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ESWT vs. surgery

Posted by DW on 11/26/01 at 18:49 (065338)

I'm just back from the dr and, naturally, NOW come the questions. I have been given the options of ESWT or surgery (heel spur removal, tendon excision, and nerve release). I have a ruptured PF already, after receiving a cortisone shot in April. I was casted for 4 weeks with no noticeable improvement. The dr leans towards ESWT (if covered by insurance) as less invasive, and stated that surgery is not always that successful. (He's honest, at least.) However, if the ESWT doesn't work, I'm facing surgery anyway. My question starts with: will the ESWT do all, most, or part of what typical surgery is aiming for? From what I understand, it will not reduce/remove the heel spur, itself, but will it heal the tissue so that wouldn't be a problem anyway? What about the TTS symptoms I've been having since April? Will the ESWT work on that too? I don't want surgery if I can avoid it. But I don't want to fiddle around with something that may only prolong the inevitable, either. What do you think my odds are?
Thanks.
Dona

Re: ESWT vs. surgery

Dr. Zuckerman on 11/27/01 at 13:34 (065412)

ESWT is non-invasive without the long term and short term complications that can and do occur with foot surgery. There is one question I have and that is if you are talking about a TTS release then ESWT won't address this problem.

Re: ESWT vs. surgery

DW on 11/27/01 at 16:20 (065429)

Yes, one part of the 3-part surgery would be a release of entrapped nerves in the tarsal tunnel area. I didn't think it would address this, but maybe fixing some of the other problems will alleviate the TTS symptoms? What about the heel spur, itself? Will it reduce it at all?
Thanks.
Dona

Re: ESWT vs. surgery

DR Zuckerman on 11/27/01 at 17:13 (065439)

ESWT will heal the plantar fasciitis that inserts into the heel bone. IT doesn't blast or disolve the bone spur but this isn't necessary to get pain relief. ESWT doesn't treat nerve entrapement such as TTS. Many cases of TTS are due to the swelling and pain from the tear or injuried pf

Re: ESWT vs. surgery

DW on 11/28/01 at 13:54 (065510)

First of all....thank you, Dr. Zuckerman, for your time in answering my questions. I really appreciate it.

I guess I'm still a little confused; I'm having a lot of pain in my heel when I walk, I'm assuming from the heel spur, since the PF ruptured back in April. My heel is tender to the touch if squeezed lightly from the sides or when touched on the inside arch. (Xrays taken last month did not show any fractures.) Once ruptured, does the fascia still cause pain in the heel? And what tendon would still be causing the pain? Also, I'm having a great deal of pain in my inside-arch when I'm off my feet. I get distinctly uncomfortable 'tingles' when I try to put heat on my feet (or get in a jacuzzi to try to soothe achy knees), so I reverted back to only ice. (I thought heat would heal the PF rupture...?) I WANT to go the ESWT route if at all possible, but I also don't want to undergo 2 separate *operations* if the first isn't going to be able to address all the problems. Am I making any sense here?
Thanks for your time and your help.
Dona

Re: ESWT vs. surgery

DR Zuckerman on 11/28/01 at 15:02 (065515)

Before any surgery or ESWT I would want you to have an mri to rule out a stress fracture of the heeel bone. You are describing a stress fracture when you tell me that it hurts when putting pressure side to side. An x-ray won't show the stress fracture. Also would like to have an mri of the posterior tibial tendon

Re: ESWT vs. surgery

Jen R on 12/20/01 at 07:28 (067453)

Dona,

Hi. Just thought I'd put in my 2 cents...for whatever it may be worth. I had ESWT twice for my PF. I did not get any relief and after the 2 treatments I decided to have a 3-part surgery which included a PF release, nerve decompression and osteotomy (where heel bone is cut and moved). It has been 7 months since my surgery and let me tell you...although I walk normal I am in as much pain, if not more, than I was before my surgery. I was told that my recovery would take a year but I have not improved much, if any, in the past two months. I'm gonna give my foot that one year time frame to heal and if it's no better I will consider another ESWT treatment if my doctor or Dr. Z give me reason to believe that it could help me. Do not enter lightly into surgery. It is a long and frustrating road to recovery.

