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Is ESWT right for me?

Posted by Susan H on 8/21/02 at 14:57 (093106)

I have been suffering with PF for the past three years. To date, I have had 3 surgeries (one full fascia release on the left foot, one partial and one full fascia release on the right, and heal spurs removed from both feet), physical therapy, massage, etc, yet still to this day I can barely stand, much less walk without being in excruciating pain. Currently I am in pain management. They are looking into putting in some electronic spinal nerve block in my back to help with the pain. I am desperately looking for any other type of treatment that can be done on my feet before going to this extreme for the pain. From reading the boards, it looks like my workers comp may cover the ESWT treatments. I was wondering if someone could explain the benefits, risks, and the procedures for this type of treatment. Also, would this type of treatment be beneficial for my condition?

Re: Is ESWT right for me?

Dr. Zuckerman on 8/21/02 at 20:11 (093150)

Do you have pain when you first get up in the morning. ? Is the pain all the time?

Re: Is ESWT right for me?

Susan H on 8/21/02 at 22:55 (093173)

The pain is constant. It is a bit worse when I get out of bed or if I have been off my feet for a period of time.

Re: Is ESWT right for me?

Susan H on 8/22/02 at 00:10 (093176)

To try and clarify. In the mornings and when I have been off of my feet for a period of time, when I first try and walk it feels that the bones in my ankles and the top of my feet are breaking (this pain is new since my last surgery on both feet in April). This is in addition to the constant pain that I have on the bottoms of both feet. After I have been up and moving for awhile, the bone breaking feeling subsides, but the pain on my heals and the bottom of my feet never goes away. At this point, I dread getting out of bed in the morning, as the pain is so intense. The pain management is working very hard to help with this pain, but I just can't believe that there is nothing else out there that can actually help the injuries to both of my feet.

Re: Is ESWT right for me?

cindy e. on 8/22/02 at 11:26 (093212)

SORRY TO HEAR ABOUT THE PAIN. WHAT KIND OF RELEASE SURGERY DID YOU HAVE DONE? WAS IT ENDOSCOPIC OR MINIMALLY INVASIVE OR AN OPEN HEEL SURGERY? WAS IT A PARTIAL OR FULL RELEASE? I AM SCHEDULED FOR SURGERY TOMORROW AFTER HAVING TRIED EVERYTHING ELSE. MY DOC WILL DO THE ENDOSCOPIC 3/4 RELEASE. HE SAID HE HAS EXTREMELY GOOD RESULTS. I'VE SEEN HIS PROOF IN OTHERS I'VE TALKED TO . I SURE HOPE IT WORKS AS SOME DAYS ARE VERY MISERABLE. GOOD LUCK. MRS. E.

Re: Is ESWT right for me?

Dr. Zuckerman on 8/23/02 at 08:15 (093300)

I won't rule off ESWT for your completely. I would have to examine your feet to determine the condition of the plantar fascia and to evaluate any nerve damage or involvement. The fact that you do have pain in the morning when first getting up is a plus .

Re: Is ESWT right for me?

Dr. David Lee on 8/24/02 at 00:03 (093388)

Dear Susan,

Chronic heel pain is disabling. If you not had any success in traditional therapies this often means that certain areas may not have been addressed. Sometimes when I see patients who have had failed surgeries for plantarfasciitis and still not responding I question the following:

Was the condition properly diagnosed. Is it be truly plantarfasciitis or could it be a calcaneal stress fracture or even a system wide arthritic condition? Could it be nerve related and not skeletal?

Was the post-operative management and follow up appropriate? This could mean things such as correct applications of functional orthotics, muscle/tendon therapies, etc.

I recommend before having any other procedures to seek out a second opinion to rule out other causes of heel pain. You can go to http://www.acfas.org for the guidelines for heel pain treatments and causes.

Best Regards,

Dr. Lee

Re: Is ESWT right for me?

James B on 8/30/02 at 11:57 (093982)

I am scheduled to have ESWT treatment in Los Angeles near the end of September, however I have a question.
For about 4 months I had the classic PF symptoms, severe heel pain when I first got out of bed, that pretty much went away after I walked around for a few minutes. I had anti-inflammatories, orthotics, physical therapy and a cortisone shot and was able to walk and jog daily with no discomfort (except when I got out of bed the next morning). Then, within a day or two, the pain moved from the bottom of my heel, more to my arch. I now have esentially no pain in my heel when I get out of bed. However I now feel pain in my arch on every step walking as I come off of my foot (and stretch my arch). I had a second cortisone shot a month ago that did not help, and I have not jogged since then. It is as if the PF symptoms have moved from my heel to my arch.

Would the ESWT be administered in a different manner (to the arch instead of the heel, or to both the heel and the arch)? Is there any reason to think that it would be less appropriate or effective?

Re: Is ESWT right for me?

