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ESWT for edge heel pain/tendonitis?

Posted by Donna SL on 3/01/01 at 03:02 (040141)

Dear Doctors,

Can ESWT be done for pain in the back of the heels? The rest of my feet are getting better, but I am still having trouble with pain in the bottom edges towards the back of both my heels, and up the sides a little. It sometimes spreads foward to the entire heel. It's not constant, and I usually don't have pain at home anymore. It starts when I walk, or stand to long, usually a couple of hours, but sometimes much sooner. I had many other PF symptoms/pain over the last 2 years (insertional pain, severe arch, foot, and heel pain) at one time, but they have all improved significantly, but not completely. The heel pain towards the back of the heels was always the most bothersome. That was the first problem I had before I got everything else. The arch pain was mostly in my right foot, but over the last month it hasn't been giving me that much trouble. I felt something pop in my arch a year ago when I was exercising, and could have hurt a tendon, the fascia, etc., but it didn't show on a recent MRI.

I stretch every day, wear night splints, and still gong to PT 2 to 3 tims a week. Sometimes I can walk for a couple of hours before it starts, and other times the smallest change will trigger the pain sooner like changing to a different shoe, trying a new orthotics, etc. I'm so tired of this. Could the shock wave just be run all over the back/bottom of the heel like the way ultra sound is done? Do You have to be point specific? I just want to knock this out already.

I had an MRI in Dec 2000, and it only showed some soft tissure irritation in my left heel. The report said all my tendons, including the achilles, were in tact. My fascia looks completely normal. The report just said I have some mild fluid in the ankles, and a possible chronic sprain. I also have an old osteochondral injury of the talar dome on my left ankle which showed it had improved, since 3 years ago when I first injured it. My doctor re-read the MRI, and said there is fluid in the mid-foot too, plus some other things he found not mentioned on the report, but nothing stood out as far as achilles tendonitis, or anything seriously wrong with the heel. I know MRI's don't show everything. He's just guessing it's some type of tendonitis.

Could calcifications of the tendons, bursitis, micro tears, etc, not show up on an MRI or x-ray? I'm sure if someone went in surgically they would find something, but I would not risk doing that. That's why I was wondering if the shock wave could just remove what ever is causing this type of heel pain even if you don't have a specific diagnosis. I thought I had read a post once about ESWT performed for tendonitis in this area, but I don't remember the doctor's name. Also, could it be done in the arch area if the fascia appears normal? I also have high arched feet, which I know doesn't help things.

Sorry about the long post, but I wanted to give you my history to help in determining if I'm a candidate for ESWT.

Donna

Re: ESWT for edge heel pain/tendonitis?

Dr. Zuckerman on 3/01/01 at 09:56 (040174)

yes

I do use ESWT for the treatment of chronic insertional for Achilles Tendonitis. This will depend on the experience of the treating doctor and what he feels comfortable doing.

Re: Re Dr Zuckerman: ESWT for edge heel pain/tendonitis?

Donna SL on 3/01/01 at 11:50 (040189)

Dear Dr.Zuckerman,

I wish I lived closer to you. You're probably the only doctor I would trust with ESWT at this time. I live in California. I'm orginally from Philadelphia. I keep toying around with flying out there, but I don't know if it would be to much of a hardship for me. If not I would have to condider someone closer.

From the symptoms I described in the above post, and my test results do you think it is achilles insertional tendonitis? Would it have to be confirmed any other way? Would you do the ESWT in the Achilles area, all over the heel as I described in my prior post, just at the attachment, or all of the above? I don't have pain, or inflamation in the achilles tendon in back of the ankle unless I go without orthotics, but it's very mild pain in that area that dissapears very quickly if my foot is stabilized. I did have peroneal tendonitis at one time, but that seemes to have been reduced dramatically through PT.

Does insertionaI achilles tendonitis cause the type of heel pain I described above, because the achilles is pulling on the heel bone at the attachment? The pain is not in one spot, like PF. If I get really inflamed like I am today, I can actually feel a pulling type sensation in the heels, along with the pain.

How would the treatment differ from PF pain at the insertion point that can be pinpointed? Also, how many treatments would I need, and how close together could they be done? Would the medial talar dome injury (8mm lesion) which has showed improvement since an MRI done in 98 rule out treatment on my left foot?

Any input you could give me would be greatly appreciated.

Donna

Re: Re Dr Zuckerman: ESWT for edge heel pain/tendonitis?

DR. Zuckerman on 3/01/01 at 17:04 (040215)

Hi,

IF the ankle talar dome injured is significant to cause restriction of motion at the ankle it will cause both peroneal and achilles tendonitis such as what you are decribing.

So it the ankle motion is restricted and this needs to be determine by a clincial examination with the knee extended and flexed then itis the dome injury that is causing the problem. It probaby is because of this that you are having the achilles tendon problem

No if the pain is at the insertion of the achilles tendon insertion and there pain on palpation then ESWT would be a very good consideration.

The clinical examination is the most important determination for your next step.

Re: ESWT for edge heel pain/tendonitis?

Dr. Zuckerman on 3/01/01 at 09:56 (040174)

yes

I do use ESWT for the treatment of chronic insertional for Achilles Tendonitis. This will depend on the experience of the treating doctor and what he feels comfortable doing.

Re: Re Dr Zuckerman: ESWT for edge heel pain/tendonitis?

Donna SL on 3/01/01 at 11:50 (040189)

Dear Dr.Zuckerman,

I wish I lived closer to you. You're probably the only doctor I would trust with ESWT at this time. I live in California. I'm orginally from Philadelphia. I keep toying around with flying out there, but I don't know if it would be to much of a hardship for me. If not I would have to condider someone closer.

From the symptoms I described in the above post, and my test results do you think it is achilles insertional tendonitis? Would it have to be confirmed any other way? Would you do the ESWT in the Achilles area, all over the heel as I described in my prior post, just at the attachment, or all of the above? I don't have pain, or inflamation in the achilles tendon in back of the ankle unless I go without orthotics, but it's very mild pain in that area that dissapears very quickly if my foot is stabilized. I did have peroneal tendonitis at one time, but that seemes to have been reduced dramatically through PT.

Does insertionaI achilles tendonitis cause the type of heel pain I described above, because the achilles is pulling on the heel bone at the attachment? The pain is not in one spot, like PF. If I get really inflamed like I am today, I can actually feel a pulling type sensation in the heels, along with the pain.

How would the treatment differ from PF pain at the insertion point that can be pinpointed? Also, how many treatments would I need, and how close together could they be done? Would the medial talar dome injury (8mm lesion) which has showed improvement since an MRI done in 98 rule out treatment on my left foot?

Any input you could give me would be greatly appreciated.

Donna

Re: Re Dr Zuckerman: ESWT for edge heel pain/tendonitis?

DR. Zuckerman on 3/01/01 at 17:04 (040215)

Hi,

IF the ankle talar dome injured is significant to cause restriction of motion at the ankle it will cause both peroneal and achilles tendonitis such as what you are decribing.

So it the ankle motion is restricted and this needs to be determine by a clincial examination with the knee extended and flexed then itis the dome injury that is causing the problem. It probaby is because of this that you are having the achilles tendon problem

No if the pain is at the insertion of the achilles tendon insertion and there pain on palpation then ESWT would be a very good consideration.

The clinical examination is the most important determination for your next step.