Jen R

Re: ESWT vs. surgery

wendyn on 12/20/01 at 20:01 (067516)

Jen, I have been around here almost as long as you - but I haven't seen you post for a while. I assumed that you were all better.

I'm sorry to hear you are not....can you give us an update on what's happened since your surgery?

Re: ESWT vs. surgery

Jen R on 12/21/01 at 06:49 (067560)

Wendyn,

My surgery was back on May 8...over 7 months ago. My initial recovery was slow but for the first 4 months I seemed to be able to see the improvement on a daily basis. Since the time I became totally back on my feet my progress has not continued in such a quick pace. In fact, the past two months I have noticed no improvement and my morning pain actually seems to be getting worse. I can hardly walk for about my first 10 or so steps in the morning. As far as treatment goes...I had been released from therapy back in September but was sent back again to have a course of iontophoresis (which from what I understand is a steriod treatment that is not as intense as cortisone which also eats away at the bad tissue) and continued stretching exercises. I am almost thru with my ionto treatment and I feel no better. I am worse at this point than I was before my surgery. I can walk and while most people don't realize there is anything wrong with me...I am in severe pain after walking or standing any more than 15 minutes and just sitting with my feet touching the floor gives me a constant ache. Mall walking and grocery shopping are torture. And...finding shoes that are comfortable is impossible. I've been able to wear dressy boots and a pair of loafers but otherwise a normal dress shoe is out of the question. Fortunately my job is mostly sitting. But as far as I am concerned, anyone who does not consider ESWT before surgery is making a big mistake. After my recovery time passes...if I still am not better I may try ESWT again.

Hope this is the information you were looking for. Thanks for the concern.

Have a great holiday.

Jen

Re: ESWT vs. surgery

Dr. Zuckerman on 12/21/01 at 08:40 (067565)

Hi, Jen

I did get your other e-mail. I just want you to know that ESWT has been very effective after pf surgery. So long as the area is insertional and confined we can give you another ESWT treatment. Will respond to your other e-mails but can't at this time because it was down loaded on my home computer and I am reading only today's e-mails from my server. So Merry Christmas and always here for you if you need me. !!

Re: ESWT vs. surgery

Jen R on 12/22/01 at 19:04 (067662)

Dr. Z,

Hi. Thanks for the holiday wishes and the support. I see from other postings here that the FDA has approved the Dornier machine. Any chance that I could get a different result from a different machine? I know that some of these machines are low level and some high level and that the number of treatments can be different according to the level of treatment. Is one way better than other for certain kinds of problems or are they all basically the same? Thought others out there might be interested is this as well.

Thanks again for your help. Have a great holiday!

Sincerely,

Jen R

Re: ESWT vs. surgery

Dr. Zuckerman on 11/27/01 at 13:34 (065412)

ESWT is non-invasive without the long term and short term complications that can and do occur with foot surgery. There is one question I have and that is if you are talking about a TTS release then ESWT won't address this problem.

Re: ESWT vs. surgery

DW on 11/27/01 at 16:20 (065429)

Yes, one part of the 3-part surgery would be a release of entrapped nerves in the tarsal tunnel area. I didn't think it would address this, but maybe fixing some of the other problems will alleviate the TTS symptoms? What about the heel spur, itself? Will it reduce it at all?
Thanks.
Dona

Re: ESWT vs. surgery

DR Zuckerman on 11/27/01 at 17:13 (065439)

ESWT will heal the plantar fasciitis that inserts into the heel bone. IT doesn't blast or disolve the bone spur but this isn't necessary to get pain relief. ESWT doesn't treat nerve entrapement such as TTS. Many cases of TTS are due to the swelling and pain from the tear or injuried pf

Re: ESWT vs. surgery

DW on 11/28/01 at 13:54 (065510)

First of all....thank you, Dr. Zuckerman, for your time in answering my questions. I really appreciate it.

