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To Dr and all : Which one to do first ESWT or EPF ?

Posted by MattP on 6/11/01 at 01:36 (050422)

After 3 yrs of right PF and heelspur, I quitted working 9 months ago, on complete rest. After 6 months, felt 70 % better, then had a setback and now 3 mths after the setback, felt 50 % better. I can't afford to be off work too much longer. Starting to lose patient, I am pondering EPF or ESWT which I hope may get me back to work earlier.
Currently, after about 20-30 minutes of walking on hard floor, I have no pain in the heel but the area of diameter 1 1/2 inch in front of anterior mid calcaneal will be swollen, feeling itchy tingling when pressed. I guess there is still incomplete healing in fascia right in front of the heelspur.
I think EPF with partially cutting of fascia in problem area right in front of the heelspur may solve the pulling problem but I don't like the fact that foot structure will be changed and the outcome of the change is not known.
Or ESWT which may help with healing but the pull to the anterior mid calcaneal is still there and may create the same problem again.
Do you think my thought about these two alternatives are correct and which one will be more appropriate to go with first ?

Re: To Dr and all : Which one to do first ESWT or EPF ?

BrianG on 6/11/01 at 07:06 (050427)

Hi MattP,

If money is no object, I'd go with the ESWT. The main reason I'd choose it, is beacause it's non-invasive. I had EPF after five years of PF, it was a total failure. The doctor is very limited as to what he can see with that little scope (EPF).

Good luck
BCG

Re: Matt -- I suggest you re-post this on the "Ask The Foot Doctors" message board.................regards........eom

Steve P on 6/11/01 at 10:50 (050446)

.

Re: To Dr and all : Which one to do first ESWT or EPF ?

JudyS on 6/11/01 at 11:52 (050449)

Matt, please keep in mind that I'm not a doctor, but, after a year's worth of research, I can at least share a bit of what I've learned about EPF/ESWT.
My understanding is that surgery can be one of three levels of 'invasiveness'. Apparently each has suceeded the one before as less-invasive procedures were developed. And each decision is based on the individual case as well as the doctor's expertise or preference. EPF is the least-invasive of them but as such has it's limitations. It uses a scope through one tiny incision and a cutting tool through another, or, I think, sometimes the cutting tool is with the scope. The drawback is that it's limited in 'visability' - you can read lots about it here on Scott's website. The ESWT is non-invasive so clearly it's risk of changing the foot structure is extremely limited or non-existant. It's cost is just about the only serious drawback but........I guess it depends on deciding how much one's feet are really worth. Last, according to some data that has been seen here, informally and unofficially, the success rate between surgery and ESWT is about the same. Having said that, given it's non-invasive nature, ESWT is clearly the better choice while perhaps leaving surgery open as a 'last resort'. Others here know much more about that than I do so I hope they'll correct me if I'm wrong. Good Luck!

Re: To Dr and all : Which one to do first ESWT or EPF ?

Dr. Zuckerman on 6/11/01 at 12:02 (050451)

Once you have had surgery there is no turning back the clock. With ESWT not only does it avoid the dangers that can and do happen with heel spur surgery it is an option that can avoid foot surgery and if it doesn't help your present heel pain problem doesn't prevent you from having any future foot surgery.

Re: To Dr and all : Which one to do first ESWT or EPF ?

footpro on 6/16/01 at 08:47 (050824)

Dr. Zuckerman,

I've been told by one of the primary investigators of the Ossatron that previous surgery is not a contraindication to ESWT. I have several patients who have had previous surgery that still have some pain associated with plantar fasciitis. I am the only DPM in my area certified for in ESWT and have been contemplating trying this on these patients who's traditional plantar fasciotomy have not worked. Have you had any experience with patients who have had previous surgery and now want ESWT? If so, how are the results post ESWT?

Thank you

Re: To Dr and all : Which one to do first ESWT or EPF ?

Dr. Zuckerman on 6/16/01 at 09:48 (050830)

Hi,

ESWT is indicated for failed pf release. So long as there isn't any nerve entrapement and you still have insertional proximal pf then ESWT is indicated.

I have about twenty cases that I have done after failed pf release. Some are over one year old. I don't know the percentage of sucess over all but there are at least five off the top of my head that are pain free post fifteen months after failed pf release.

