Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Surgery or ESWT?

Posted by Paula S on 1/25/02 at 21:46 (071329)

I've had disabling plantar fasciitis for 4 years, and have been through all the conservative treatments available. I've read good things about ESWT but have seen a couple of doctors who tell me that the EPF is a better option because the success rate is higher, and the ESWT is currently not well understood. It looks to me like results vary with both treatments. I have somewhat flat feet, which concerns me because I've read that the EPF can cause arch destabilization and other problems in flat-footers. However, I'm not independtly wealthy and don't want to spend thousands of dollars for ESWT if it's not going to help my problem. It's a tough decision. Any comments?

Re: Surgery or ESWT?

Julie on 1/26/02 at 02:15 (071346)

Paula, I'm sure one or more of the doctors here will have something to say about this, but meanwhile I suggest that you read up about ESWT on this website and inform yourself about how it works, who it may be appropriate for, and what can be expected of it. Because it's a (relatively) new treatment in the States (though it has been used in Europe for longer) it's natural for doctors who aren't yet familiar with it, but who are used to doing surgery for PF, to dismiss it (as did my podiatrist who, although otherwise knowledgeable and capable, really didn't want to know.)

All the doctors who regularly help us here are skilled, experienced surgeons, and they have all said that ESWT, if deemed appropriate for the person's condition, should be tried before considering surgery. And though I shouldn't speak for them, both Dr Z and Dr Ed have said that they don't think EPF is as good a procedure as minimial incision surgery.

So find out more about it, and then see if you can't find a foot doctor who knows more about ESWT than the ones you've consulted, and can give you a more unbiased view of its appropriateness for your condition.

Re: Surgery or ESWT?

Jen R on 1/28/02 at 11:34 (071630)

Paula,
Hi. I was in a similar situation. I had 2 ESWT treatments done on my feet after suffering from PF for about 3 or 4 years. Unfortunately, I did not have the success that others are getting from ESWT so I elected to have a very aggressive surgery. My surgery was over 9 months ago and my feet are more painful now than ever. If I could go back...I might try another round of ESWT or tried a different machine...or I might have had just the EPF...and not a Release, Osteotomy and nerve decompression surgery all at one time.
In any case, I will tell you this. Surgery can be successful but it can also be a disaster. There is much, much, much more risk to the long term effects of surgery than ESWT. The great thing about ESWT is that although it doesn't help everybody...it also doesn't make the sitation worse. You can always elect to have surgery if the ESWT doesn't work, but once you have surgery it's not quite so easy to go back. Believe me, I am living proof.
Good luck.

Jen R

Re: Surgery or ESWT?

Dr. Marlene Reid on 1/28/02 at 23:41 (071744)

Paula,

I used to do plantar fascia releases through a small incision. I never did EPF's - too many complications. It is WAY overused nowadays. Now I use the Ossatron and I will probably NEVER do a release again. I am getting 90-100% success without any of the complications of surgery. There is very, very little chance about getting worse with ESWT vs. surgery. If my mother had chronic heel pain, I'd have her have Ossatron ESWT in a second!!

Re: Surgery or ESWT?

Dr. Marlene Reid on 1/28/02 at 23:45 (071745)

Also, I did not remove the spur. Most DPM's now feel that the spur does not cause the pain and is not necessary to remove it.

Re: Surgery or ESWT?

Glennx on 1/29/02 at 13:45 (071810)

Dr. Reid,
What a beautifully bold statement! Enormously informative and encouraging.
Thanks!

Re: Surgery or ESWT?

Julie on 1/30/02 at 02:52 (071890)

I thought so too! Encouraging and energizing.

Re: 90-100% ESWT success?

elliott on 1/30/02 at 22:05 (072022)

Your ESWT success rate seems very high, much higher than I gather is Dr. Z's. Could you explain?

---

Re: 90-100% ESWT success?

DR Zuckerman on 1/31/02 at 19:22 (072133)

It is also much higher then any literature or any european experience that I am aware. In fact Dr. Gordon one of the first doctors using the ossatron in Toronto makes this statement on his web site. If you don't tells you he is getting more then 70% sucess rate then better go to another doctor.

Re: 90-100% ESWT success?

