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QUESTION FOR DR Z ON ESWT

Posted by JO-ANNEB on 10/16/01 at 06:13 (063050)

Is ESWT effective for hamstring insertional tendonitis. The areas affected are upper hamstrings and buttocks. If ESWT is effective, info re number of treatments, recovery period, etc. would be appreciated.

Re: QUESTION FOR DR Z ON ESWT

Dr. Zuckerman on 10/16/01 at 10:29 (063067)

It is one of the indications. I haven't use it so that is all I can tell you about it. Maybe able to help you in Canada at the Bayshore Clinic.

ESWT is for chronic insertional tendonitis.and your description is insertional but the area of treatment can't be over a major nerve.

Re: QUESTION FOR DR Z ON ESWT

elliott on 10/16/01 at 10:51 (063071)

Does 'major nerve' include the posterior tibial nerve (e.g. for a tissue/tendon problem right below or around the medial ankle) so that ESWT would not be appropriate here?

Re: QUESTION FOR DR Z ON ESWT

Dr. Zuckerman on 10/16/01 at 17:23 (063092)

I wouldn't place a shockwave device over the posterior tibial nerve. There is no indication or reason that I can think of to do this

Re: area along posterior tibial nerve

elliott on 10/16/01 at 19:52 (063104)

I am suspicious that the orthopedic surgeon who did a TTS release and posterior tibial tenosynovectomy on my right foot two years ago left a scar tissue mess (due to poor technique), concentrated just below the medial ankle, where the posterior tibial tendon inserts. It felt all wrong at that spot immediately upon waking up from surgery. It has weakened my foot tremendously when there was none before surgery (even though an MRI has shown mild tenosynovitis). My pre-surgery symptoms included burning and numbness on the medial aspect of the heel and beginning of arch, as well as some strange heel pain on the medial side. All this presumably was running-induced. Despite ridiculously prolonged rest, the foot has never recovered. The last time I tried to run, almost a year ago, I believe tissue tore from that spot both forward along the medial side and also around my instep to the lateral side, places I had no trouble pre-surgery. A navicular stress fracture also showed up along the way, exactly when it first was there who knows, and a year after being detected, that too still does not feel right. In addition, I have severe heel pain at times, much worse with no shoes on or after any prolonged activity (walking, standing) and which seems to originate close to that same spot; this may have been there pre-surgery but was never that bad before. At times my foot feels like it is not gliding properly at that spot and in the heel; this gliding problem was only post-surgery. New ortho is having trouble zoning in on exactly what's going on. The only activities I can do are yoga and cycling, which is easier than walking. A bright spot is that I'm much better now than I was a month ago. Maybe if I just wait another two years?

There are a lot more details to the case, but why complicate things now? I was simply wondering if a series of ESWT blasts around my medial ankle would be an option to consider. Are you saying NO due to the posterior tibial nerve located there?

Re: Dr. Z? You there?

elliott on 10/20/01 at 22:49 (063368)

Let me shorten this by asking if ESWT is appropriate for helping eliminate or minimize the problem of scar tissue that extends over a wide area of the foot, say around the medial ankle and extending both a few inches forward medially and around the instep to the lateral side. Thanks.

Re: Dr. Z? You there?

Dr. Zuckerman on 10/21/01 at 18:17 (063392)

It could be helful but it is best for pin point insertional pain where the plantar fascia attaches to the bottom of the heel bone. You can have more then one spot but if it is the entire area pretty tough but not impossible to get some improvement if the problem is scar tissue and not something else

Re: QUESTION FOR DR Z ON ESWT

JO-ANNEB on 10/22/01 at 03:28 (063407)

Dr Z,
Thank you for your reply to my earlier message. I'm unable to visit Bayshore Clinic (I live in Cape Town, South Africa). I am advised my diagnosis is chronic insertional hamstring tendonitis. The final comment on the MRI report is 'ischial rami bony stress injuries immediately beneath the insertion of the hamstring tendons with associated bilateral hamstring tendonitis / bursitis.'

Hamstring release surgery has been recommended to me but I would prefer to try ESWT first if it is indicated.

