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Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

Posted by Mike T on 3/04/02 at 11:54 (075622)

Now 47 year old male. Always been very active and worked out to stay in shape. Diagnosed with heel spurs about 5 years ago. Seen the podiatrist, have taken the anti inflammatory meds, had the cortizone injections, have and use the custom made orthotics, stretch my feet / calves daily. Continue to attempt to stay in shape despite extreme, chronic heel pain most of the time. Can not find a pair of shoes that do not to some degree aggrevate the condition.

Recently had spinal fusion surgery (old football injury), my doctor (a sports doctor in the Dallas area for professional teams) adamantly told me, that under no circumstances have the plantar faschia cut (surgery).

The ESWT looks extremely promising. Has the procedure been approved by the FDA yet? Is the procedure being covered by health insurance plans yet? If so, are there any Dallas area locations? If not, are there any treatment studies being conducted in the Dallas Ft. Worth area in which I might be able to participate. I would like to see if I might qualify. I am desperately looking for help with this condition.

Thanks.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/04/02 at 12:30 (075630)

Mike: there are people in your city who do ESWT. Search under the ESWT section on this board. Visit http://www.healthtronics.com and http://www.bayshore.com or Dr. Zuckermans website for more information. I totally agree with your Doctor in that go the ESWT route before you ever consider surgery. I have had them both.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/04/02 at 12:32 (075631)

My bayshore URL should have been http://www.bayshore.ca/

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/04/02 at 12:35 (075632)

DR Z: http://www.thefootspecialist.com

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/04/02 at 12:41 (075634)

Hi Mike --

In the Dallas area, tha main ESWT doctor seems to be Charles Cook (214-265-7175). He treated Rusty Grier of the Rangers baseball club. You might also want to check John Marymount in Houston. Both doctors use the OssaTron.

Be sure you fully understand the cost of the procedure. You might even want to get it in writing so there is no misunderstanding. Good Luck!

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

Mike T on 3/04/02 at 15:08 (075642)

Thanks Brian. My orthopedic told me of Rusty Grier's experimental treatments and that he had been traveling to Canada. Do you know if the Ossa Tron treatments are now covered by insurance? Or, do I just need to contact my carrier to see what they say? Any actual experience with this?

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

Mike T on 3/04/02 at 15:12 (075643)

John, thanks for your speedy feedback. You indicate that you have had both surgical and non-surgical treatments. How did yoru problem respond to the surgical option? Are you now pain free after the ESWT treatments? My concern is that the treatments are not covered by insurance. I can not afford to pay the costs of the treatments out of pocket.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

John h on 3/04/02 at 16:18 (075653)

The surgical option neither made me better or made me worse. It was pretty much a minimal invasvive procedure and probably no more than 15-20% of the fascia was released.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/05/02 at 08:31 (075715)

Mike --

Rusty Grier was treated twice with ESWT -- the first time in Canada (85% improvement) and the second time in Dallas (additional 10% improvement). There was an article on this about a year ago in the Fort Worth Star Telegram.

I had two ESWT treatments from Dr. Cook and didn't feel any noticeable improvement, but I think I am the exception, not the rule. My insurance did not cover the procedures, and I think that most insurance carriers still refuse to cover ESWT.

Hope this helps.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

LaurieL on 3/11/02 at 16:11 (076191)

Just had ESWT treatment Jan 10, 02 with Podiatrist Dr.Ashton in Plano, Tx. Have been hurting for 3 years now, treating the last 18 months. The first Treatment hasn't worked yet, may have to have 2nd treatment. Am having to ride on a scooter to be able to continue to work because of severe pain.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

Mikt T on 3/12/02 at 09:29 (076252)

Thanks Laurie for providing your feedback. I am sorry to hear that you are still having the heel pain. So, let me repeat to be sure I have your history straight. You have been having heel pain for 3 years. You have been undergoing treatments of some kind for the last 18 months, having the ESWT treatment in January of this year. Is the pain greater or less than before you had the ESWT? I hear it may take some time to recover from the ESWT treatments, often requiring a second or subsequent treatments. Hang in there. I am relatively new to this arena and have learned a great deal from reading the other comments in this forum.

