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Just received ESWT for arch/heel pain

Posted by Doug P on 10/02/01 at 22:12 (062123)

I just had ESWT done on my right foot this weekend by Dr. Weil in Chicago. I know on this message board people have said the ESWT doesn't help arch pain. Dr Weil said it can help, but the percentage of success isn't as high as those who have only heel pain. I'm hoping the ESWT helps me, if only somewhat. He uses a very high powered machine. I was put completely under for the procedure and a local anesthetic was given to my foot. Today, four days later, my foot feels a bit sore but I can walk on it. Anyone want to weigh in what my chance are? Have others with arch pain received any relief from this procedure? If so, what can I expect? I have bilateral PF and if this helps my right foot, I'll go back for the left. I'll post here later with my progress. Thanks!

Re: To Dr. Z Just received ESWT for arch/heel pain

Pauline on 10/03/01 at 15:18 (062167)

Dr. Z,
I was under the impression that Dr. Weil was using the Orbasone, although
Doug indicated in his post he was put completely under. Has he switched to using the Ossatron now or is this a different Dr. Weil?

Re: Just received ESWT for arch/heel pain

BrianG on 10/03/01 at 16:40 (062173)

Hi Doug,

Good luck, and please keep us updated. There are plenty of us out here that will get ESWT sooner, or later. Aren't their two Dr. Weils, father and son? About the anesthetic, did you have a choice of a block, or to be put out? It must have really raised the price. Would you mind sharing what you paid, total price. Thanks in advance, hope it works great for you. Oh ya, like Pauline said, was it Ossatron, or Orbasone?

BCG

Re: To Dr. Z Just received ESWT for arch/heel pain

Dr. Zuckerman on 10/03/01 at 17:06 (062176)

It is the same orbasone machine. Just a different approach to
giving ESWT. Some doctors will use IV sedation and a local
anesthetic

Re: To Dr. Z Just received ESWT for arch/heel pain

Pauline on 10/03/01 at 18:59 (062184)

Dr. Z,
Is he using it on the 'high' delivery most of the time, thus the need for I.V. sedation and foot block. Is Dr. Weil trying to use the Ossatron approach for his delivery. The one treatment idea with the machine run on high most of the time?

Re: Just received ESWT for arch/heel pain

Doug P on 10/03/01 at 22:06 (062193)

To be honest, I am not sure if it was Ossatron or Orbasone. All I know is they use a rather high (voltage? shockwave?) such that it requires a general anesthetic. I asked the anesthesiologist if I was going to be put completely under and he said most people had to be in order to withstand the pain. I was out like a light. One moment I was talking to Dr. Weil and next thing I knew I was being wheeled out of there.

There are two Weils, father and son. They are pretty big proponents of ESWT and they have lecturing about it at conferences. They have performed ESWT on hundreds of people.

The price was $2000. That doesn't include the price of the anesthesia. My insurance is paying for the procedure and they should cover the anesthesiologist as well. Although I don't know how much he is charging.

What I am wondering is if anybody with arch pain has been helped with this, but I haven't seen any testimonials about that, just scannning the ESWT database.

Re: To Dr. Z Just received ESWT for arch/heel pain

Ron on 10/03/01 at 22:11 (062194)

Dr Weil Jr. does use the Orbasone, IV sedation and a local on the treated area. 2000+ hits with 21Kv/treatment. As far as the success rate I was a classic pain in the inside of the heel patient. Took 2 treatments to put me on the road to recovery. My experience was to be patient and be prepared for setbacks.

Re: Dr. Z

Pauline on 10/04/01 at 09:27 (062210)

Dr. Z,
Are the doctors that use the Orbasone trying at all to standardize their treatment protocol or is each one doing something different? Didn't the FDA pretty much set standard guidelines for the Ossatron's usage?