Any information you may have concerning number of treatments, period for recovery, etc., albeit text book information, would be greatly appreciated.
The inflammed area is question is large, the whole buttock and top of hamstrings.
Regards

Re: QUESTION FOR DR Z ON ESWT

Jo-AnneB on 10/22/01 at 04:01 (063408)

Posted by JO-ANNEB on 10/22/01 at 03:28

Dr Z,
Thank you for your reply to my earlier message. I'm unable to visit Bayshore Clinic (I live in Cape Town, South Africa). I am advised my diagnosis is chronic insertional hamstring tendonitis. The final comment on the MRI report is 'ischial rami bony stress injuries immediately beneath the insertion of the hamstring tendons with associated bilateral hamstring tendonitis / bursitis.'

Hamstring release surgery has been recommended to me but I would prefer to try ESWT first if it is indicated.

Any information you may have concerning number of treatments, period for recovery, etc., albeit text book information, would be greatly appreciated.
The inflammed area is question is large, the whole buttock and top of hamstrings.
Regards
Category: ESWT . . All Heel Pain Categories

Re: QUESTION FOR DR Z ON ESWT

Dr. Zuckerman on 10/23/01 at 01:28 (063445)

Hi,

The use of ESWT for insetional tendonitis is very limited in your specific area of problem. You may want to still contact Bayshore ESWT clinic and ask them what their experience is and if they know of any clinic in either your area or Europe. In addition there is a web called http://www . iswt.com . This will list the ESWT doctors world wide.

Re: QUESTION FOR DR Z ON ESWT

JOANNEB on 10/23/01 at 07:54 (063448)

Dr Z
Your reply is appreciated. Regrettably I cannot access website called http://www . Do you have the website name for Bayshore ESWT clinic in Canada?

Thank you

JOANNE

Re: QUESTION FOR DR Z ON ESWT

J. P. Jacob on 10/25/01 at 07:51 (063589)

Jo-Anne,
Our website address is http://www.bayshore.ca
We have recently been in contact with an ESWT clinic in South Africa. Perhaps you would like to get in touch with them:
Ms Malindi Loader
Telephone Number: 27 11 462 5407
Fax Number: 27 11 462 5217
E-mail: malindi@footfoundation.co.za
Postal: P.O. Box 71766
Bryanston
Johannesburg
South Africa
2021

I will respond to your question about hamstring tendonitis shortly.
J. P. Jacob

Re: QUESTION FOR DR Z ON ESWT

JOANNEB on 10/26/01 at 05:18 (063608)

Thank you for responding. I look forward to your response on hamstring tendonitis with interest.

Regards

Re: QUESTION FOR DR Z ON ESWT

J. P. Jacob on 10/27/01 at 13:05 (063684)

Joanne,
I am following up regarding your question about hamstring tendonitis.
During the last 12 months we have treated two cases of hamstring tendinitis at Bayshore - both athletes with chronic pain around the knee (duration 8 and 10 months). They had undergone all conventional first line of treatment and surgery had been recommended. They decided to try ESWT at Bayshore clinic. Their pain levels (with activity) were VAS 8 and 9. Six weeks later, with 3 and 4 ESWT sessions, the pain levels with activity dropped to VAS scale 1 and 2 and they were able to maintain this level even with sports activity.
The candidates should be able to direct the maximum pain point/points, as we cannot treat pain on a generalized large muscular area with ESWT.
J. P. Jacob

Re: QUESTION FOR DR Z ON ESWT

JOANNEB on 10/29/01 at 02:35 (063747)

Thank you very much for the information. I shall try ESWT before undergoing surgery. If ESWT helps me, I will advise you accordingly.

Regards

Re: QUESTION FOR DR Z ON ESWT

J. P. Jacob on 10/29/01 at 06:56 (063748)

Joanne,
I am happy to see thatyou will give ESWT a try. Will you be able to receive ESWT in South Africa, - Malindi Loader at Foot Foundation? We would be interested to hear more about it. Perhaps they could also list their clinic as a treatmentlocation on this site? I am sure many readers may be interested to know about this facility. Please keep us updated on your progress and experience.
J. P. Jacob

Re: QUESTION FOR DR Z ON ESWT

Greg C on 11/12/01 at 01:57 (064677)

I've had the same problems. I'm a professional athlete and have had four surgeries. One on the left and three on the right. Prior to surgeries I had four or five cortison injections into both legs. On my right leg the second surgery consisted of the tendon release. The area was the lower region of the hamstring behind the knee. It was the semi-tendonosis tendon or more commonly known as the monster hamstring. I'm not sure where your's is located. I could go on for hours. I would first consider injections (depo-medrol) followed by a lot of rest . My release was not successful and they had to go back in clean up scar tissue and strip out the tendon. You can e-amil with additional questions at gregcariec@earthlink.net No one has had more problems with the hamstring tendon than me.

