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Eswt vs. EPF, I am so confused!

Posted by Kim K. on 7/14/01 at 17:16 (053175)

After a year of trying all the conservative treatments for PF, my Podiatrist says I am a canidate for surgery. He is referring me to another Dr. who does EPF because my Dr. does not have enough surgery experience. ESWT has not come to my area of Southeast Florida yet, I would have to Drive 3 hours to a Podiatry practice in Orlando who has the Ossatron. Or fly to a Dr.who does ESWT out of state. I am a 35 year old mother of a very active 5 1/2 year old, my house has at least 2200 square feet of ceramic tile all on one level and I need to lose at least 50 lbs. I work from home and run alot of family errands.My husband works alot of hours out of the house annd so I do most of the work for the household. My main concern is being incapacitated during the recouperation. EPF or ESWT, which one will it be? Any sugeestions?

Re: Eswt vs. EPF, I am so confused!

Nancy N on 7/14/01 at 18:22 (053184)

Kim--

The recovery time for ESWT is dramatically shorter than for surgery, because there is no cutting involved with ESWT. Depending on which machine is used, there will be a varying degree of soreness, but you should not need crutches, and there is no risk of infection.

Surgery can also be helpful if you are a good candidate for it, but in most cases now, it's best to look into ESWT thoroughly before deciding on surgery, because surgery can have negative effects, such as lowering of the arch. There is a lot of information on the ESWT page and board, and you can always ask questions--there are some doctors here, and the rest of us are pretty educated at this point. Regardless of our background, we'll do our best to help.

Re: Eswt vs. EPF, I am so confused! PS

Nancy N on 7/14/01 at 18:23 (053185)

Kim--

I forgot to mention that it wouldn't hurt to take a look at the heel pain book just to make sure you've tried everything you can among the conservative treatments. There's a lot of good information there.

Re: Eswt vs. EPF, I am so confused!

Dr. Zuckerman on 7/14/01 at 20:31 (053207)

The only advice I can give you is once you have surgery you can't turn the clock back. With ESWT there are no major complications. Now it might not help you but you can still have surgery. EPF in my opinion is a bad procedure with alot of complications

Re: Eswt vs. EPF, I am so confused!

Cynthia D on 7/14/01 at 20:51 (053210)

Hi Kim, if it is closer for you, there is an ESWT machine in Ft. Myers, Fla. It's in the office of Ft. Myers Foot and Ankle Surgery. If you want more info, I'll be happy to look it up for you. I've been there, and they seem to know what they are doing. Most of us here will try any other treatment we can before surgery. Good luck.

Re: Eswt vs. EPF, I am so confused!

Jeff on 7/20/01 at hrmin (053844)

I am too and I'm a podiatrist! I'm finding that there is no silver bullet when it comes to treating PF. The big hurdle with ESWT is cost, and as a result, the prior authorization hurdles are huge. It seems like a great alternative to EPF's but it's hard to overcome the costs.
The downside of EPF's is the potential for lateral column syndrome post-op and the stiffness that some folks don't like. Stiffnes can continue for months after EPF surgery but will resolve over time.
As a result, most of my patients end up with EPF's because they get tired of waiting and are unwilling to shoulder the cost of ESWT. It's not a silver bullet, but at least a choice.
Jeff

Re: Eswt vs. EPF, I am so confused!

Julie on 7/21/01 at 06:01 (053896)

Jeff, are you really saying that 'most' of your patients end up with EPFs - or do you mean most of those for whom conservative treatments haven't worked? If the latter, would you mind saying what proportion have surgery?

Over what period of time do you work with your patients on conservative treatments, and at what point do you advise them that surgery is their best option?

Do you ever do Minimal Incision Surgery?

Re: Eswt vs. EPF, I am so confused!

Nancy N on 7/14/01 at 18:22 (053184)

Kim--

The recovery time for ESWT is dramatically shorter than for surgery, because there is no cutting involved with ESWT. Depending on which machine is used, there will be a varying degree of soreness, but you should not need crutches, and there is no risk of infection.

Surgery can also be helpful if you are a good candidate for it, but in most cases now, it's best to look into ESWT thoroughly before deciding on surgery, because surgery can have negative effects, such as lowering of the arch. There is a lot of information on the ESWT page and board, and you can always ask questions--there are some doctors here, and the rest of us are pretty educated at this point. Regardless of our background, we'll do our best to help.

Re: Eswt vs. EPF, I am so confused! PS

Nancy N on 7/14/01 at 18:23 (053185)

Kim--

I forgot to mention that it wouldn't hurt to take a look at the heel pain book just to make sure you've tried everything you can among the conservative treatments. There's a lot of good information there.

Re: Eswt vs. EPF, I am so confused!

Dr. Zuckerman on 7/14/01 at 20:31 (053207)

The only advice I can give you is once you have surgery you can't turn the clock back. With ESWT there are no major complications. Now it might not help you but you can still have surgery. EPF in my opinion is a bad procedure with alot of complications

Re: Eswt vs. EPF, I am so confused!

Cynthia D on 7/14/01 at 20:51 (053210)

Hi Kim, if it is closer for you, there is an ESWT machine in Ft. Myers, Fla. It's in the office of Ft. Myers Foot and Ankle Surgery. If you want more info, I'll be happy to look it up for you. I've been there, and they seem to know what they are doing. Most of us here will try any other treatment we can before surgery. Good luck.

Re: Eswt vs. EPF, I am so confused!

Jeff on 7/20/01 at hrmin (053844)

I am too and I'm a podiatrist! I'm finding that there is no silver bullet when it comes to treating PF. The big hurdle with ESWT is cost, and as a result, the prior authorization hurdles are huge. It seems like a great alternative to EPF's but it's hard to overcome the costs.
The downside of EPF's is the potential for lateral column syndrome post-op and the stiffness that some folks don't like. Stiffnes can continue for months after EPF surgery but will resolve over time.
As a result, most of my patients end up with EPF's because they get tired of waiting and are unwilling to shoulder the cost of ESWT. It's not a silver bullet, but at least a choice.
Jeff

Re: Eswt vs. EPF, I am so confused!

Julie on 7/21/01 at 06:01 (053896)

Jeff, are you really saying that 'most' of your patients end up with EPFs - or do you mean most of those for whom conservative treatments haven't worked? If the latter, would you mind saying what proportion have surgery?

Over what period of time do you work with your patients on conservative treatments, and at what point do you advise them that surgery is their best option?

Do you ever do Minimal Incision Surgery?