JudyS on 8/30/02 at 12:51 (093988)

James, the symptoms, and their changes, you're describing are not unusual.
Many of us started with the classic heel-centered pain only to have had it extend to the arch, or Plantar, itself. I think it's part of the inflammation given that the enter problem is one of plantar tendon inflammation which tends to initially show itself in the classic heel pain.
I'm sure the docs here will correct me if I'm wrong, but, having studied ESWT a bit and having had the treatments, I think the 'usual' machines, like Ossotron, 'aim' the treatment at the plantar insertion point on the heel bone even when the soreness has extended along the Plantar. That insertion point tends to be where the serious inflammation is.
I think, though, that some of the newer treatments utilize a concurrent sonogram (?) to visually locate inflammation along the Plantar even while the ESWT treatment is being administered.
I'm sure someone here is far more knowledgeable about that than I am and will correct me if necessary.

Re: Is ESWT right for me?

john h on 8/30/02 at 18:49 (094015)

James: The Doctors on the board will give you informed medical advice but as a patient I would proceed with ESWT. Your symptoms of first step pain that eventally move to the arch area are a very common post for PF people. I think the majority of the people end up having the area just forward of te heel where the fascia connects to he heel treated with ESWT. It is very important that you be able to identify an area where the pain is coming from as the focal point of the ESWT equipment is very narrow. Lay on your back and probe your foot by pressing hard with your thumb or fingers or have your partner do this for you. This is what the doctor will do. Sometimes it is hard to get enough leverage to apply enouhg pressure to reporduce the pain.

Re: Is ESWT right for me?

john h on 8/30/02 at 18:50 (094016)

No way Jose that I am going to correct you Judy.

Re: Is ESWT right for me?

Dr. Z on 8/30/02 at 19:05 (094019)

It sounds like posterior tibial tendonitis. If there is no morning pain at the level of the heel and there isn't any pain at the insertion of the plantar fasciitis then ESWT isn't a very choice for tretment with your specific case. Find out what is giong on with your PT tendon.

Re: Is ESWT right for me?

Dr. David Lee on 8/31/02 at 18:24 (094090)

Dear James,

ESWT still may be a proper treatment if the condition is truly proximal plantar fasciitis. ESWT is indicated for proximal plantar fasciitis and not distal (or towards the toes). However, in the future distal plantar fasciitis will be an FDA indication.

Should you move forward with the ESWT? That depends on whether your conservative therapies are now aimed at the arch area instead of the heel condition. Your condition could also have associated posterior tibial tendon dysfunction with pain or a congential tight plantar fascia. These conditions would not be indications for ESWT. This should be determined by your physician.

As I recommend to my patients...If you have any doubts, seek a second opinion from another qualified surgeon before moving forward.

Hope this helps.

Sincerely

David Lee DPM
http://www.leepodiatry.com

Re: Is ESWT right for me?

Dr. Zuckerman on 8/21/02 at 20:11 (093150)

Do you have pain when you first get up in the morning. ? Is the pain all the time?

Re: Is ESWT right for me?

Susan H on 8/21/02 at 22:55 (093173)

The pain is constant. It is a bit worse when I get out of bed or if I have been off my feet for a period of time.

Re: Is ESWT right for me?

Susan H on 8/22/02 at 00:10 (093176)

To try and clarify. In the mornings and when I have been off of my feet for a period of time, when I first try and walk it feels that the bones in my ankles and the top of my feet are breaking (this pain is new since my last surgery on both feet in April). This is in addition to the constant pain that I have on the bottoms of both feet. After I have been up and moving for awhile, the bone breaking feeling subsides, but the pain on my heals and the bottom of my feet never goes away. At this point, I dread getting out of bed in the morning, as the pain is so intense. The pain management is working very hard to help with this pain, but I just can't believe that there is nothing else out there that can actually help the injuries to both of my feet.

Re: Is ESWT right for me?

cindy e. on 8/22/02 at 11:26 (093212)

SORRY TO HEAR ABOUT THE PAIN. WHAT KIND OF RELEASE SURGERY DID YOU HAVE DONE? WAS IT ENDOSCOPIC OR MINIMALLY INVASIVE OR AN OPEN HEEL SURGERY? WAS IT A PARTIAL OR FULL RELEASE? I AM SCHEDULED FOR SURGERY TOMORROW AFTER HAVING TRIED EVERYTHING ELSE. MY DOC WILL DO THE ENDOSCOPIC 3/4 RELEASE. HE SAID HE HAS EXTREMELY GOOD RESULTS. I'VE SEEN HIS PROOF IN OTHERS I'VE TALKED TO . I SURE HOPE IT WORKS AS SOME DAYS ARE VERY MISERABLE. GOOD LUCK. MRS. E.

Re: Is ESWT right for me?

