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pain shift after ESWT

Posted by Mike J on 6/05/02 at 19:43 (086443)

I had ESWT by Dr Z almost 2 months ago and overall my foot has not improved much. However the pain has seemed to move from the inside of the heel to the outside. Its actually so far on the outside its almost on the side of the foot/heel. The inside of the heel which is where the treatment was done feels probably 75% better but on some days the outside is as bad as the inside once was.

Last week was an extremly good week for my foot and the pain level was very minimal but it came back this week. I have kept my physical activity (on my feet) to almost nothing ever since the treatment so the changes should not be related to activity as one might think.

I was just wondering if anyone else who has had ESWT has had any of these experiences?

BTW the donier machine was used on my foot.

Thanks,
Mike

Re: pain shift after ESWT

DR Zuckerman on 6/05/02 at 21:23 (086453)

Hi

You may need the outside of the foot treated. This sounds like the lateral band of the plantar fascia. Some times during heel pain you start to walk on the outside of the foot causing pain on the lateral band

If there is a discrete spot a local steriod may resolve this pain. If not then another treatment at that spot

Re: pain shift after ESWT

BrianG on 6/05/02 at 22:55 (086465)

Hi MikeJ,

Just a quick question, does your foot hurt where the Dornier machine touched your foot / ankle? Or was it the other side of your heel? I had insertional pain, on one side, where the Epos touched my ankle. It was off and on, finally going away about a week ago (at 7 weeks). Good luck, hope you get some relief.

BrianG

Re: pain shift after ESWT

Mike J on 6/05/02 at 23:24 (086469)

BrianG,

The pain was on the inside of the heel and thats where the machine touched it. The pain seems to be getting less and less sore in this area which would indicate it may have been successfull. However most the pain now is on the other side of the heel (but even this side has some good days).

I guess I will have to wait another month and see how things go. If I dont get significant improvement from where I am now I will definately get another treatment.

Mike

Re: pain shift after ESWT

dave on 6/06/02 at 07:27 (086482)

Its been ten weeks for me since i had eswt treatment on both heels. For awhile i was doing very good but now i am back to where i was prior to the treatment. I would like to get a second treatment doctor Z. DO you think that i should wait a few more weeks to see what happens or should i set up another appointment? the head of the machine was placed at the insertion point. Im not sure if my tender area was hit or not. It seemed that the large amount of waves would cover a large area.

Re: pain shift after ESWT

DR Zuckerman on 6/06/02 at 07:50 (086483)

Hi

If the pain is at the lateral aspect and you didb't have this pain before I would wait the full twelve weeks plus. If after tweleve weeks no improvement then lets do a second treatment

Re: pain shift after ESWT

dave on 6/06/02 at 08:53 (086488)

Good morning doctor z. Im not sure where the lateral aspect is on my foot.
But i did have the same amount of discomfort before the first procedure.

Re: pain shift after ESWT

john h on 6/06/02 at 09:57 (086504)

When receiving ESWT I would find it very hard to tell the technician that the shockwaves are hitting the right spot. The shockwaves jar the entire foot and mask any one spot that might be more painful. Feedback from me as a patient during the procedure would not seem very helpful. Finding the painful spot prior to the procedure is not that hard on most days. Seems to me it is important for the operator to keep the foot and machine focused to the proper area. What ever helps him do that seems very important since the focal point is very narrow. Dr. Ed, I think, sugested that although the focal point is narrow the waves are spread out and hitting the surrounding area. Is it possible that what we perceive as the painful spot when pressing on the foot may in realty be at some other injured area on the foot? Not necessarily directly under where we are pressing? the source of pain is not always where we feel the pain.

Re: pain shift after ESWT

john h on 6/06/02 at 10:15 (086511)

dave I think I waited about 6 months before my second treatment with Dr. Z. I would wait at least 12 weeks or longer as it is generally accepted that it can take 12 weeks to receive full benefits. I most certainly would go for another treatment. I had four and always seemed to improve a little after each treatment. I am much better than before ESWT which started about 4 years ago. I am still of the opinion that I can benefit from another treatment even though I have come a long way. I do plan on another treatment sometimes this year. I preface this information based ont the information that you received a high energy treatment. The protocol for sonnocur is 3-5 treatments spaced either 1 day or in some places 1 week apart. Dr. Gordon in Canada is currently conducting a study comparing high energy treatments vs low energy treatments (i think this is what his study is all about). We should all be very interested in his findings. Allan and others have suggested that it is the accumulated dosage of ESWT that is important. Over what period of time I have no idea or even if that is correct.