Re: QUESTION FOR DR Z ON ESWT

Dr. Zuckerman on 10/16/01 at 10:29 (063067)

It is one of the indications. I haven't use it so that is all I can tell you about it. Maybe able to help you in Canada at the Bayshore Clinic.

ESWT is for chronic insertional tendonitis.and your description is insertional but the area of treatment can't be over a major nerve.

Re: QUESTION FOR DR Z ON ESWT

elliott on 10/16/01 at 10:51 (063071)

Does 'major nerve' include the posterior tibial nerve (e.g. for a tissue/tendon problem right below or around the medial ankle) so that ESWT would not be appropriate here?

Re: QUESTION FOR DR Z ON ESWT

Dr. Zuckerman on 10/16/01 at 17:23 (063092)

I wouldn't place a shockwave device over the posterior tibial nerve. There is no indication or reason that I can think of to do this

Re: area along posterior tibial nerve

elliott on 10/16/01 at 19:52 (063104)

I am suspicious that the orthopedic surgeon who did a TTS release and posterior tibial tenosynovectomy on my right foot two years ago left a scar tissue mess (due to poor technique), concentrated just below the medial ankle, where the posterior tibial tendon inserts. It felt all wrong at that spot immediately upon waking up from surgery. It has weakened my foot tremendously when there was none before surgery (even though an MRI has shown mild tenosynovitis). My pre-surgery symptoms included burning and numbness on the medial aspect of the heel and beginning of arch, as well as some strange heel pain on the medial side. All this presumably was running-induced. Despite ridiculously prolonged rest, the foot has never recovered. The last time I tried to run, almost a year ago, I believe tissue tore from that spot both forward along the medial side and also around my instep to the lateral side, places I had no trouble pre-surgery. A navicular stress fracture also showed up along the way, exactly when it first was there who knows, and a year after being detected, that too still does not feel right. In addition, I have severe heel pain at times, much worse with no shoes on or after any prolonged activity (walking, standing) and which seems to originate close to that same spot; this may have been there pre-surgery but was never that bad before. At times my foot feels like it is not gliding properly at that spot and in the heel; this gliding problem was only post-surgery. New ortho is having trouble zoning in on exactly what's going on. The only activities I can do are yoga and cycling, which is easier than walking. A bright spot is that I'm much better now than I was a month ago. Maybe if I just wait another two years?

There are a lot more details to the case, but why complicate things now? I was simply wondering if a series of ESWT blasts around my medial ankle would be an option to consider. Are you saying NO due to the posterior tibial nerve located there?

Re: Dr. Z? You there?

elliott on 10/20/01 at 22:49 (063368)

Let me shorten this by asking if ESWT is appropriate for helping eliminate or minimize the problem of scar tissue that extends over a wide area of the foot, say around the medial ankle and extending both a few inches forward medially and around the instep to the lateral side. Thanks.

Re: Dr. Z? You there?

Dr. Zuckerman on 10/21/01 at 18:17 (063392)

It could be helful but it is best for pin point insertional pain where the plantar fascia attaches to the bottom of the heel bone. You can have more then one spot but if it is the entire area pretty tough but not impossible to get some improvement if the problem is scar tissue and not something else

Re: QUESTION FOR DR Z ON ESWT

JO-ANNEB on 10/22/01 at 03:28 (063407)

Dr Z,
Thank you for your reply to my earlier message. I'm unable to visit Bayshore Clinic (I live in Cape Town, South Africa). I am advised my diagnosis is chronic insertional hamstring tendonitis. The final comment on the MRI report is 'ischial rami bony stress injuries immediately beneath the insertion of the hamstring tendons with associated bilateral hamstring tendonitis / bursitis.'

Hamstring release surgery has been recommended to me but I would prefer to try ESWT first if it is indicated.

Any information you may have concerning number of treatments, period for recovery, etc., albeit text book information, would be greatly appreciated.
The inflammed area is question is large, the whole buttock and top of hamstrings.
Regards

Re: QUESTION FOR DR Z ON ESWT

Jo-AnneB on 10/22/01 at 04:01 (063408)

Posted by JO-ANNEB on 10/22/01 at 03:28

Dr Z,
Thank you for your reply to my earlier message. I'm unable to visit Bayshore Clinic (I live in Cape Town, South Africa). I am advised my diagnosis is chronic insertional hamstring tendonitis. The final comment on the MRI report is 'ischial rami bony stress injuries immediately beneath the insertion of the hamstring tendons with associated bilateral hamstring tendonitis / bursitis.'

