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Post ESWT Treatment

Posted by Cindy H on 6/05/01 at hrmin (050034)

I'd like to hear from anyone who had ESWT and particularly w/Orbasone. I'd like to know what your recovery is like, your pain and soreness right after the treatment, several weeks on and at the end of 12 weeks.

Have some of you had some post treatment pain and still had a good end result?

This is Tuesday night 6-5, I was treated Saturday 6-2 & I'm trying to figure out if my pain/soreness level still dictates using heat or if it's the kind of discomfort I need to ice. The first couple of days saw a quite an improvement in my pain from what it was the day before treatment. I had local anesthesia so couldn't really tell about the first night. Now I have some pain that may be more soreness than pain but I'm not sure enough to know if I should ice....I'm continuing to use heat.

Dr. Z, you may see this and respond or I may e-mail or ring you.

Best,
Cindy

Re: Post ESWT Treatment

Scott R on 6/06/01 at 06:33 (050049)

I wouldn't ever use heat. Always ice. Heat may increase inflammation if it's applied after an injury like ESWT.

Re: Post ESWT Treatment

Cindy H on 6/06/01 at hrmin (050056)

Hi Scott and all,

Dr. Z said heat after ESWT to bring bloodflow to the area to hasten healing. He did say to ice if I begin to feel sharp pain. I have some pain, more than first two days but I'm not sure if it's bad enough to warrant ice.

Re: Post ESWT Treatment

john h on 6/06/01 at 09:58 (050063)

most injuries (which is what ESWT is) ice is usually recommended for the first 24 hours and then heat. actually ice will increase the blood flow because once it is removed blood rushes to the area in an increasing amount. if there is a standard protocol for treatment after ESWT i have not read about it. you would have thought the studies conducted by the FDA would have set such a protocol.

Re: Post ESWT Treatment

Dr. Zuckerman on 6/06/01 at 10:37 (050065)

ESWT is an injury but not the same magnitude as foot surgery or a tramatic injury. We want blood flow to the area to injury with ESWT, which is inflamation. Ice, local steriod injection all impede this normal reaction

Now if you are experiencing serve swelling from ESWT. which is so real and not to never happening then ice is indicated.

I have a funny saying in my office. Take the advice of friends and relatives as soon as they show you their medical degree. Please take this a joke I just made it up !!!

Re: Post ESWT Treatment

Dr. Zuckerman on 6/06/01 at 10:39 (050066)

ESWT is an injury but not the same magnitude as foot surgery or a tramatic injury. We want blood flow to the area with an ESWT injury, which provides inflamation. Ice, local steriod injections all impede this normal reaction

Now if you are experiencing serve swelling from ESWT. which is so rare and next to never happening, then ice is indicated.

I have a funny saying in my office. Take the advice of friends and relatives as soon as they show you their medical degree. Please take this a joke I just made it up !!!

Re: Post ESWT Treatment

Adrienne on 6/06/01 at 14:34 (050086)

Hi Cindy.

I am at the 5 week mark after doing a second Orbasone treatment with Dr. Z.
For a few days after, my feet defintely felt like they were battered.
Dr. Z. gave me the same advice about heat over using ice unless a sharp pain and that is what I have done. However, I do remember ebing in the same spot as you and not knowing what to do: heat or ice.
I also heat my calves just to keep everything loose as I'm constantly stretching. Some nights I use ice before going to bed because the night splints I've worn (for almost 2 yrs) are not comfortable for someone who tosses a lot. I've never liked the idea of icing and then walking around on contracted muscles.

I can say that around week 4 I had 3 good days in a row. I do still have many bad days where I am still crawling around my house. With the exception of the few good days my pain level I would say remains about an 8. Still have fingers crossed that around week 12 I will be saying something completely different. I was able to make Dr. Reynold's list for Jade Balm so we'll see what that does as well.

Good luck and even though it's extremely difficult, try to keep patient with your healing time!

Regards,
Adrienne

Re: Post ESWT Treatment

Cindy H on 6/06/01 at hrmin (050119)

Thanks Adrienne.

How many weeks after your first treatment did you have the second? What is Jade Balm? Best of luck to you.

Cindy H

Re: Post ESWT Treatment

Adrienne on 6/07/01 at 16:38 (050175)

Cindy H,
I got the second treatment after about 4 wks. I wanted to wait longer to see if I would have results (since I didnt' have any), but I have a really bad case of PF. I am trying to go to grad school in August (have put it off a year already to just rest). If I waited like 12 wks and then do a 2nd treatment if i needed it -well i think I would still be in a lot of pain going to school. So I mentioned this in brief to Dr. Z and he suggested that I just go ahead and get the 2nd treatment. So now if I don't get relief in the 12 wks after the 2nd round, I still have a few weeks left to maybe try acupuncture or rethink my graduate school plans - knowing at least that I gave ESWT a good chance. By the way, I got zapped in both feet both times.