Re: pain shift after ESWT

dave on 6/06/02 at 10:27 (086514)

thanks John, I will do that. I appriciate your input very much! I would just like to have something set up at least in advance so that i can get a reduced rate on airfare. I have been folowing your progress for a long time. Im glad that you are improving.

Re: pain shift after ESWT

CarlW on 6/06/02 at 12:48 (086542)

John ,

I just finished my third treatment with the Sonorex machine (low energy, clinical focusing) and can tell you definitively that the area that I thought was my pain spot from palapation was actually slightly different( about 1/2 an inch away ) than the postition that the machine was able to generate the greatest pain response in. Whether or not this correlates into treating the 'correct' area remains to be seen. Also with the lower energy machine it was definitely noticeable moving from an area that was painfull to an area that was not, even though the actual movement was probably in an area just slightly larger that a quarter.

CarlW

Re: jarring the foot???

BrianG on 6/06/02 at 17:12 (086587)

JohnH, whats this talk about the shockwaves jarring the entire foot? Sounds like you may have been treated with a dinosaur, or a Model T at best. The Dornier is just a series of clicks, no bone jarring at all. You should check out what modern medicine has to offer these days :*) :*)

BrianG

Re: pain shift after ESWT

DR Zuckerman on 6/06/02 at 19:48 (086599)

The lateral aspect is the outside of your foot. The side where the little toe is .

Re: pain shift after ESWT

john h on 6/06/02 at 21:55 (086617)

Carl: that is very interesting. i have wondered how a patient good give feedback with the constant very strong shockwaves. your foot actuall goes sort of numb after about 10 blast with the orby so if they moved the head I would have no idea. with the low energy you are telling me that you can tell when they move the head and feel a difference in pain level from spot to spot. where did you have your treatments?

Re: jarring the foot???

john h on 6/06/02 at 21:59 (086618)

Dr. Z had the Orby on pedal to the metal when he treated me. the clicks you heard were not like a jet breaking sound barrier which i heard. I did not think Judy and Texas Barb would survive and they almost jumped off the table. It was not painful just jarring (is that a new word?)

Re: CarlW

wendyn on 6/07/02 at 07:32 (086633)

How are your feet doing now?

Any improvement?

Re: pain shift after ESWT

CarlW on 6/07/02 at 11:52 (086667)

Hello Wendy & John,

My last treatment( 3 spaced 1 week aprt) was on Wednesday and my foot was definitely tender but not overley sore yesterday. For comparison my two cortizone shots were way more painfull. No real improvement yet, however with each successive treatment they were able to turn the machine up to a higher level to generate the response. They said to give it 4 to six weeks to see if I responded or not. This makes sense to me because if it is promoting tissue healing it will take time. Its almost hard to get your hopes up.

John I had my treatment at the Univeristy of Calgary on a Sonorex machine that has been there for about 2 years for research and commercial purposes. I cant remember where you are but the cost is cheap at $800 Canadian [about $10 US :)] and Calgary is a decent place to visit as WendyN and I can both attest to.

Different spots on my foot definitely illicited specific different pain responses. It was interesting in that they would find a painfull spot and 'ping' away on it for about a minute until it would go numb and then probe for another spot. They did this on about 3 spots, all within a small area on my heal.

This is why I posted awhile back about the focal point on the higher energy machines. It also seemed odd that the spots that caused pains didnt line up exactly linerally where I thought they would looking at the bottom of my foot.

My personal thoughts on the machines are that ultrasound may be of some assistance but the clinical focusing offered by Sonorex definitely ensures that the area that is painful is the area that is treated. The question that follows from this is whether or not the area that is painfull is the area that needs to be treated. It seems like the obvious answer is yes but I am not sure.

I also think about Moez who was unsuccessful with the lower energy machines and eventually got relief from the big blast. Possible a hybred machine that uses low energy clinical focusing to find the spots and then a big blast from machine to finsish them off.

I spend way to much time thinking about feet!!!!

Carl

Re: pain shift after ESWT

Pete R on 6/07/02 at 14:29 (086678)

Carl,

You make some good points and one's I've thought of myself recently. I had ESWT in LOndon recently without ultrasound, and with the Head being aimed at where I said it was most painful to the touch.....but is this where the problem actually is ? I'm researching further before having another treatment. I'll definitely have more ESWT, it just depends who with, and whether with ultrasound. The recent debate here with the Doc's doesn't really clarify for me whether ultrasound is actually needed, but from a layman's view I would have thought it can only help.

Knowledge of PF is the UK is VERY limited.

