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ESWT vs. EPR

Posted by Steve M on 1/31/02 at 11:11 (072076)

I am a long time PF suffer, about 2 years. Tried all of the conservative things, orthotics, stretching, icing. My DPM says I do not have tradittional pf since I have no morning pain and no inflamation and no heel spurs. I have bilateral burning on the bottoms of both feet. DPM says my fascia tendon is very tight and I have very high arches. He says the only thing that will help is surgery- partial endoscopic plantar release. I asked him about ESWT and he said it would not work for me because my tendon is so tight. What do others think. Is this correct? Should I consider surgery?

Thanks in advance.

Re: ESWT vs. EPR

Allan G on 1/31/02 at 16:55 (072116)

Hi Steve,
Have you had a diagnostic Ultrasound to check the plantar fascia ?? It doesn't sound as though you have the classic plantar fasciitis.
However We in Australia have found that there appears to be 2 different appearances of the fascia. The classic morning pain fasciitis where on USound the plantar attachment is quite thickened, especially directly covering the calcaneum. The other we see , where the symptoms seem to be no great pain in the morning but gets worse during the day, is where the plantar fascia is swollen distal to the attachment (further along the tendon) This can be in the form of a plantar nodule or an area of diffuse inflammation. This tends to cause more symptoms during the day as the fascia stretches during activity or direct pressure on the sole of the foot.
If you haven't had an Ultrasound I suggest this is a quick and easy test to eliminate the possibility of of a plantar fascial lesion.
Regards Allan G
PS ESWT can still treat the distal lesions.

Re: Be careful of the knife !

BrianG on 1/31/02 at 18:59 (072128)

Hi Steve,

There are quite a few of us here that have had failed Endoscopic surgeries, myself included. Less and less doctors seem to be doing it now. I'd get another opinion if I were you.

If you insist on getting the surgery, find out how many EPF's your doctor has done. Too few could be a problem, and too many means he probably cuts everyone. Ask him to put you in touch with someone he has recently healed, that had the same problems as yourself. Don't rush into this. A bad surgery can lead to much worse, nerve type pain. Once they cut, there is no going back !! Good luck

BCG

Re: ESWT vs. EPR

DR Zuckerman on 1/31/02 at 19:27 (072134)

How far along the plantar fascia can you go . Any limitation. I know the FDA is for insertional but I would the practical answer. The practical answer means what are you guys doing how is it working out. Thanks

Re: Be careful of the knife !

John h on 1/31/02 at 21:39 (072149)

Most Podiatrist in my area have dropped the EPF in favor of MIS. I agree with Brian.

Re: ESWT vs. EPR

JudyS on 2/01/02 at 12:28 (072183)

Steve, were you able to ask the doctor why a high, tight arch would not respond to ESWT? Do you know what level of ESWT expertise he/she has?

Re: ESWT vs. EPR

Steve M on 2/01/02 at 21:44 (072272)

That is the the question I have been wondering. The DPM said ESWT would not work because the tendon was so tight. He said it is like when you wear a belt that is too tight the only way to get relief is to lossen it. DPM said the EPF was very simple procedure and I would have a complete recovery in 3 months.

I do not know how many ESWT the DPM has done he did say he was cetified to do ESWT. I am curious if others think ESWT would work. I really don't want surgery. Thanks

Re: ESWT vs. EPR

DR Zuckerman on 2/01/02 at 21:58 (072274)

I would still do ESWT if you have proximal insertional plantar fasciitis
with or without a spur I have found that what appears to be a tight fascia isn't a tight fascia and that pain is place the plantar structure taunt due to pain. I don't feel that a fight fascia even exists . IT is so strong in texture that it is not possible to become tight. Now the other tendons below the fascia can be tight . Once the fascia is cut there is no way to put it back together. You can always do surgery if for some reason no response to ESWT

Re: ESWT vs. EPR

Dr. Marlene Reid on 2/02/02 at 19:48 (072340)

I do not agree with what he is saying. Many people live with a tight fascia without developing PF.

Re: ESWT vs. EPR

Allan.G on 2/03/02 at 16:17 (072463)

Hi Dr Zuckerman
Sorry for the delay in this reply.
You can treat anywhere along the plantar fascia , providing you can see it on our localizing Ultrasound and make contact with the bellows for treatment.
Also , we have had good success with treating Achilles ( though with low energies only ... a published paper stated that high energies can cause an increase in ruptures in Rabbits tendons), also if we can access Posterior Tibialis and Peroneal tendons.
Regards again
Happy to keep the info coming.
I'd still be interested in doing treatments in The USA if the conditions could be found.
Allan Gottliebsen

Re: ESWT vs. EPR

Dr. Zuckerman on 2/03/02 at 20:44 (072486)

This have been asked but what is the cost of the epos in the outback country.

Re: ESWT vs. EPR

john h on 2/04/02 at 09:38 (072521)

Dr. Z is the 'Outback Country' sort of like Woodbury?

Re: ESWT vs. EPR

Dr. Zuckerman on 2/04/02 at 12:41 (072536)

In Woodbury we have better beer holes !!!!

Re: ESWT vs. EPR

Allan.G on 2/05/02 at 02:27 (072609)

Please do not even suggest that there are better 'Beer holes' than those in Australia . !!!
Only joking...
Loved the Bud while I was there.
Regards again
Allan G

Re: ESWT vs. EPR

john h on 2/05/02 at 10:37 (072634)

Love the Forster while I am here Alan.