Re: Just received ESWT for arch/heel pain

BrianG on 10/04/01 at 09:27 (062211)

Hi Doug,

I must say you are a trusting soul, getting zapped by a machine without even checking it out. I hate to be a pain, but do you think you could find out the make of the machine. I need as much information as I can get before I make my final decision as to which machine to use. All ESWT machine are not created equal. You are very lucky that your insurance is paying for the ESWT. I hope you have it in writing. Thanks in advance.

BCG

PS Was it Sr, or Weil Jr ? or both ?
I hope it cures your arches. Have you checked using a search engine?

Re: Dr. Z

Steve P on 10/04/01 at 17:25 (062240)

Pauline -- Speaking here as both an electrical engineer & an ESWT patient, I know that the same Kv setting will produce different degrees of shockwave penetration for different patients.

For example, a slightly built person with a thin foot might have full shockwave penetration at, say, 15Kv, whereas a stocky person with a thicker, denser foot might need 20Kv from the same machine to achieve the same degree of penetration.

Steve

Re: Dr. Z

Dr. Zuckerman on 10/04/01 at 17:36 (062241)

There are basic guildlines for treatments that are set by the company
not the FDA. The guildlines are recommendations made by the treating doctors
with ESWT experience. For example I took the ossatron training course which gave treatment recommendations and then I read in Podiatry Today where
Dr. Smith is using higher setting then the certification course treatment
guildlines. The point is that ESWT is very specific for each and every
patient and that there are guildlines that are to used to help with
treatment but they aren't written in stone. I hope that this answers your
inquiry

Re: arch pain

Dan L on 10/04/01 at 19:07 (062247)

I also have severe bilateral arch pain. I hope this will be addressed by others. Thanks. P.S. I had ESWT sonocur treatments that ended approx September 13th. So far, I can tell no difference at all in my heel pain, arches or burning. I'm no better and no worse. Just a bit poorer (financially).

Re: Just received ESWT for arch/heel pain

john h on 10/05/01 at 12:49 (062306)

doug: when you say arch pain where in the arch are you talking about? the classic place for PF pain is not in the heel but just forward of the heel where the fascia inserts into the heel and on the inside area of the foot. to me i would call this area 'the arch' although a doctor might not. you must be prepared to wait at least 12 weeks to know the final results of your treatment. during this time you may have ups and downs. improvement is not linear by any means. I had my 4th ESWT treatment a week ago. I improved after each treatment. Various publications put ESWT success anywhere from 60-80%. From all i read there is no maximum number of treatments for ESWT and it may be the one you had will be the magic one for you. How long had you had PF when you received your treatment? Dr Weil has an outstanding reputation as a Podiatrist and is very experienced in ESWT. You are in good hands.

Re: To Dr. Z Just received ESWT for arch/heel pain

john h on 10/05/01 at 12:51 (062307)

Pauline: I do think Dr Weil uses the Orbasone. He has always to my knowledge done the procedure with the patient under anathesia. I spoke to him once on the phone.

Re: To Dr. Z Just received ESWT for arch/heel pain

john h on 10/05/01 at 12:57 (062309)

having had 4 ESWT treatments now i can speak with some authority on how it 'feels' to me. I think Dr Z used 3000 shocks per foot with the power setting at anywhere from 16-20KV. My very first treatment was with a local ankle block. After that we just did the procedure with nothing. If i were going to assign a pain level to the procedure i would place it at a 3 for the first 10 shocks and then less than a 1 after that. i read books,carried on conversations,drank a coke,watched tv and i just did not notice any pain worth mentioning. the needle stick from the one ankle block i had was worse than the treatments without an akle block. the needle stick did not hurt either. i watched several other people receive treatments and to some it did seem to hurt. i guess it must be how your foot feels going in as i am no high tollerance pain hero.

Re: Dr. Z

john h on 10/05/01 at 13:01 (062310)

pauline: i got to read some of the FDA protocol for the Ossatron in dr. Z's office. as i recall they did not take away the doctors authority to vary the treatment. obviously one size does not fit all. some people have very very thick callused soles on their feet and they will need a higher setting than some one with very soft,thin, dainty soles.