I too think a lot about my feet but have resolved to give myself the night off since England have just beaten Argentina in the World Cup......SUPERB !

Re: Carl

wendyn on 6/07/02 at 19:35 (086724)

I hope this helps for you Carl. We should do coffee now that the snow has stopped. (Although I believe we were only 1 degree above freezing last nigth)

Re: Carl

CarlW on 6/07/02 at 23:22 (086745)

Wendy

Coffee would be great!

Carl

Re: pain shift after ESWT

john h on 6/08/02 at 08:56 (086761)

If you could discover the secret of not thinking about your feet when they hurt Carl pass it on. Your information is very helpful and informative. Thank you. I think you are the first one that has posted that used the 1 week protocol between treatments. As you may have seen Bayshore studies indicated 1 week between treatments to be the most effective.

Re: Carl

john h on 6/08/02 at 08:58 (086762)

Wendy do you have trendy coffee shops in your area (lattes,etc)? If so i will join you and carl.

Re: John

wendyn on 6/08/02 at 17:58 (086793)

John, OF COURSE we have trendy coffee shops. You can have a soy latte or a chai tea - whatever you like. We even have several Starbucks.

If you join us, I figured that maybe a Molson would more to your liking.

Re: John

john h on 6/08/02 at 19:22 (086798)

It is tough for me to get one by you Wendy. Like the rest of the Ladies on the board you have a memory like an elephant. Yes Moulson still makes its home in my frig. Soy Latte???? Arkansas is I think is the soy bean capital of the world. I keep a container of soy powder handy for my frequent soy shakes. Scott I thinks inhales his through his nose.

Re: John

wendyn on 6/08/02 at 23:13 (086817)

John I do have a memory like an elephant (sometimes).

And it's still MOLSON not MOULSON

Soy Latte's are gross (IMNSHO) but Soy Chai Tea Latte's are THE BEST.

Re: John

john h on 6/09/02 at 10:06 (086835)

You girls are killing me on my spelling. I cannot even spell the name of a beer correctly. I am very good at other things! Soy Chai Tea Latte? I will ask for one of those the next time I go to Barnes and Noble which is across the street from my office. Seems girls all ways win spelling bees. Why is that?

Re: John

wendyn on 6/09/02 at 10:32 (086837)

Trust me on the soy chai john - if you like soy and you like chai, they are a perfect combination!

Re: Carl

CarlW on 6/10/02 at 08:28 (086915)

John,

Sorry I missed this thread on the weekend. My weekend net access is pretty limited and my 4 year demands/deserves most of my attention .

I would be pleased to give you an opportunity to sample our local spirit selections.

Carl

Re: pain shift after ESWT

DR Zuckerman on 6/05/02 at 21:23 (086453)

Hi

You may need the outside of the foot treated. This sounds like the lateral band of the plantar fascia. Some times during heel pain you start to walk on the outside of the foot causing pain on the lateral band

If there is a discrete spot a local steriod may resolve this pain. If not then another treatment at that spot

Re: pain shift after ESWT

BrianG on 6/05/02 at 22:55 (086465)

Hi MikeJ,

Just a quick question, does your foot hurt where the Dornier machine touched your foot / ankle? Or was it the other side of your heel? I had insertional pain, on one side, where the Epos touched my ankle. It was off and on, finally going away about a week ago (at 7 weeks). Good luck, hope you get some relief.

BrianG

Re: pain shift after ESWT

Mike J on 6/05/02 at 23:24 (086469)

BrianG,

The pain was on the inside of the heel and thats where the machine touched it. The pain seems to be getting less and less sore in this area which would indicate it may have been successfull. However most the pain now is on the other side of the heel (but even this side has some good days).

I guess I will have to wait another month and see how things go. If I dont get significant improvement from where I am now I will definately get another treatment.

Mike

Re: pain shift after ESWT

dave on 6/06/02 at 07:27 (086482)

Its been ten weeks for me since i had eswt treatment on both heels. For awhile i was doing very good but now i am back to where i was prior to the treatment. I would like to get a second treatment doctor Z. DO you think that i should wait a few more weeks to see what happens or should i set up another appointment? the head of the machine was placed at the insertion point. Im not sure if my tender area was hit or not. It seemed that the large amount of waves would cover a large area.

Re: pain shift after ESWT

DR Zuckerman on 6/06/02 at 07:50 (086483)

Hi

If the pain is at the lateral aspect and you didb't have this pain before I would wait the full twelve weeks plus. If after tweleve weeks no improvement then lets do a second treatment

Re: pain shift after ESWT

dave on 6/06/02 at 08:53 (086488)

Good morning doctor z. Im not sure where the lateral aspect is on my foot.
But i did have the same amount of discomfort before the first procedure.