Re: ESWT vs. EPR

LaurieL on 3/11/02 at 17:18 (076202)

OVer the last several months and after ESWT of both feet I am experiencing burning instead of the prior pain upon getting out of bed in the morning. Does this mean I have developed another condition on top of pf?

Re: ESWT vs. EPR

john h on 3/12/02 at 10:06 (076259)

When I first developed PF it started out as burning and then developed into what I guess whe call just plain old pain.

Re: ESWT vs. EPR

Allan G on 1/31/02 at 16:55 (072116)

Hi Steve,
Have you had a diagnostic Ultrasound to check the plantar fascia ?? It doesn't sound as though you have the classic plantar fasciitis.
However We in Australia have found that there appears to be 2 different appearances of the fascia. The classic morning pain fasciitis where on USound the plantar attachment is quite thickened, especially directly covering the calcaneum. The other we see , where the symptoms seem to be no great pain in the morning but gets worse during the day, is where the plantar fascia is swollen distal to the attachment (further along the tendon) This can be in the form of a plantar nodule or an area of diffuse inflammation. This tends to cause more symptoms during the day as the fascia stretches during activity or direct pressure on the sole of the foot.
If you haven't had an Ultrasound I suggest this is a quick and easy test to eliminate the possibility of of a plantar fascial lesion.
Regards Allan G
PS ESWT can still treat the distal lesions.

Re: Be careful of the knife !

BrianG on 1/31/02 at 18:59 (072128)

Hi Steve,

There are quite a few of us here that have had failed Endoscopic surgeries, myself included. Less and less doctors seem to be doing it now. I'd get another opinion if I were you.

If you insist on getting the surgery, find out how many EPF's your doctor has done. Too few could be a problem, and too many means he probably cuts everyone. Ask him to put you in touch with someone he has recently healed, that had the same problems as yourself. Don't rush into this. A bad surgery can lead to much worse, nerve type pain. Once they cut, there is no going back !! Good luck

BCG

Re: ESWT vs. EPR

DR Zuckerman on 1/31/02 at 19:27 (072134)

How far along the plantar fascia can you go . Any limitation. I know the FDA is for insertional but I would the practical answer. The practical answer means what are you guys doing how is it working out. Thanks

Re: Be careful of the knife !

John h on 1/31/02 at 21:39 (072149)

Most Podiatrist in my area have dropped the EPF in favor of MIS. I agree with Brian.

Re: ESWT vs. EPR

JudyS on 2/01/02 at 12:28 (072183)

Steve, were you able to ask the doctor why a high, tight arch would not respond to ESWT? Do you know what level of ESWT expertise he/she has?

Re: ESWT vs. EPR

Steve M on 2/01/02 at 21:44 (072272)

That is the the question I have been wondering. The DPM said ESWT would not work because the tendon was so tight. He said it is like when you wear a belt that is too tight the only way to get relief is to lossen it. DPM said the EPF was very simple procedure and I would have a complete recovery in 3 months.

I do not know how many ESWT the DPM has done he did say he was cetified to do ESWT. I am curious if others think ESWT would work. I really don't want surgery. Thanks

Re: ESWT vs. EPR

DR Zuckerman on 2/01/02 at 21:58 (072274)

I would still do ESWT if you have proximal insertional plantar fasciitis
with or without a spur I have found that what appears to be a tight fascia isn't a tight fascia and that pain is place the plantar structure taunt due to pain. I don't feel that a fight fascia even exists . IT is so strong in texture that it is not possible to become tight. Now the other tendons below the fascia can be tight . Once the fascia is cut there is no way to put it back together. You can always do surgery if for some reason no response to ESWT

Re: ESWT vs. EPR

Dr. Marlene Reid on 2/02/02 at 19:48 (072340)

I do not agree with what he is saying. Many people live with a tight fascia without developing PF.

Re: ESWT vs. EPR

Allan.G on 2/03/02 at 16:17 (072463)

Hi Dr Zuckerman
Sorry for the delay in this reply.
You can treat anywhere along the plantar fascia , providing you can see it on our localizing Ultrasound and make contact with the bellows for treatment.
Also , we have had good success with treating Achilles ( though with low energies only ... a published paper stated that high energies can cause an increase in ruptures in Rabbits tendons), also if we can access Posterior Tibialis and Peroneal tendons.
Regards again
Happy to keep the info coming.
I'd still be interested in doing treatments in The USA if the conditions could be found.
Allan Gottliebsen

Re: ESWT vs. EPR

Dr. Zuckerman on 2/03/02 at 20:44 (072486)

This have been asked but what is the cost of the epos in the outback country.

Re: ESWT vs. EPR

john h on 2/04/02 at 09:38 (072521)

Dr. Z is the 'Outback Country' sort of like Woodbury?

Re: ESWT vs. EPR

Dr. Zuckerman on 2/04/02 at 12:41 (072536)

In Woodbury we have better beer holes !!!!

Re: ESWT vs. EPR

Allan.G on 2/05/02 at 02:27 (072609)

Please do not even suggest that there are better 'Beer holes' than those in Australia . !!!
Only joking...
Loved the Bud while I was there.
Regards again
Allan G

Re: ESWT vs. EPR

john h on 2/05/02 at 10:37 (072634)

Love the Forster while I am here Alan.

Re: ESWT vs. EPR

LaurieL on 3/11/02 at 17:18 (076202)

OVer the last several months and after ESWT of both feet I am experiencing burning instead of the prior pain upon getting out of bed in the morning. Does this mean I have developed another condition on top of pf?

Re: ESWT vs. EPR

john h on 3/12/02 at 10:06 (076259)

When I first developed PF it started out as burning and then developed into what I guess whe call just plain old pain.