Ed Davis, DPM on 2/01/02 at 19:58 (072260)

The success rate (90%) probably is a 'cumulative' success rate that includes not only EPF but the other conservative treatment applied. Presumably, ESWT is used for intractable plantar fasciitis and, as such, is used after the full range of conservative modalities have been applied.
Ed

Re: 90-100% ESWT success?

Dr. Marlene Reid on 2/01/02 at 21:25 (072271)

Most of the patients are 90 -100% better, not all. There have been a few that reequired a second treatment. At least 75% of the patients we have done have said they are nearly 100% improved. Some others have said they have only a twinge of morning pain with the first step only. I would call that 95% improved. Many people it takes 4 months to be that much better. I have only a few that were only 70% better. I have only had a few that needed a second treatment.

Re: 90-100% ESWT success?

DR Zuckerman on 2/01/02 at 21:54 (072273)

So how many didn't respond to ESWT at all ?

Re: 90-100% ESWT success?

DR Zuckerman on 2/01/02 at 22:05 (072275)

Ok After reading this over and over . What you are saying is that 75% of your patients have between 90-100% pain relief. So there is a 25% failure rate. This is what the ossatron studies are showing. IS this a correct evaluation of your posting. At first I though you were saying 90-100% of all your ESWT treated patients were pain free or nearly pain free.

Re: 90% is the published accepted pre-surgery, pre-ESWT success rate

elliott on 2/02/02 at 19:32 (072338)

So I hope that's not what she meant, because then she's doing worse than everyone else.

---

Re: "success" is not the same as "improvement"

elliott on 2/02/02 at 19:43 (072339)

When you first said '90-100% success', we took that to mean, as it implies in standard doctor language, that this percentage of patients undergoing ESWT with you have 'success', however pre-defined. That is not the same as given success, what percentage improvement is shown. Not trying to be picky, but ESWT is of much interest to the board, not to mention expensive and often inaccessible. So clarity is especially desireable, especially from a doctor. Thanks.

---

Re: 90-100% ESWT success?

Dr. Marlene Reid on 2/02/02 at 19:48 (072341)

None

Re: 90-100% ESWT success?

Dr. Marlene Reid on 2/02/02 at 19:53 (072343)

No, that's not what I am saying. The other 25% are getting a sucess rate of less then 90% but certainly much improved. Only 1 patient has said he was not significantly improved and he now plays golf 3 times a week, so he has had improvment. Of those that had less then 90%, only 4 felt that they required a second treatment and those have all met the 90 or 100% improvment. But we haven't done as many as you, we've only done 60 or 70 so far.

Re: "success" is not the same as "improvement"

Dr. Marlene Reid on 2/02/02 at 19:58 (072344)

Out of the 60 or 70 patients we have done in our office, at least 75% of those patients have had 90 - 100%. Of the remaining 20 or 25% of patients, all except one have been happy with their improvement (except one patient)and only 4 patients have felt a second treatment was necessary - all 4 of those then met the 90-100% improvment point. All the others were significantly improved and felt the procedure was a success. I am not saying my sucess rate is 90 -100%. It is not an all or nothing issue like other surgeries can be. Wouldn't you all be happy if you had 80% improvment????

Re: question about ranges (no, not stoves)

elliott on 2/02/02 at 20:01 (072345)

Pre-surgery, surgeons often give you a range of success (e.g. 85-90% given on my first foot) rather than a single number. Dr. Reid gave a range here too (90-100%), apparently for level of improvement. My question is, why not a single number? This has always bothered me. If the surgeon had 100 previous such surgeries and 85 were 'successes', however defined, then the number is 85%. If some of the surgical results are unclear (inadequate followup, lack of clarity from patient's post-op description, etc.), they should be either eliminated or weighted to still give a single number. And ideally, they should define 'success' beforehand too (two common ones are the patient's description of 'generally satisfied' and 'better than pre-surgery', but there are many more, e.g. diagnostic success but patient now can't walk :-)) rather than, as I'm suspicious, nebulously mix success and improvement together and give a range.

---

Re: I'm still confused

elliott on 2/02/02 at 20:28 (072348)

'The other 25% are getting a sucess rate of less then 90% but certainly much improved.'