Re: pain shift after ESWT

john h on 6/06/02 at 09:57 (086504)

When receiving ESWT I would find it very hard to tell the technician that the shockwaves are hitting the right spot. The shockwaves jar the entire foot and mask any one spot that might be more painful. Feedback from me as a patient during the procedure would not seem very helpful. Finding the painful spot prior to the procedure is not that hard on most days. Seems to me it is important for the operator to keep the foot and machine focused to the proper area. What ever helps him do that seems very important since the focal point is very narrow. Dr. Ed, I think, sugested that although the focal point is narrow the waves are spread out and hitting the surrounding area. Is it possible that what we perceive as the painful spot when pressing on the foot may in realty be at some other injured area on the foot? Not necessarily directly under where we are pressing? the source of pain is not always where we feel the pain.

Re: pain shift after ESWT

john h on 6/06/02 at 10:15 (086511)

dave I think I waited about 6 months before my second treatment with Dr. Z. I would wait at least 12 weeks or longer as it is generally accepted that it can take 12 weeks to receive full benefits. I most certainly would go for another treatment. I had four and always seemed to improve a little after each treatment. I am much better than before ESWT which started about 4 years ago. I am still of the opinion that I can benefit from another treatment even though I have come a long way. I do plan on another treatment sometimes this year. I preface this information based ont the information that you received a high energy treatment. The protocol for sonnocur is 3-5 treatments spaced either 1 day or in some places 1 week apart. Dr. Gordon in Canada is currently conducting a study comparing high energy treatments vs low energy treatments (i think this is what his study is all about). We should all be very interested in his findings. Allan and others have suggested that it is the accumulated dosage of ESWT that is important. Over what period of time I have no idea or even if that is correct.

Re: pain shift after ESWT

dave on 6/06/02 at 10:27 (086514)

thanks John, I will do that. I appriciate your input very much! I would just like to have something set up at least in advance so that i can get a reduced rate on airfare. I have been folowing your progress for a long time. Im glad that you are improving.

Re: pain shift after ESWT

CarlW on 6/06/02 at 12:48 (086542)

John ,

I just finished my third treatment with the Sonorex machine (low energy, clinical focusing) and can tell you definitively that the area that I thought was my pain spot from palapation was actually slightly different( about 1/2 an inch away ) than the postition that the machine was able to generate the greatest pain response in. Whether or not this correlates into treating the 'correct' area remains to be seen. Also with the lower energy machine it was definitely noticeable moving from an area that was painfull to an area that was not, even though the actual movement was probably in an area just slightly larger that a quarter.

CarlW

Re: jarring the foot???

BrianG on 6/06/02 at 17:12 (086587)

JohnH, whats this talk about the shockwaves jarring the entire foot? Sounds like you may have been treated with a dinosaur, or a Model T at best. The Dornier is just a series of clicks, no bone jarring at all. You should check out what modern medicine has to offer these days :*) :*)

BrianG

Re: pain shift after ESWT

DR Zuckerman on 6/06/02 at 19:48 (086599)

The lateral aspect is the outside of your foot. The side where the little toe is .

Re: pain shift after ESWT

john h on 6/06/02 at 21:55 (086617)

Carl: that is very interesting. i have wondered how a patient good give feedback with the constant very strong shockwaves. your foot actuall goes sort of numb after about 10 blast with the orby so if they moved the head I would have no idea. with the low energy you are telling me that you can tell when they move the head and feel a difference in pain level from spot to spot. where did you have your treatments?

Re: jarring the foot???

john h on 6/06/02 at 21:59 (086618)

Dr. Z had the Orby on pedal to the metal when he treated me. the clicks you heard were not like a jet breaking sound barrier which i heard. I did not think Judy and Texas Barb would survive and they almost jumped off the table. It was not painful just jarring (is that a new word?)

Re: CarlW

wendyn on 6/07/02 at 07:32 (086633)

How are your feet doing now?

Any improvement?

Re: pain shift after ESWT

CarlW on 6/07/02 at 11:52 (086667)

Hello Wendy & John,

My last treatment( 3 spaced 1 week aprt) was on Wednesday and my foot was definitely tender but not overley sore yesterday. For comparison my two cortizone shots were way more painfull. No real improvement yet, however with each successive treatment they were able to turn the machine up to a higher level to generate the response. They said to give it 4 to six weeks to see if I responded or not. This makes sense to me because if it is promoting tissue healing it will take time. Its almost hard to get your hopes up.