Re: Just received ESWT for arch/heel pain

john h on 10/05/01 at 13:14 (062312)

Brian: you are right in that all machines are not the same. However the technology for spark-gap machines is very much the same and the way the shockwave is delivered to the foot is very much the same in that a sparkplug fires into a vat of water creating a shockwave that is transferred to the feet through a rubber membrane. The only real difference that i can see is the power delivered and where the focal point is located for a particular machine. Since the idea is to damage the tissue i am not even sure the small differences in the focal point are of that much importance. What appears to me to be of great importance is the guy operating that machine or doctor who makes the judgement on where to place the machine so as to hit the desired area. The other unaswered question is whether 4-5 low power treatments on successive days with a machine like the Sonnocur are as good as one high powered treatment with a machine like the OssaTron. The Orbason though considered high power seems to strike somewhere in the middle of the Sonnocur and Ossatron. I do not think all the research in the world is going to answer these questions as there are just to many variables. There is one thing to be sure of and that is to have confidence in your doctor to be able to accurately place the machine in the area that needs to be hit. The focal point of these machines is very narrow. much less than a size of a dime i think so if your doc is off that much you may have just wasted your dollars.

Re: arch pain

Dr. Zuckerman on 10/05/01 at 13:49 (062315)

Don't give up yet. Some patients will take the six weeks plus time to see
a positive response. Some patients will need additional treatments. Let time do its thing

Re: Just received ESWT for arch/heel pain

BrianG on 10/05/01 at 19:55 (062347)

I heare you John, but I do think there is a big difference in machines. Unfortunatly the technology is still so new in this country, we really can't tell which machines are best. With time, and lots of patients, I think this informaton will become available some day. I know there are machines in Europe that haven't even seen the U.S. yet. Time will tell, and I don't have a lot to waste :*(

BCG

Re: Just received ESWT for arch/heel pain

Dr. Zuckerman on 10/05/01 at 21:17 (062350)

Here is my opinion for whatever it is worth. The best machine will
the one that can deliver all levels of ESWT power. From very
low to very high. There is still no machine out there that
I am aware of that can do this. I have a low, medium and some
what high machine which I feel is on the right track, but still
would want a machine with more lower and more higher energy.
levels.

Re: Just received ESWT for arch/heel pain

Dr. Zuckerman on 10/06/01 at 10:12 (062370)

Dr. Weil is one of podiatry's best. He has done alot of ESWT and yes you are in very good hands. !!!!

Re: To Dr. Z Just received ESWT for arch/heel pain

Pauline on 10/03/01 at 15:18 (062167)

Dr. Z,
I was under the impression that Dr. Weil was using the Orbasone, although
Doug indicated in his post he was put completely under. Has he switched to using the Ossatron now or is this a different Dr. Weil?

Re: Just received ESWT for arch/heel pain

BrianG on 10/03/01 at 16:40 (062173)

Hi Doug,

Good luck, and please keep us updated. There are plenty of us out here that will get ESWT sooner, or later. Aren't their two Dr. Weils, father and son? About the anesthetic, did you have a choice of a block, or to be put out? It must have really raised the price. Would you mind sharing what you paid, total price. Thanks in advance, hope it works great for you. Oh ya, like Pauline said, was it Ossatron, or Orbasone?

BCG

Re: To Dr. Z Just received ESWT for arch/heel pain

Dr. Zuckerman on 10/03/01 at 17:06 (062176)

It is the same orbasone machine. Just a different approach to
giving ESWT. Some doctors will use IV sedation and a local
anesthetic

Re: To Dr. Z Just received ESWT for arch/heel pain

Pauline on 10/03/01 at 18:59 (062184)

Dr. Z,
Is he using it on the 'high' delivery most of the time, thus the need for I.V. sedation and foot block. Is Dr. Weil trying to use the Ossatron approach for his delivery. The one treatment idea with the machine run on high most of the time?