There have been some done up in Canada by Dr. Galea via Ossatron that were failed EPF and went on to a cure. So yes it is indicated and yes it does resolve the pain.

Re: To Dr and all : Which one to do first ESWT or EPF ?

RogerC on 8/15/01 at hrmin (056768)

Is there anywhere in Texas to get ESWT

Re: ESWT locations in Texas

RogerC on 8/15/01 at hrmin (056769)

Anyone doing ESWT in Texas?

Re: To Dr and all : Which one to do first ESWT or EPF ?

BrianG on 6/11/01 at 07:06 (050427)

Hi MattP,

If money is no object, I'd go with the ESWT. The main reason I'd choose it, is beacause it's non-invasive. I had EPF after five years of PF, it was a total failure. The doctor is very limited as to what he can see with that little scope (EPF).

Good luck
BCG

Re: Matt -- I suggest you re-post this on the "Ask The Foot Doctors" message board.................regards........eom

Steve P on 6/11/01 at 10:50 (050446)

.

Re: To Dr and all : Which one to do first ESWT or EPF ?

JudyS on 6/11/01 at 11:52 (050449)

Matt, please keep in mind that I'm not a doctor, but, after a year's worth of research, I can at least share a bit of what I've learned about EPF/ESWT.
My understanding is that surgery can be one of three levels of 'invasiveness'. Apparently each has suceeded the one before as less-invasive procedures were developed. And each decision is based on the individual case as well as the doctor's expertise or preference. EPF is the least-invasive of them but as such has it's limitations. It uses a scope through one tiny incision and a cutting tool through another, or, I think, sometimes the cutting tool is with the scope. The drawback is that it's limited in 'visability' - you can read lots about it here on Scott's website. The ESWT is non-invasive so clearly it's risk of changing the foot structure is extremely limited or non-existant. It's cost is just about the only serious drawback but........I guess it depends on deciding how much one's feet are really worth. Last, according to some data that has been seen here, informally and unofficially, the success rate between surgery and ESWT is about the same. Having said that, given it's non-invasive nature, ESWT is clearly the better choice while perhaps leaving surgery open as a 'last resort'. Others here know much more about that than I do so I hope they'll correct me if I'm wrong. Good Luck!

Re: To Dr and all : Which one to do first ESWT or EPF ?

Dr. Zuckerman on 6/11/01 at 12:02 (050451)

Once you have had surgery there is no turning back the clock. With ESWT not only does it avoid the dangers that can and do happen with heel spur surgery it is an option that can avoid foot surgery and if it doesn't help your present heel pain problem doesn't prevent you from having any future foot surgery.

Re: To Dr and all : Which one to do first ESWT or EPF ?

footpro on 6/16/01 at 08:47 (050824)

Dr. Zuckerman,

I've been told by one of the primary investigators of the Ossatron that previous surgery is not a contraindication to ESWT. I have several patients who have had previous surgery that still have some pain associated with plantar fasciitis. I am the only DPM in my area certified for in ESWT and have been contemplating trying this on these patients who's traditional plantar fasciotomy have not worked. Have you had any experience with patients who have had previous surgery and now want ESWT? If so, how are the results post ESWT?

Thank you

Re: To Dr and all : Which one to do first ESWT or EPF ?

Dr. Zuckerman on 6/16/01 at 09:48 (050830)

Hi,

ESWT is indicated for failed pf release. So long as there isn't any nerve entrapement and you still have insertional proximal pf then ESWT is indicated.

I have about twenty cases that I have done after failed pf release. Some are over one year old. I don't know the percentage of sucess over all but there are at least five off the top of my head that are pain free post fifteen months after failed pf release.

There have been some done up in Canada by Dr. Galea via Ossatron that were failed EPF and went on to a cure. So yes it is indicated and yes it does resolve the pain.

Re: To Dr and all : Which one to do first ESWT or EPF ?

RogerC on 8/15/01 at hrmin (056768)

Is there anywhere in Texas to get ESWT

Re: ESWT locations in Texas

RogerC on 8/15/01 at hrmin (056769)

Anyone doing ESWT in Texas?