John I had my treatment at the Univeristy of Calgary on a Sonorex machine that has been there for about 2 years for research and commercial purposes. I cant remember where you are but the cost is cheap at $800 Canadian [about $10 US :)] and Calgary is a decent place to visit as WendyN and I can both attest to.

Different spots on my foot definitely illicited specific different pain responses. It was interesting in that they would find a painfull spot and 'ping' away on it for about a minute until it would go numb and then probe for another spot. They did this on about 3 spots, all within a small area on my heal.

This is why I posted awhile back about the focal point on the higher energy machines. It also seemed odd that the spots that caused pains didnt line up exactly linerally where I thought they would looking at the bottom of my foot.

My personal thoughts on the machines are that ultrasound may be of some assistance but the clinical focusing offered by Sonorex definitely ensures that the area that is painful is the area that is treated. The question that follows from this is whether or not the area that is painfull is the area that needs to be treated. It seems like the obvious answer is yes but I am not sure.

I also think about Moez who was unsuccessful with the lower energy machines and eventually got relief from the big blast. Possible a hybred machine that uses low energy clinical focusing to find the spots and then a big blast from machine to finsish them off.

I spend way to much time thinking about feet!!!!

Carl

Re: pain shift after ESWT

Pete R on 6/07/02 at 14:29 (086678)

Carl,

You make some good points and one's I've thought of myself recently. I had ESWT in LOndon recently without ultrasound, and with the Head being aimed at where I said it was most painful to the touch.....but is this where the problem actually is ? I'm researching further before having another treatment. I'll definitely have more ESWT, it just depends who with, and whether with ultrasound. The recent debate here with the Doc's doesn't really clarify for me whether ultrasound is actually needed, but from a layman's view I would have thought it can only help.

Knowledge of PF is the UK is VERY limited.

I too think a lot about my feet but have resolved to give myself the night off since England have just beaten Argentina in the World Cup......SUPERB !

Re: Carl

wendyn on 6/07/02 at 19:35 (086724)

I hope this helps for you Carl. We should do coffee now that the snow has stopped. (Although I believe we were only 1 degree above freezing last nigth)

Re: Carl

CarlW on 6/07/02 at 23:22 (086745)

Wendy

Coffee would be great!

Carl

Re: pain shift after ESWT

john h on 6/08/02 at 08:56 (086761)

If you could discover the secret of not thinking about your feet when they hurt Carl pass it on. Your information is very helpful and informative. Thank you. I think you are the first one that has posted that used the 1 week protocol between treatments. As you may have seen Bayshore studies indicated 1 week between treatments to be the most effective.

Re: Carl

john h on 6/08/02 at 08:58 (086762)

Wendy do you have trendy coffee shops in your area (lattes,etc)? If so i will join you and carl.

Re: John

wendyn on 6/08/02 at 17:58 (086793)

John, OF COURSE we have trendy coffee shops. You can have a soy latte or a chai tea - whatever you like. We even have several Starbucks.

If you join us, I figured that maybe a Molson would more to your liking.

Re: John

john h on 6/08/02 at 19:22 (086798)

It is tough for me to get one by you Wendy. Like the rest of the Ladies on the board you have a memory like an elephant. Yes Moulson still makes its home in my frig. Soy Latte???? Arkansas is I think is the soy bean capital of the world. I keep a container of soy powder handy for my frequent soy shakes. Scott I thinks inhales his through his nose.

Re: John

wendyn on 6/08/02 at 23:13 (086817)

John I do have a memory like an elephant (sometimes).

And it's still MOLSON not MOULSON

Soy Latte's are gross (IMNSHO) but Soy Chai Tea Latte's are THE BEST.

Re: John

john h on 6/09/02 at 10:06 (086835)

You girls are killing me on my spelling. I cannot even spell the name of a beer correctly. I am very good at other things! Soy Chai Tea Latte? I will ask for one of those the next time I go to Barnes and Noble which is across the street from my office. Seems girls all ways win spelling bees. Why is that?

Re: John

wendyn on 6/09/02 at 10:32 (086837)

Trust me on the soy chai john - if you like soy and you like chai, they are a perfect combination!

Re: Carl

CarlW on 6/10/02 at 08:28 (086915)

John,

Sorry I missed this thread on the weekend. My weekend net access is pretty limited and my 4 year demands/deserves most of my attention .

I would be pleased to give you an opportunity to sample our local spirit selections.

Carl