Dr. Zuckerman on 8/23/02 at 08:15 (093300)

I won't rule off ESWT for your completely. I would have to examine your feet to determine the condition of the plantar fascia and to evaluate any nerve damage or involvement. The fact that you do have pain in the morning when first getting up is a plus .

Re: Is ESWT right for me?

Dr. David Lee on 8/24/02 at 00:03 (093388)

Dear Susan,

Chronic heel pain is disabling. If you not had any success in traditional therapies this often means that certain areas may not have been addressed. Sometimes when I see patients who have had failed surgeries for plantarfasciitis and still not responding I question the following:

Was the condition properly diagnosed. Is it be truly plantarfasciitis or could it be a calcaneal stress fracture or even a system wide arthritic condition? Could it be nerve related and not skeletal?

Was the post-operative management and follow up appropriate? This could mean things such as correct applications of functional orthotics, muscle/tendon therapies, etc.

I recommend before having any other procedures to seek out a second opinion to rule out other causes of heel pain. You can go to http://www.acfas.org for the guidelines for heel pain treatments and causes.

Best Regards,

Dr. Lee

Re: Is ESWT right for me?

James B on 8/30/02 at 11:57 (093982)

I am scheduled to have ESWT treatment in Los Angeles near the end of September, however I have a question.
For about 4 months I had the classic PF symptoms, severe heel pain when I first got out of bed, that pretty much went away after I walked around for a few minutes. I had anti-inflammatories, orthotics, physical therapy and a cortisone shot and was able to walk and jog daily with no discomfort (except when I got out of bed the next morning). Then, within a day or two, the pain moved from the bottom of my heel, more to my arch. I now have esentially no pain in my heel when I get out of bed. However I now feel pain in my arch on every step walking as I come off of my foot (and stretch my arch). I had a second cortisone shot a month ago that did not help, and I have not jogged since then. It is as if the PF symptoms have moved from my heel to my arch.

Would the ESWT be administered in a different manner (to the arch instead of the heel, or to both the heel and the arch)? Is there any reason to think that it would be less appropriate or effective?

Re: Is ESWT right for me?

JudyS on 8/30/02 at 12:51 (093988)

James, the symptoms, and their changes, you're describing are not unusual.
Many of us started with the classic heel-centered pain only to have had it extend to the arch, or Plantar, itself. I think it's part of the inflammation given that the enter problem is one of plantar tendon inflammation which tends to initially show itself in the classic heel pain.
I'm sure the docs here will correct me if I'm wrong, but, having studied ESWT a bit and having had the treatments, I think the 'usual' machines, like Ossotron, 'aim' the treatment at the plantar insertion point on the heel bone even when the soreness has extended along the Plantar. That insertion point tends to be where the serious inflammation is.
I think, though, that some of the newer treatments utilize a concurrent sonogram (?) to visually locate inflammation along the Plantar even while the ESWT treatment is being administered.
I'm sure someone here is far more knowledgeable about that than I am and will correct me if necessary.

Re: Is ESWT right for me?

john h on 8/30/02 at 18:49 (094015)

James: The Doctors on the board will give you informed medical advice but as a patient I would proceed with ESWT. Your symptoms of first step pain that eventally move to the arch area are a very common post for PF people. I think the majority of the people end up having the area just forward of te heel where the fascia connects to he heel treated with ESWT. It is very important that you be able to identify an area where the pain is coming from as the focal point of the ESWT equipment is very narrow. Lay on your back and probe your foot by pressing hard with your thumb or fingers or have your partner do this for you. This is what the doctor will do. Sometimes it is hard to get enough leverage to apply enouhg pressure to reporduce the pain.

Re: Is ESWT right for me?

john h on 8/30/02 at 18:50 (094016)

No way Jose that I am going to correct you Judy.

Re: Is ESWT right for me?

Dr. Z on 8/30/02 at 19:05 (094019)

It sounds like posterior tibial tendonitis. If there is no morning pain at the level of the heel and there isn't any pain at the insertion of the plantar fasciitis then ESWT isn't a very choice for tretment with your specific case. Find out what is giong on with your PT tendon.

Re: Is ESWT right for me?

Dr. David Lee on 8/31/02 at 18:24 (094090)

Dear James,

ESWT still may be a proper treatment if the condition is truly proximal plantar fasciitis. ESWT is indicated for proximal plantar fasciitis and not distal (or towards the toes). However, in the future distal plantar fasciitis will be an FDA indication.

Should you move forward with the ESWT? That depends on whether your conservative therapies are now aimed at the arch area instead of the heel condition. Your condition could also have associated posterior tibial tendon dysfunction with pain or a congential tight plantar fascia. These conditions would not be indications for ESWT. This should be determined by your physician.

As I recommend to my patients...If you have any doubts, seek a second opinion from another qualified surgeon before moving forward.

Hope this helps.

Sincerely

David Lee DPM
http://www.leepodiatry.com