I am taking the advice of Brian J and pursuing at least evaluation by Dr Cook here in Dallas. My problem, is that I can't afford the out of pocket expense of the treatments, and although BCBS of Texas does not deny that the treatment is not covered, they can not confirm that it is either. Therefore, I am going to discuss evaluating my heel spur condition as being medically necessary, and making an appeal to the BCBS of Texas review board to cover the treatments. Rest assured, I will get any consent in writing prior to any treatments. Did you have to pay for your treatments out of pocket, and if so how much did it run you? Thanks for sharing.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/12/02 at 12:41 (076265)

Mike --

I paid about $4,000 (total, both feet) for ESWT with Dr. Cook. He quoted this amount for one round of treatment, but ended up treating me for a second time at no charge. Needless to say, this was quite generous of him. Of course, I also paid for the anesthesiologist both times and for the use of the surgery center both times.

Only problem was that a few months after the last treatment, I got a bill from Ossatron (the maker of the ESWT machine) for $9,000. When I told them I had not been made aware of this fee, they withdrew their request.

Please don't quote me on any of this, but I hope it helps.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

LaurieL on 3/12/02 at 13:04 (076268)

I am suppose to pay my deductable and 20% because it is out of network - but nothing has come from the insurance yet, after it does I will go the Medical Director about not paying the out of network since the equipment was not available at an in-network facitilty. I spoke with Beatrice Long I believe with Ossatron.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

John h on 3/12/02 at 14:57 (076280)

Brian: I become somewhat ill everytime I see these charges. I lay most of this at the feet of the FDA! This sucks!

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/12/02 at 18:06 (076291)

John H --

It IS truly a shame that Ossatron treatment costs so much, as many people simply can't afford it. I'll be going to Dr. Z and the 'Big O' soon, to see if he can give me relief that the Ossatron did not. I want to give ESWT every chance before proceeding with the Baxter surgery. Also, you know I must be desperate when I can't stop thinking about that capcaisin article ....

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

LaurieL on 3/13/02 at 10:42 (076348)

Is the Baxter surgery the endoscopic partial faciotomy?

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/13/02 at 13:51 (076358)

Baxter surgery is intended to relieve entrapment of the first branch of the lateral plantar nerve. It is an 'open' surgery where an incision is made in the medial aspect of the foot. The surgeon carefully dissects down to where the nerve is and removes nearby tissue that may be pressing against the nerve and causing pain. Check out the 'Baxter's Neuritis' article in the online version of 'Podiatry Today.'

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/14/02 at 10:10 (076419)

No! The Baxter surgery is made with a very small incision. A semi-circular wedge of fascia about 1/2' wide is removed where the fascia attaches to the heel. This wedge is over the baxter nerve and if the pain you have is caused by the fascia pressing on this nerve then the theory is this will fix it. It also provides about a 15% release of the fascia which is not enough to cause foot instability in the future. I think the beauty of this procedure is you are unlikely to be made worse or have a problem with foot instability in the future. Not many surgeons are trained in this procedure. The procedure should take no more than 30 minutes or less and there was not pain and very little swelling involved. You will probably be in a surgical shoe and perhaps crutches for maybe 2 weeks. Stitches out in 10 days. Only a few. The other side of this is some doctors think that not enough of the fascia is released so you have to weigh the pros and cons by talking to doctors who do both procedures. My greatest concern was not that I would be cured but that I could be made worse. I told the doctor as much. We have several large teaching hospitals in our city and their is only one doctor who trained under Dr. Baxter and does the procedure. Many of them I talked with had never heard of it. Some may say they do the Baxter procedure so ask them where and who trained them. I would also make sure my doctor had done a lot of surgery if you go that route. I would also make sure I tried ESWT before I ever considered surgery, Most doctors will rightly put you through all the conservative protocol but I came up on one who wanted to release the entire fascia, several who wanted to operate after my first visit, and one guy who wanted to but an artifical joint in my great toe because he said it had zero cartlidge. Facts were it had plenty of cartlidge. So like everything else in life their are Doctors and their are Doctors. Good luck.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/14/02 at 10:54 (076423)