Re: Just received ESWT for arch/heel pain

Doug P on 10/03/01 at 22:06 (062193)

To be honest, I am not sure if it was Ossatron or Orbasone. All I know is they use a rather high (voltage? shockwave?) such that it requires a general anesthetic. I asked the anesthesiologist if I was going to be put completely under and he said most people had to be in order to withstand the pain. I was out like a light. One moment I was talking to Dr. Weil and next thing I knew I was being wheeled out of there.

There are two Weils, father and son. They are pretty big proponents of ESWT and they have lecturing about it at conferences. They have performed ESWT on hundreds of people.

The price was $2000. That doesn't include the price of the anesthesia. My insurance is paying for the procedure and they should cover the anesthesiologist as well. Although I don't know how much he is charging.

What I am wondering is if anybody with arch pain has been helped with this, but I haven't seen any testimonials about that, just scannning the ESWT database.

Re: To Dr. Z Just received ESWT for arch/heel pain

Ron on 10/03/01 at 22:11 (062194)

Dr Weil Jr. does use the Orbasone, IV sedation and a local on the treated area. 2000+ hits with 21Kv/treatment. As far as the success rate I was a classic pain in the inside of the heel patient. Took 2 treatments to put me on the road to recovery. My experience was to be patient and be prepared for setbacks.

Re: Dr. Z

Pauline on 10/04/01 at 09:27 (062210)

Dr. Z,
Are the doctors that use the Orbasone trying at all to standardize their treatment protocol or is each one doing something different? Didn't the FDA pretty much set standard guidelines for the Ossatron's usage?

Re: Just received ESWT for arch/heel pain

BrianG on 10/04/01 at 09:27 (062211)

Hi Doug,

I must say you are a trusting soul, getting zapped by a machine without even checking it out. I hate to be a pain, but do you think you could find out the make of the machine. I need as much information as I can get before I make my final decision as to which machine to use. All ESWT machine are not created equal. You are very lucky that your insurance is paying for the ESWT. I hope you have it in writing. Thanks in advance.

BCG

PS Was it Sr, or Weil Jr ? or both ?
I hope it cures your arches. Have you checked using a search engine?

Re: Dr. Z

Steve P on 10/04/01 at 17:25 (062240)

Pauline -- Speaking here as both an electrical engineer & an ESWT patient, I know that the same Kv setting will produce different degrees of shockwave penetration for different patients.

For example, a slightly built person with a thin foot might have full shockwave penetration at, say, 15Kv, whereas a stocky person with a thicker, denser foot might need 20Kv from the same machine to achieve the same degree of penetration.

Steve

Re: Dr. Z

Dr. Zuckerman on 10/04/01 at 17:36 (062241)

There are basic guildlines for treatments that are set by the company
not the FDA. The guildlines are recommendations made by the treating doctors
with ESWT experience. For example I took the ossatron training course which gave treatment recommendations and then I read in Podiatry Today where
Dr. Smith is using higher setting then the certification course treatment
guildlines. The point is that ESWT is very specific for each and every
patient and that there are guildlines that are to used to help with
treatment but they aren't written in stone. I hope that this answers your
inquiry

Re: arch pain

Dan L on 10/04/01 at 19:07 (062247)

I also have severe bilateral arch pain. I hope this will be addressed by others. Thanks. P.S. I had ESWT sonocur treatments that ended approx September 13th. So far, I can tell no difference at all in my heel pain, arches or burning. I'm no better and no worse. Just a bit poorer (financially).

Re: Just received ESWT for arch/heel pain

john h on 10/05/01 at 12:49 (062306)

doug: when you say arch pain where in the arch are you talking about? the classic place for PF pain is not in the heel but just forward of the heel where the fascia inserts into the heel and on the inside area of the foot. to me i would call this area 'the arch' although a doctor might not. you must be prepared to wait at least 12 weeks to know the final results of your treatment. during this time you may have ups and downs. improvement is not linear by any means. I had my 4th ESWT treatment a week ago. I improved after each treatment. Various publications put ESWT success anywhere from 60-80%. From all i read there is no maximum number of treatments for ESWT and it may be the one you had will be the magic one for you. How long had you had PF when you received your treatment? Dr Weil has an outstanding reputation as a Podiatrist and is very experienced in ESWT. You are in good hands.