Please define 'success'. Thanks.

--

Re: 80% improvement

elliott on 2/02/02 at 20:36 (072349)

Now where did that figure come from? I might be happy with it if I knew what it was. Look, I'm not contesting the merits of ESWT; it seems to show a lot of promise. I and I'm sure others just want as clear a picture as possible of it's merits.

Most runners would be happy only if they could run again. Were any of your ESWT patients runners? Did any return to running? Any to their pre-PF levels? Thanks.

--

Re: question about ranges (no, not stoves)

Dr. Marlene Reid on 2/02/02 at 20:56 (072353)

Again, what I am saying is that at least 75% of my patients have stated that they are at least 90% better after a single Ossatron treatment.

Re: "success" is not the same as "improvement"

Dr. Marlene Reid on 2/02/02 at 20:59 (072354)

By the way, did 'we' mean the entire board's interpretation?? It is difficult to be very clear on the internet, over a key board, isn't it. That is also why the doctors here always say it is impossible to give a diagnosis and individual advise over the internet. There are too many misunderstandings in a type written conversation. For those of you that are looking for specific treatment advise for a given problem, it is very important that you seek your own individual medical advise.

Re: "success" is not the same as "improvement"

Dr. Marlene Reid on 2/02/02 at 21:07 (072355)

It really depends on what you call sucess in this case. Is success when you can take those first steps in the morning without limping, or is it when you can now walk instead of crawl out of bed in the morning. Is it when you can play a round of golf again in a day or when you can now play 3 rounds of golf in one afternoon. (Is that even possible? I'm not a golfer). I have not had any patients not happy. Dr. Kosova has only had one who wasn't happy. Actually, its probably more like 90% that are at least 90% successful. I was estimating on the cautions side before. One of these days I'll actually so an analysis of the follow up studies we've been doing. It's been a year now since we first started doing them and we've starting having patients fill out evaluations for several months. Its a pain scale of 1-5 and most people are in the 4 or 5 range for the pain categories before treatment and end up with 0 or 1 after. Thats where I'm getting the 90-100% from. There are a few different statments they have to rank.

Re: "we" meant Dr Z and I (nm)

elliott on 2/02/02 at 21:53 (072361)

.

Re: 90-100% ESWT success?

Dr. Zuckerman on 2/04/02 at 12:30 (072532)

Dr. Reid that is excellent Keep up the great work.

Re: Surgery or ESWT?

Julie on 1/26/02 at 02:15 (071346)

Paula, I'm sure one or more of the doctors here will have something to say about this, but meanwhile I suggest that you read up about ESWT on this website and inform yourself about how it works, who it may be appropriate for, and what can be expected of it. Because it's a (relatively) new treatment in the States (though it has been used in Europe for longer) it's natural for doctors who aren't yet familiar with it, but who are used to doing surgery for PF, to dismiss it (as did my podiatrist who, although otherwise knowledgeable and capable, really didn't want to know.)

All the doctors who regularly help us here are skilled, experienced surgeons, and they have all said that ESWT, if deemed appropriate for the person's condition, should be tried before considering surgery. And though I shouldn't speak for them, both Dr Z and Dr Ed have said that they don't think EPF is as good a procedure as minimial incision surgery.

So find out more about it, and then see if you can't find a foot doctor who knows more about ESWT than the ones you've consulted, and can give you a more unbiased view of its appropriateness for your condition.

Re: Surgery or ESWT?

Jen R on 1/28/02 at 11:34 (071630)

Paula,
Hi. I was in a similar situation. I had 2 ESWT treatments done on my feet after suffering from PF for about 3 or 4 years. Unfortunately, I did not have the success that others are getting from ESWT so I elected to have a very aggressive surgery. My surgery was over 9 months ago and my feet are more painful now than ever. If I could go back...I might try another round of ESWT or tried a different machine...or I might have had just the EPF...and not a Release, Osteotomy and nerve decompression surgery all at one time.
In any case, I will tell you this. Surgery can be successful but it can also be a disaster. There is much, much, much more risk to the long term effects of surgery than ESWT. The great thing about ESWT is that although it doesn't help everybody...it also doesn't make the sitation worse. You can always elect to have surgery if the ESWT doesn't work, but once you have surgery it's not quite so easy to go back. Believe me, I am living proof.
Good luck.