According to Dr. Baxter, the incision made in the medial aspect of the heel is 4 centimeters long. The surgeon then dissects down to the nerve and removes a small portion of the fascia of the abductor hallicus (not the PF) which may be pressing on the nerve. A small portion of the plantar fascia may also be removed in order to view the operative area clearly. Post-surgery, the average time to resumption of full activity is 3.3 months. This is all from Baxter's article 'Treatment of Chronic Heel Pain by Surgical Release of the First Branch of the Lateral Plantar Nerve' in the June 1992 issue of Clinical Orthopaedics and Related Research.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/15/02 at 09:38 (076500)

Brian: I was back in my shoes and off crutches in two weeks. Of course I did not do any running or serious activity. The doctor drew me a picture to scale of the piece of fascia he would remove and it was what I would call a half moon. He was a board certified Orthopedic Foot and Ankle Surgeon. One of two in our city. He was in his 40's and as you might expect does a lot of surgery. He told me that in all of his surgery using this procedure only one person was made worse and it was a lady who had diabetes. Complications from the diabetes made it worse. At the same time I had the PF release and Tarsal Tunnel Release I also had a Cheilectomy on the great toe ( all on same foot at same time). The Cheilectomy was by far the worst part of this deal as they remove a wedge of bone and spurs from the 2nd joint of the great toe and scraped the joint clean. This is done through an incision of perhaps 4' long that runs straight down the top of the great toe. That baby did hurt as I had to start bending it the next day as part of the recovery. Even with this I was walking without a limp within two weeks. The incision for the TTS and PF is just one very long incision that runs from just under the bottom of the foot at the insertion point to well above the ankle bone. It must be at least 5' long. Dr. Z has looked at the incisions and said whoever did those did very good work. The only thing the Doctor told me he found while exploring the nerves in the tarsal tunnel procedure was an interior vericose vein that 'might' be pressing on a nerve when it swelled from being on your feet for a long time. The doctor told me that TTS was really a hit and miss type of surgery regardless of the various test results. He did not recommend it one way or the other. He just said if I wanted to go that route we could do it all at the same time and eliminate as a possible cause of my pain. I made the decision to have the TTS about 5 minutes before they rolled me into surgery.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/04/02 at 12:30 (075630)

Mike: there are people in your city who do ESWT. Search under the ESWT section on this board. Visit http://www.healthtronics.com and http://www.bayshore.com or Dr. Zuckermans website for more information. I totally agree with your Doctor in that go the ESWT route before you ever consider surgery. I have had them both.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/04/02 at 12:32 (075631)

My bayshore URL should have been http://www.bayshore.ca/

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/04/02 at 12:35 (075632)

DR Z: http://www.thefootspecialist.com

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/04/02 at 12:41 (075634)

Hi Mike --

In the Dallas area, tha main ESWT doctor seems to be Charles Cook (214-265-7175). He treated Rusty Grier of the Rangers baseball club. You might also want to check John Marymount in Houston. Both doctors use the OssaTron.

Be sure you fully understand the cost of the procedure. You might even want to get it in writing so there is no misunderstanding. Good Luck!

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

Mike T on 3/04/02 at 15:08 (075642)

Thanks Brian. My orthopedic told me of Rusty Grier's experimental treatments and that he had been traveling to Canada. Do you know if the Ossa Tron treatments are now covered by insurance? Or, do I just need to contact my carrier to see what they say? Any actual experience with this?