Re: To Dr. Z Just received ESWT for arch/heel pain

john h on 10/05/01 at 12:51 (062307)

Pauline: I do think Dr Weil uses the Orbasone. He has always to my knowledge done the procedure with the patient under anathesia. I spoke to him once on the phone.

Re: To Dr. Z Just received ESWT for arch/heel pain

john h on 10/05/01 at 12:57 (062309)

having had 4 ESWT treatments now i can speak with some authority on how it 'feels' to me. I think Dr Z used 3000 shocks per foot with the power setting at anywhere from 16-20KV. My very first treatment was with a local ankle block. After that we just did the procedure with nothing. If i were going to assign a pain level to the procedure i would place it at a 3 for the first 10 shocks and then less than a 1 after that. i read books,carried on conversations,drank a coke,watched tv and i just did not notice any pain worth mentioning. the needle stick from the one ankle block i had was worse than the treatments without an akle block. the needle stick did not hurt either. i watched several other people receive treatments and to some it did seem to hurt. i guess it must be how your foot feels going in as i am no high tollerance pain hero.

Re: Dr. Z

john h on 10/05/01 at 13:01 (062310)

pauline: i got to read some of the FDA protocol for the Ossatron in dr. Z's office. as i recall they did not take away the doctors authority to vary the treatment. obviously one size does not fit all. some people have very very thick callused soles on their feet and they will need a higher setting than some one with very soft,thin, dainty soles.

Re: Just received ESWT for arch/heel pain

john h on 10/05/01 at 13:14 (062312)

Brian: you are right in that all machines are not the same. However the technology for spark-gap machines is very much the same and the way the shockwave is delivered to the foot is very much the same in that a sparkplug fires into a vat of water creating a shockwave that is transferred to the feet through a rubber membrane. The only real difference that i can see is the power delivered and where the focal point is located for a particular machine. Since the idea is to damage the tissue i am not even sure the small differences in the focal point are of that much importance. What appears to me to be of great importance is the guy operating that machine or doctor who makes the judgement on where to place the machine so as to hit the desired area. The other unaswered question is whether 4-5 low power treatments on successive days with a machine like the Sonnocur are as good as one high powered treatment with a machine like the OssaTron. The Orbason though considered high power seems to strike somewhere in the middle of the Sonnocur and Ossatron. I do not think all the research in the world is going to answer these questions as there are just to many variables. There is one thing to be sure of and that is to have confidence in your doctor to be able to accurately place the machine in the area that needs to be hit. The focal point of these machines is very narrow. much less than a size of a dime i think so if your doc is off that much you may have just wasted your dollars.

Re: arch pain

Dr. Zuckerman on 10/05/01 at 13:49 (062315)

Don't give up yet. Some patients will take the six weeks plus time to see
a positive response. Some patients will need additional treatments. Let time do its thing

Re: Just received ESWT for arch/heel pain

BrianG on 10/05/01 at 19:55 (062347)

I heare you John, but I do think there is a big difference in machines. Unfortunatly the technology is still so new in this country, we really can't tell which machines are best. With time, and lots of patients, I think this informaton will become available some day. I know there are machines in Europe that haven't even seen the U.S. yet. Time will tell, and I don't have a lot to waste :*(

BCG

Re: Just received ESWT for arch/heel pain

Dr. Zuckerman on 10/05/01 at 21:17 (062350)

Here is my opinion for whatever it is worth. The best machine will
the one that can deliver all levels of ESWT power. From very
low to very high. There is still no machine out there that
I am aware of that can do this. I have a low, medium and some
what high machine which I feel is on the right track, but still
would want a machine with more lower and more higher energy.
levels.

Re: Just received ESWT for arch/heel pain

Dr. Zuckerman on 10/06/01 at 10:12 (062370)

Dr. Weil is one of podiatry's best. He has done alot of ESWT and yes you are in very good hands. !!!!