Jen R

Re: Surgery or ESWT?

Dr. Marlene Reid on 1/28/02 at 23:41 (071744)

Paula,

I used to do plantar fascia releases through a small incision. I never did EPF's - too many complications. It is WAY overused nowadays. Now I use the Ossatron and I will probably NEVER do a release again. I am getting 90-100% success without any of the complications of surgery. There is very, very little chance about getting worse with ESWT vs. surgery. If my mother had chronic heel pain, I'd have her have Ossatron ESWT in a second!!

Re: Surgery or ESWT?

Dr. Marlene Reid on 1/28/02 at 23:45 (071745)

Also, I did not remove the spur. Most DPM's now feel that the spur does not cause the pain and is not necessary to remove it.

Re: Surgery or ESWT?

Glennx on 1/29/02 at 13:45 (071810)

Dr. Reid,
What a beautifully bold statement! Enormously informative and encouraging.
Thanks!

Re: Surgery or ESWT?

Julie on 1/30/02 at 02:52 (071890)

I thought so too! Encouraging and energizing.

Re: 90-100% ESWT success?

elliott on 1/30/02 at 22:05 (072022)

Your ESWT success rate seems very high, much higher than I gather is Dr. Z's. Could you explain?

---

Re: 90-100% ESWT success?

DR Zuckerman on 1/31/02 at 19:22 (072133)

It is also much higher then any literature or any european experience that I am aware. In fact Dr. Gordon one of the first doctors using the ossatron in Toronto makes this statement on his web site. If you don't tells you he is getting more then 70% sucess rate then better go to another doctor.

Re: 90-100% ESWT success?

Ed Davis, DPM on 2/01/02 at 19:58 (072260)

The success rate (90%) probably is a 'cumulative' success rate that includes not only EPF but the other conservative treatment applied. Presumably, ESWT is used for intractable plantar fasciitis and, as such, is used after the full range of conservative modalities have been applied.
Ed

Re: 90-100% ESWT success?

Dr. Marlene Reid on 2/01/02 at 21:25 (072271)

Most of the patients are 90 -100% better, not all. There have been a few that reequired a second treatment. At least 75% of the patients we have done have said they are nearly 100% improved. Some others have said they have only a twinge of morning pain with the first step only. I would call that 95% improved. Many people it takes 4 months to be that much better. I have only a few that were only 70% better. I have only had a few that needed a second treatment.

Re: 90-100% ESWT success?

DR Zuckerman on 2/01/02 at 21:54 (072273)

So how many didn't respond to ESWT at all ?

Re: 90-100% ESWT success?

DR Zuckerman on 2/01/02 at 22:05 (072275)

Ok After reading this over and over . What you are saying is that 75% of your patients have between 90-100% pain relief. So there is a 25% failure rate. This is what the ossatron studies are showing. IS this a correct evaluation of your posting. At first I though you were saying 90-100% of all your ESWT treated patients were pain free or nearly pain free.

Re: 90% is the published accepted pre-surgery, pre-ESWT success rate

elliott on 2/02/02 at 19:32 (072338)

So I hope that's not what she meant, because then she's doing worse than everyone else.

---

Re: "success" is not the same as "improvement"

elliott on 2/02/02 at 19:43 (072339)

When you first said '90-100% success', we took that to mean, as it implies in standard doctor language, that this percentage of patients undergoing ESWT with you have 'success', however pre-defined. That is not the same as given success, what percentage improvement is shown. Not trying to be picky, but ESWT is of much interest to the board, not to mention expensive and often inaccessible. So clarity is especially desireable, especially from a doctor. Thanks.

---

Re: 90-100% ESWT success?

Dr. Marlene Reid on 2/02/02 at 19:48 (072341)

None

Re: 90-100% ESWT success?

Dr. Marlene Reid on 2/02/02 at 19:53 (072343)

No, that's not what I am saying. The other 25% are getting a sucess rate of less then 90% but certainly much improved. Only 1 patient has said he was not significantly improved and he now plays golf 3 times a week, so he has had improvment. Of those that had less then 90%, only 4 felt that they required a second treatment and those have all met the 90 or 100% improvment. But we haven't done as many as you, we've only done 60 or 70 so far.