Jade Balm is a product mentioned either on this message board or on the heelspurs.com message board. A doc is offering 20 people who emailed him 2 free tubes of it b/c he thinks it may help some of us. I was able to sign on and will get in the mail next week(?) to give it a whirl.

Hope all that helps in some way and isn't too confusing!

A

Re: Post ESWT Treatment

Cindy H on 6/07/01 at hrmin (050186)

Adrienne, (love that name & that spelling:-) thanks for posting back. Did you have any relief during or at the end of the four weeks? Some relief and just thought you might gain a bit more?

The Sunday and Monday after my treatments on Sat were good walking. I hope that wasn't leftover local anesthesia (surely not after that long) I limited the walking amt by taking the golf carts & wheelchairs in airports. I had some aching in the outer ankles the first night and some the next day that I think was from the knocking around, but that's mainly gone away. I have some pain now when walking, maybe more of a soreness in my old spots and in arches a bit. It's duller than the pain before...I pray this is just from the treatments less than a week ago and that I will still get results.

I wish very good things for you, your healing and school plans.

Thinking Positive,
Cindy

Re: I'm sorry Adrienne

Cindy H on 6/07/01 at hrmin (050188)

I realize I just re-asked you some questions about post-first treatment...please forgive me...I've read so much today I'm wonky in the head....Cindy

Re: Post ESWT Treatment

Dr. Marlene Reid on 6/07/01 at 20:07 (050194)

We use ice for 20 minutes of each hour for the day of ESW and the next day. We never use heat. I feel the icing will help control the inflammation that can cause pain but with 20 min of/40 min off, it will not impede the vascular response.

Re: Post ESWT Treatment

DeniseA on 6/07/01 at hrmin (050221)

Hey Cindy,

Relax girl! Just listen to your body. Don't worry and fret over this. Just think positive, have faith in Doc Z (he doesn't give up!), and let this run it's course.

You really do have to give it a full 12 weeks before you will be able to assess any results so you might as well just stay peaceful, follow doc's orders and chill.

Your bud,
Denise

Re: Post ESWT Treatment

Cindy H on 6/08/01 at hrmin (050253)

You're Denise Ashcraft I just figured out. It didn't hit me at first as I thought everyone on here was either a patient, sufferer or a doc.

Yes, I shall think positive and chill more.

Re: Post ESWT Treatment

JudyS on 6/08/01 at 12:32 (050274)

Dr's - I'm soooo confused! Ice or no ice? Heat or no heat? Anti-inflammatories or not? My understanding was that post-ESW inflammation is encouraged....
I can understand the idea of using ice to help with inflammation pain, but what is the reason for using heat after ESWT?

Re: I'm sorry Adrienne

Adrienne on 6/08/01 at 13:21 (050280)

That's ok! Listen to Denise - she has good advice. We get to take it easy and wait with fingers crossed!

Re: Post ESWT Treatment

Dr. Zuckerman on 6/08/01 at 15:23 (050286)

I like heat . Always have . Heat will give you increase blood flow to the area. I have never seen extreme swelling with ESWT. We want to have some inflamation. Ice I like to use when there is pain. The physical confort of the patient is my main reason for using heat first and only ice for servere throbbing type pain. ESWT isn't a severe tramatic injury.

Re: Post ESWT Treatment

Camilla on 6/10/01 at 12:45 (050390)

Dr. Z.,

I am a post-operative surgical nurse on a Women's Health unit. Help me interupt your response to the ice vs. heat issue. We have a surgeon that DOES NOT allow ice to his abominal incisions because ice shunts the blood flow away for the area that has been surgically traumatized; nor does he use heat. He wants blood flow supplied to this area to promote healing. I realize that one area is surgically cut, i.e. hysterectomy, and with ESWT the plantar facititis is already inflamed and then traumatized by ESWT. Would you not apply the same reasoning to post-operative ESWT and not use ice?

Thanks,
Camilla

Re: Post ESWT Treatment

Dr. Zuckerman on 6/10/01 at 13:26 (050393)

There really isn't this great amount of trauma with ESWT. Now with surgery there is alot more trauma. I can undestand the fear of shunting blood to a skin incision. I am only talking about ESWT at this point and I want blood flow to this area. Blood flow is good. Excessive pain is bad and in my opinion I only use heat unless there is severe pain and then I use ice for pain relief. Very rare to have severe pain post-ESWT, but it does happen.

So yes the theory is one and the same. Need blood flow for healing and ice will stop this if used too much. I never place ice over the surgical site when doing surgery it is in front of or on front of the ankle.

