the joules/mm2 .

Re: ESWT for Plantar fibromas

DR.Kosova on 1/22/01 at 00:17 (037048)

Your Technique for no anesthesia is worth a try and makes sense if we can accomplish the same results. I know you just swicthed to this technique so for the next few cases My patients will still be monitored. This is the FDA protocol that I MUST follow for the time being.

As far as Dr. Eichmeir(sp) You had the podiatry management atricle that you sent me so you know when she stared doing eswt in 1997. Her results are good. I never tell my patients that they will get 100% pain relief for any thing. But I so have many patints for heel pain that state that they are 100% better at the time I evalulte them. Then they might come back for an ingrown nail months or years later and they still admit to being 100% relived of the heel pain. I know Kim used a vas pain scale. How do you evauluate pain. I use a 0-100% scale with 100% means no pain. My patients tend to understand this better then the typical reverse scale.

as far as the other info. go to http://www.digest-ev.de or http://www.ismst.com which we will bve members soon. You know that I am a self admiited eswt neophyte but:

The energy density that I believe you are speaking about is .22mj\mm2 at 18kv. I beleve that the shape of the of the diameter at f2 and size are important. focal size-6db with 5.5X61mm at 20kv and the pressure rise tim of 10ns+\-2ns. And the presuure at focal point of 20MPa to40 Mpa at 14kv to28kv. The generator capacitance is 50nf. The tech. can control the machine with .5,1.0.2.0 4.0 shocks per second. This machine is a different then your machine with a higher impact at f2. That is the point.

I generally post late do to two kids to put to sleep. But Why do you insist that anyone is trying to hide information?