Re: "success" is not the same as "improvement"

Dr. Marlene Reid on 2/02/02 at 19:58 (072344)

Out of the 60 or 70 patients we have done in our office, at least 75% of those patients have had 90 - 100%. Of the remaining 20 or 25% of patients, all except one have been happy with their improvement (except one patient)and only 4 patients have felt a second treatment was necessary - all 4 of those then met the 90-100% improvment point. All the others were significantly improved and felt the procedure was a success. I am not saying my sucess rate is 90 -100%. It is not an all or nothing issue like other surgeries can be. Wouldn't you all be happy if you had 80% improvment????

Re: question about ranges (no, not stoves)

elliott on 2/02/02 at 20:01 (072345)

Pre-surgery, surgeons often give you a range of success (e.g. 85-90% given on my first foot) rather than a single number. Dr. Reid gave a range here too (90-100%), apparently for level of improvement. My question is, why not a single number? This has always bothered me. If the surgeon had 100 previous such surgeries and 85 were 'successes', however defined, then the number is 85%. If some of the surgical results are unclear (inadequate followup, lack of clarity from patient's post-op description, etc.), they should be either eliminated or weighted to still give a single number. And ideally, they should define 'success' beforehand too (two common ones are the patient's description of 'generally satisfied' and 'better than pre-surgery', but there are many more, e.g. diagnostic success but patient now can't walk :-)) rather than, as I'm suspicious, nebulously mix success and improvement together and give a range.

---

Re: I'm still confused

elliott on 2/02/02 at 20:28 (072348)

'The other 25% are getting a sucess rate of less then 90% but certainly much improved.'

Please define 'success'. Thanks.

--

Re: 80% improvement

elliott on 2/02/02 at 20:36 (072349)

Now where did that figure come from? I might be happy with it if I knew what it was. Look, I'm not contesting the merits of ESWT; it seems to show a lot of promise. I and I'm sure others just want as clear a picture as possible of it's merits.

Most runners would be happy only if they could run again. Were any of your ESWT patients runners? Did any return to running? Any to their pre-PF levels? Thanks.

--

Re: question about ranges (no, not stoves)

Dr. Marlene Reid on 2/02/02 at 20:56 (072353)

Again, what I am saying is that at least 75% of my patients have stated that they are at least 90% better after a single Ossatron treatment.

Re: "success" is not the same as "improvement"

Dr. Marlene Reid on 2/02/02 at 20:59 (072354)

By the way, did 'we' mean the entire board's interpretation?? It is difficult to be very clear on the internet, over a key board, isn't it. That is also why the doctors here always say it is impossible to give a diagnosis and individual advise over the internet. There are too many misunderstandings in a type written conversation. For those of you that are looking for specific treatment advise for a given problem, it is very important that you seek your own individual medical advise.

Re: "success" is not the same as "improvement"

Dr. Marlene Reid on 2/02/02 at 21:07 (072355)

It really depends on what you call sucess in this case. Is success when you can take those first steps in the morning without limping, or is it when you can now walk instead of crawl out of bed in the morning. Is it when you can play a round of golf again in a day or when you can now play 3 rounds of golf in one afternoon. (Is that even possible? I'm not a golfer). I have not had any patients not happy. Dr. Kosova has only had one who wasn't happy. Actually, its probably more like 90% that are at least 90% successful. I was estimating on the cautions side before. One of these days I'll actually so an analysis of the follow up studies we've been doing. It's been a year now since we first started doing them and we've starting having patients fill out evaluations for several months. Its a pain scale of 1-5 and most people are in the 4 or 5 range for the pain categories before treatment and end up with 0 or 1 after. Thats where I'm getting the 90-100% from. There are a few different statments they have to rank.

Re: "we" meant Dr Z and I (nm)

elliott on 2/02/02 at 21:53 (072361)

.

Re: 90-100% ESWT success?

Dr. Zuckerman on 2/04/02 at 12:30 (072532)

Dr. Reid that is excellent Keep up the great work.