Hamstring release surgery has been recommended to me but I would prefer to try ESWT first if it is indicated.

Any information you may have concerning number of treatments, period for recovery, etc., albeit text book information, would be greatly appreciated.
The inflammed area is question is large, the whole buttock and top of hamstrings.
Regards
Category: ESWT . . All Heel Pain Categories

Re: QUESTION FOR DR Z ON ESWT

Dr. Zuckerman on 10/23/01 at 01:28 (063445)

Hi,

The use of ESWT for insetional tendonitis is very limited in your specific area of problem. You may want to still contact Bayshore ESWT clinic and ask them what their experience is and if they know of any clinic in either your area or Europe. In addition there is a web called http://www . iswt.com . This will list the ESWT doctors world wide.

Re: QUESTION FOR DR Z ON ESWT

JOANNEB on 10/23/01 at 07:54 (063448)

Dr Z
Your reply is appreciated. Regrettably I cannot access website called http://www . Do you have the website name for Bayshore ESWT clinic in Canada?

Thank you

JOANNE

Re: QUESTION FOR DR Z ON ESWT

J. P. Jacob on 10/25/01 at 07:51 (063589)

Jo-Anne,
Our website address is http://www.bayshore.ca
We have recently been in contact with an ESWT clinic in South Africa. Perhaps you would like to get in touch with them:
Ms Malindi Loader
Telephone Number: 27 11 462 5407
Fax Number: 27 11 462 5217
E-mail: malindi@footfoundation.co.za
Postal: P.O. Box 71766
Bryanston
Johannesburg
South Africa
2021

I will respond to your question about hamstring tendonitis shortly.
J. P. Jacob

Re: QUESTION FOR DR Z ON ESWT

JOANNEB on 10/26/01 at 05:18 (063608)

Thank you for responding. I look forward to your response on hamstring tendonitis with interest.

Regards

Re: QUESTION FOR DR Z ON ESWT

J. P. Jacob on 10/27/01 at 13:05 (063684)

Joanne,
I am following up regarding your question about hamstring tendonitis.
During the last 12 months we have treated two cases of hamstring tendinitis at Bayshore - both athletes with chronic pain around the knee (duration 8 and 10 months). They had undergone all conventional first line of treatment and surgery had been recommended. They decided to try ESWT at Bayshore clinic. Their pain levels (with activity) were VAS 8 and 9. Six weeks later, with 3 and 4 ESWT sessions, the pain levels with activity dropped to VAS scale 1 and 2 and they were able to maintain this level even with sports activity.
The candidates should be able to direct the maximum pain point/points, as we cannot treat pain on a generalized large muscular area with ESWT.
J. P. Jacob

Re: QUESTION FOR DR Z ON ESWT

JOANNEB on 10/29/01 at 02:35 (063747)

Thank you very much for the information. I shall try ESWT before undergoing surgery. If ESWT helps me, I will advise you accordingly.

Regards

Re: QUESTION FOR DR Z ON ESWT

J. P. Jacob on 10/29/01 at 06:56 (063748)

Joanne,
I am happy to see thatyou will give ESWT a try. Will you be able to receive ESWT in South Africa, - Malindi Loader at Foot Foundation? We would be interested to hear more about it. Perhaps they could also list their clinic as a treatmentlocation on this site? I am sure many readers may be interested to know about this facility. Please keep us updated on your progress and experience.
J. P. Jacob

Re: QUESTION FOR DR Z ON ESWT

Greg C on 11/12/01 at 01:57 (064677)

I've had the same problems. I'm a professional athlete and have had four surgeries. One on the left and three on the right. Prior to surgeries I had four or five cortison injections into both legs. On my right leg the second surgery consisted of the tendon release. The area was the lower region of the hamstring behind the knee. It was the semi-tendonosis tendon or more commonly known as the monster hamstring. I'm not sure where your's is located. I could go on for hours. I would first consider injections (depo-medrol) followed by a lot of rest . My release was not successful and they had to go back in clean up scar tissue and strip out the tendon. You can e-amil with additional questions at gregcariec@earthlink.net No one has had more problems with the hamstring tendon than me.