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

Mike T on 3/04/02 at 15:12 (075643)

John, thanks for your speedy feedback. You indicate that you have had both surgical and non-surgical treatments. How did yoru problem respond to the surgical option? Are you now pain free after the ESWT treatments? My concern is that the treatments are not covered by insurance. I can not afford to pay the costs of the treatments out of pocket.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

John h on 3/04/02 at 16:18 (075653)

The surgical option neither made me better or made me worse. It was pretty much a minimal invasvive procedure and probably no more than 15-20% of the fascia was released.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/05/02 at 08:31 (075715)

Mike --

Rusty Grier was treated twice with ESWT -- the first time in Canada (85% improvement) and the second time in Dallas (additional 10% improvement). There was an article on this about a year ago in the Fort Worth Star Telegram.

I had two ESWT treatments from Dr. Cook and didn't feel any noticeable improvement, but I think I am the exception, not the rule. My insurance did not cover the procedures, and I think that most insurance carriers still refuse to cover ESWT.

Hope this helps.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

LaurieL on 3/11/02 at 16:11 (076191)

Just had ESWT treatment Jan 10, 02 with Podiatrist Dr.Ashton in Plano, Tx. Have been hurting for 3 years now, treating the last 18 months. The first Treatment hasn't worked yet, may have to have 2nd treatment. Am having to ride on a scooter to be able to continue to work because of severe pain.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

Mikt T on 3/12/02 at 09:29 (076252)

Thanks Laurie for providing your feedback. I am sorry to hear that you are still having the heel pain. So, let me repeat to be sure I have your history straight. You have been having heel pain for 3 years. You have been undergoing treatments of some kind for the last 18 months, having the ESWT treatment in January of this year. Is the pain greater or less than before you had the ESWT? I hear it may take some time to recover from the ESWT treatments, often requiring a second or subsequent treatments. Hang in there. I am relatively new to this arena and have learned a great deal from reading the other comments in this forum.

I am taking the advice of Brian J and pursuing at least evaluation by Dr Cook here in Dallas. My problem, is that I can't afford the out of pocket expense of the treatments, and although BCBS of Texas does not deny that the treatment is not covered, they can not confirm that it is either. Therefore, I am going to discuss evaluating my heel spur condition as being medically necessary, and making an appeal to the BCBS of Texas review board to cover the treatments. Rest assured, I will get any consent in writing prior to any treatments. Did you have to pay for your treatments out of pocket, and if so how much did it run you? Thanks for sharing.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/12/02 at 12:41 (076265)

Mike --

I paid about $4,000 (total, both feet) for ESWT with Dr. Cook. He quoted this amount for one round of treatment, but ended up treating me for a second time at no charge. Needless to say, this was quite generous of him. Of course, I also paid for the anesthesiologist both times and for the use of the surgery center both times.

Only problem was that a few months after the last treatment, I got a bill from Ossatron (the maker of the ESWT machine) for $9,000. When I told them I had not been made aware of this fee, they withdrew their request.

Please don't quote me on any of this, but I hope it helps.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

LaurieL on 3/12/02 at 13:04 (076268)

I am suppose to pay my deductable and 20% because it is out of network - but nothing has come from the insurance yet, after it does I will go the Medical Director about not paying the out of network since the equipment was not available at an in-network facitilty. I spoke with Beatrice Long I believe with Ossatron.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

John h on 3/12/02 at 14:57 (076280)

Brian: I become somewhat ill everytime I see these charges. I lay most of this at the feet of the FDA! This sucks!

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/12/02 at 18:06 (076291)

John H --

It IS truly a shame that Ossatron treatment costs so much, as many people simply can't afford it. I'll be going to Dr. Z and the 'Big O' soon, to see if he can give me relief that the Ossatron did not. I want to give ESWT every chance before proceeding with the Baxter surgery. Also, you know I must be desperate when I can't stop thinking about that capcaisin article ....

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

LaurieL on 3/13/02 at 10:42 (076348)

Is the Baxter surgery the endoscopic partial faciotomy?

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/13/02 at 13:51 (076358)

Baxter surgery is intended to relieve entrapment of the first branch of the lateral plantar nerve. It is an 'open' surgery where an incision is made in the medial aspect of the foot. The surgeon carefully dissects down to where the nerve is and removes nearby tissue that may be pressing against the nerve and causing pain. Check out the 'Baxter's Neuritis' article in the online version of 'Podiatry Today.'