Ever try to place ice on a a new injury it can really hurt even if it is covered with cloth

Re: Post ESWT Treatment

Jill P on 6/13/01 at hrmin (050679)

Cindy, I felt that the hot soaks really helped. I too had pain and soreness in areas of my foot that hadn't bothered me before but the heat helped. Try to do several during the day especially when you are hurting and see if that helps you too. I hope that you heal up quickly and well!

Re: Post ESWT Treatment

Scott R on 6/06/01 at 06:33 (050049)

I wouldn't ever use heat. Always ice. Heat may increase inflammation if it's applied after an injury like ESWT.

Re: Post ESWT Treatment

Cindy H on 6/06/01 at hrmin (050056)

Hi Scott and all,

Dr. Z said heat after ESWT to bring bloodflow to the area to hasten healing. He did say to ice if I begin to feel sharp pain. I have some pain, more than first two days but I'm not sure if it's bad enough to warrant ice.

Re: Post ESWT Treatment

john h on 6/06/01 at 09:58 (050063)

most injuries (which is what ESWT is) ice is usually recommended for the first 24 hours and then heat. actually ice will increase the blood flow because once it is removed blood rushes to the area in an increasing amount. if there is a standard protocol for treatment after ESWT i have not read about it. you would have thought the studies conducted by the FDA would have set such a protocol.

Re: Post ESWT Treatment

Dr. Zuckerman on 6/06/01 at 10:37 (050065)

ESWT is an injury but not the same magnitude as foot surgery or a tramatic injury. We want blood flow to the area to injury with ESWT, which is inflamation. Ice, local steriod injection all impede this normal reaction

Now if you are experiencing serve swelling from ESWT. which is so real and not to never happening then ice is indicated.

I have a funny saying in my office. Take the advice of friends and relatives as soon as they show you their medical degree. Please take this a joke I just made it up !!!

Re: Post ESWT Treatment

Dr. Zuckerman on 6/06/01 at 10:39 (050066)

ESWT is an injury but not the same magnitude as foot surgery or a tramatic injury. We want blood flow to the area with an ESWT injury, which provides inflamation. Ice, local steriod injections all impede this normal reaction

Now if you are experiencing serve swelling from ESWT. which is so rare and next to never happening, then ice is indicated.

I have a funny saying in my office. Take the advice of friends and relatives as soon as they show you their medical degree. Please take this a joke I just made it up !!!

Re: Post ESWT Treatment

Adrienne on 6/06/01 at 14:34 (050086)

Hi Cindy.

I am at the 5 week mark after doing a second Orbasone treatment with Dr. Z.
For a few days after, my feet defintely felt like they were battered.
Dr. Z. gave me the same advice about heat over using ice unless a sharp pain and that is what I have done. However, I do remember ebing in the same spot as you and not knowing what to do: heat or ice.
I also heat my calves just to keep everything loose as I'm constantly stretching. Some nights I use ice before going to bed because the night splints I've worn (for almost 2 yrs) are not comfortable for someone who tosses a lot. I've never liked the idea of icing and then walking around on contracted muscles.

I can say that around week 4 I had 3 good days in a row. I do still have many bad days where I am still crawling around my house. With the exception of the few good days my pain level I would say remains about an 8. Still have fingers crossed that around week 12 I will be saying something completely different. I was able to make Dr. Reynold's list for Jade Balm so we'll see what that does as well.

Good luck and even though it's extremely difficult, try to keep patient with your healing time!

Regards,
Adrienne

Re: Post ESWT Treatment

Cindy H on 6/06/01 at hrmin (050119)

Thanks Adrienne.

How many weeks after your first treatment did you have the second? What is Jade Balm? Best of luck to you.

Cindy H

Re: Post ESWT Treatment

Adrienne on 6/07/01 at 16:38 (050175)

Cindy H,
I got the second treatment after about 4 wks. I wanted to wait longer to see if I would have results (since I didnt' have any), but I have a really bad case of PF. I am trying to go to grad school in August (have put it off a year already to just rest). If I waited like 12 wks and then do a 2nd treatment if i needed it -well i think I would still be in a lot of pain going to school. So I mentioned this in brief to Dr. Z and he suggested that I just go ahead and get the 2nd treatment. So now if I don't get relief in the 12 wks after the 2nd round, I still have a few weeks left to maybe try acupuncture or rethink my graduate school plans - knowing at least that I gave ESWT a good chance. By the way, I got zapped in both feet both times.

Jade Balm is a product mentioned either on this message board or on the heelspurs.com message board. A doc is offering 20 people who emailed him 2 free tubes of it b/c he thinks it may help some of us. I was able to sign on and will get in the mail next week(?) to give it a whirl.