I guess I'm still a little confused; I'm having a lot of pain in my heel when I walk, I'm assuming from the heel spur, since the PF ruptured back in April. My heel is tender to the touch if squeezed lightly from the sides or when touched on the inside arch. (Xrays taken last month did not show any fractures.) Once ruptured, does the fascia still cause pain in the heel? And what tendon would still be causing the pain? Also, I'm having a great deal of pain in my inside-arch when I'm off my feet. I get distinctly uncomfortable 'tingles' when I try to put heat on my feet (or get in a jacuzzi to try to soothe achy knees), so I reverted back to only ice. (I thought heat would heal the PF rupture...?) I WANT to go the ESWT route if at all possible, but I also don't want to undergo 2 separate *operations* if the first isn't going to be able to address all the problems. Am I making any sense here?
Thanks for your time and your help.
Dona

Re: ESWT vs. surgery

DR Zuckerman on 11/28/01 at 15:02 (065515)

Before any surgery or ESWT I would want you to have an mri to rule out a stress fracture of the heeel bone. You are describing a stress fracture when you tell me that it hurts when putting pressure side to side. An x-ray won't show the stress fracture. Also would like to have an mri of the posterior tibial tendon

Re: ESWT vs. surgery

Jen R on 12/20/01 at 07:28 (067453)

Dona,

Hi. Just thought I'd put in my 2 cents...for whatever it may be worth. I had ESWT twice for my PF. I did not get any relief and after the 2 treatments I decided to have a 3-part surgery which included a PF release, nerve decompression and osteotomy (where heel bone is cut and moved). It has been 7 months since my surgery and let me tell you...although I walk normal I am in as much pain, if not more, than I was before my surgery. I was told that my recovery would take a year but I have not improved much, if any, in the past two months. I'm gonna give my foot that one year time frame to heal and if it's no better I will consider another ESWT treatment if my doctor or Dr. Z give me reason to believe that it could help me. Do not enter lightly into surgery. It is a long and frustrating road to recovery.

Jen R

Re: ESWT vs. surgery

wendyn on 12/20/01 at 20:01 (067516)

Jen, I have been around here almost as long as you - but I haven't seen you post for a while. I assumed that you were all better.

I'm sorry to hear you are not....can you give us an update on what's happened since your surgery?

Re: ESWT vs. surgery

Jen R on 12/21/01 at 06:49 (067560)

Wendyn,

My surgery was back on May 8...over 7 months ago. My initial recovery was slow but for the first 4 months I seemed to be able to see the improvement on a daily basis. Since the time I became totally back on my feet my progress has not continued in such a quick pace. In fact, the past two months I have noticed no improvement and my morning pain actually seems to be getting worse. I can hardly walk for about my first 10 or so steps in the morning. As far as treatment goes...I had been released from therapy back in September but was sent back again to have a course of iontophoresis (which from what I understand is a steriod treatment that is not as intense as cortisone which also eats away at the bad tissue) and continued stretching exercises. I am almost thru with my ionto treatment and I feel no better. I am worse at this point than I was before my surgery. I can walk and while most people don't realize there is anything wrong with me...I am in severe pain after walking or standing any more than 15 minutes and just sitting with my feet touching the floor gives me a constant ache. Mall walking and grocery shopping are torture. And...finding shoes that are comfortable is impossible. I've been able to wear dressy boots and a pair of loafers but otherwise a normal dress shoe is out of the question. Fortunately my job is mostly sitting. But as far as I am concerned, anyone who does not consider ESWT before surgery is making a big mistake. After my recovery time passes...if I still am not better I may try ESWT again.

Hope this is the information you were looking for. Thanks for the concern.

Have a great holiday.

Jen

Re: ESWT vs. surgery

Dr. Zuckerman on 12/21/01 at 08:40 (067565)

Hi, Jen

I did get your other e-mail. I just want you to know that ESWT has been very effective after pf surgery. So long as the area is insertional and confined we can give you another ESWT treatment. Will respond to your other e-mails but can't at this time because it was down loaded on my home computer and I am reading only today's e-mails from my server. So Merry Christmas and always here for you if you need me. !!

Re: ESWT vs. surgery

Jen R on 12/22/01 at 19:04 (067662)

Dr. Z,

Hi. Thanks for the holiday wishes and the support. I see from other postings here that the FDA has approved the Dornier machine. Any chance that I could get a different result from a different machine? I know that some of these machines are low level and some high level and that the number of treatments can be different according to the level of treatment. Is one way better than other for certain kinds of problems or are they all basically the same? Thought others out there might be interested is this as well.

Thanks again for your help. Have a great holiday!

Sincerely,

Jen R