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/14/02 at 10:10 (076419)

No! The Baxter surgery is made with a very small incision. A semi-circular wedge of fascia about 1/2' wide is removed where the fascia attaches to the heel. This wedge is over the baxter nerve and if the pain you have is caused by the fascia pressing on this nerve then the theory is this will fix it. It also provides about a 15% release of the fascia which is not enough to cause foot instability in the future. I think the beauty of this procedure is you are unlikely to be made worse or have a problem with foot instability in the future. Not many surgeons are trained in this procedure. The procedure should take no more than 30 minutes or less and there was not pain and very little swelling involved. You will probably be in a surgical shoe and perhaps crutches for maybe 2 weeks. Stitches out in 10 days. Only a few. The other side of this is some doctors think that not enough of the fascia is released so you have to weigh the pros and cons by talking to doctors who do both procedures. My greatest concern was not that I would be cured but that I could be made worse. I told the doctor as much. We have several large teaching hospitals in our city and their is only one doctor who trained under Dr. Baxter and does the procedure. Many of them I talked with had never heard of it. Some may say they do the Baxter procedure so ask them where and who trained them. I would also make sure my doctor had done a lot of surgery if you go that route. I would also make sure I tried ESWT before I ever considered surgery, Most doctors will rightly put you through all the conservative protocol but I came up on one who wanted to release the entire fascia, several who wanted to operate after my first visit, and one guy who wanted to but an artifical joint in my great toe because he said it had zero cartlidge. Facts were it had plenty of cartlidge. So like everything else in life their are Doctors and their are Doctors. Good luck.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

BrianJ on 3/14/02 at 10:54 (076423)

According to Dr. Baxter, the incision made in the medial aspect of the heel is 4 centimeters long. The surgeon then dissects down to the nerve and removes a small portion of the fascia of the abductor hallicus (not the PF) which may be pressing on the nerve. A small portion of the plantar fascia may also be removed in order to view the operative area clearly. Post-surgery, the average time to resumption of full activity is 3.3 months. This is all from Baxter's article 'Treatment of Chronic Heel Pain by Surgical Release of the First Branch of the Lateral Plantar Nerve' in the June 1992 issue of Clinical Orthopaedics and Related Research.

Re: Chronic Heel Spur Pain - ESWT Treatments in the Dallas Area?

john h on 3/15/02 at 09:38 (076500)

Brian: I was back in my shoes and off crutches in two weeks. Of course I did not do any running or serious activity. The doctor drew me a picture to scale of the piece of fascia he would remove and it was what I would call a half moon. He was a board certified Orthopedic Foot and Ankle Surgeon. One of two in our city. He was in his 40's and as you might expect does a lot of surgery. He told me that in all of his surgery using this procedure only one person was made worse and it was a lady who had diabetes. Complications from the diabetes made it worse. At the same time I had the PF release and Tarsal Tunnel Release I also had a Cheilectomy on the great toe ( all on same foot at same time). The Cheilectomy was by far the worst part of this deal as they remove a wedge of bone and spurs from the 2nd joint of the great toe and scraped the joint clean. This is done through an incision of perhaps 4' long that runs straight down the top of the great toe. That baby did hurt as I had to start bending it the next day as part of the recovery. Even with this I was walking without a limp within two weeks. The incision for the TTS and PF is just one very long incision that runs from just under the bottom of the foot at the insertion point to well above the ankle bone. It must be at least 5' long. Dr. Z has looked at the incisions and said whoever did those did very good work. The only thing the Doctor told me he found while exploring the nerves in the tarsal tunnel procedure was an interior vericose vein that 'might' be pressing on a nerve when it swelled from being on your feet for a long time. The doctor told me that TTS was really a hit and miss type of surgery regardless of the various test results. He did not recommend it one way or the other. He just said if I wanted to go that route we could do it all at the same time and eliminate as a possible cause of my pain. I made the decision to have the TTS about 5 minutes before they rolled me into surgery.