Hope all that helps in some way and isn't too confusing!

A

Re: Post ESWT Treatment

Cindy H on 6/07/01 at hrmin (050186)

Adrienne, (love that name & that spelling:-) thanks for posting back. Did you have any relief during or at the end of the four weeks? Some relief and just thought you might gain a bit more?

The Sunday and Monday after my treatments on Sat were good walking. I hope that wasn't leftover local anesthesia (surely not after that long) I limited the walking amt by taking the golf carts & wheelchairs in airports. I had some aching in the outer ankles the first night and some the next day that I think was from the knocking around, but that's mainly gone away. I have some pain now when walking, maybe more of a soreness in my old spots and in arches a bit. It's duller than the pain before...I pray this is just from the treatments less than a week ago and that I will still get results.

I wish very good things for you, your healing and school plans.

Thinking Positive,
Cindy

Re: I'm sorry Adrienne

Cindy H on 6/07/01 at hrmin (050188)

I realize I just re-asked you some questions about post-first treatment...please forgive me...I've read so much today I'm wonky in the head....Cindy

Re: Post ESWT Treatment

Dr. Marlene Reid on 6/07/01 at 20:07 (050194)

We use ice for 20 minutes of each hour for the day of ESW and the next day. We never use heat. I feel the icing will help control the inflammation that can cause pain but with 20 min of/40 min off, it will not impede the vascular response.

Re: Post ESWT Treatment

DeniseA on 6/07/01 at hrmin (050221)

Hey Cindy,

Relax girl! Just listen to your body. Don't worry and fret over this. Just think positive, have faith in Doc Z (he doesn't give up!), and let this run it's course.

You really do have to give it a full 12 weeks before you will be able to assess any results so you might as well just stay peaceful, follow doc's orders and chill.

Your bud,
Denise

Re: Post ESWT Treatment

Cindy H on 6/08/01 at hrmin (050253)

You're Denise Ashcraft I just figured out. It didn't hit me at first as I thought everyone on here was either a patient, sufferer or a doc.

Yes, I shall think positive and chill more.

Re: Post ESWT Treatment

JudyS on 6/08/01 at 12:32 (050274)

Dr's - I'm soooo confused! Ice or no ice? Heat or no heat? Anti-inflammatories or not? My understanding was that post-ESW inflammation is encouraged....
I can understand the idea of using ice to help with inflammation pain, but what is the reason for using heat after ESWT?

Re: I'm sorry Adrienne

Adrienne on 6/08/01 at 13:21 (050280)

That's ok! Listen to Denise - she has good advice. We get to take it easy and wait with fingers crossed!

Re: Post ESWT Treatment

Dr. Zuckerman on 6/08/01 at 15:23 (050286)

I like heat . Always have . Heat will give you increase blood flow to the area. I have never seen extreme swelling with ESWT. We want to have some inflamation. Ice I like to use when there is pain. The physical confort of the patient is my main reason for using heat first and only ice for servere throbbing type pain. ESWT isn't a severe tramatic injury.

Re: Post ESWT Treatment

Camilla on 6/10/01 at 12:45 (050390)

Dr. Z.,

I am a post-operative surgical nurse on a Women's Health unit. Help me interupt your response to the ice vs. heat issue. We have a surgeon that DOES NOT allow ice to his abominal incisions because ice shunts the blood flow away for the area that has been surgically traumatized; nor does he use heat. He wants blood flow supplied to this area to promote healing. I realize that one area is surgically cut, i.e. hysterectomy, and with ESWT the plantar facititis is already inflamed and then traumatized by ESWT. Would you not apply the same reasoning to post-operative ESWT and not use ice?

Thanks,
Camilla

Re: Post ESWT Treatment

Dr. Zuckerman on 6/10/01 at 13:26 (050393)

There really isn't this great amount of trauma with ESWT. Now with surgery there is alot more trauma. I can undestand the fear of shunting blood to a skin incision. I am only talking about ESWT at this point and I want blood flow to this area. Blood flow is good. Excessive pain is bad and in my opinion I only use heat unless there is severe pain and then I use ice for pain relief. Very rare to have severe pain post-ESWT, but it does happen.

So yes the theory is one and the same. Need blood flow for healing and ice will stop this if used too much. I never place ice over the surgical site when doing surgery it is in front of or on front of the ankle.

Ever try to place ice on a a new injury it can really hurt even if it is covered with cloth

Re: Post ESWT Treatment

Jill P on 6/13/01 at hrmin (050679)

Cindy, I felt that the hot soaks really helped. I too had pain and soreness in areas of my foot that hadn't bothered me before but the heat helped. Try to do several during the day especially when you are hurting and see if that helps you too. I hope that you heal up quickly and well!