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Is anyone else confused ?

Posted by Pete R on 9/20/02 at 06:57 (095801)

I've had ESWT once with no success, although machines in England are less powerful and the practitioners less experiened in giving the treatment, and am now totally confused by the recent JAMA studies.

We have different doctors interpretations of the actual study results, let alone whether ESWT low or high dose is best.

Re: Is anyone else confused ?

Pauline on 9/20/02 at 09:42 (095830)

Peter,
One of the articles I read by Dr. Rompe in a recent study published in 2002 suggests that multiple small dose treatments do not appear as effective as one more powerful dose.

I believe similar studies are currently being run in Canada using the Dornier. Canada as I understand has been using Dornier equipment to give 3 lower dose treatments and is now testing it against the U.S. FDA protocol of one more powerful one.

Personally, I don't know if any of this testing will provide us with the many questions that people would like to see answered.

Right now it appears you pay your money and take your chance, but you must admit it's a conservative option to consider before having any surgery. Surgery in itself doesn't hold great promise either and you have far more complication rates when you start cutting the main support to the foot.

One approach that seems to be forgotten is prevention. No discussion or studies discussing prevention have shown up, but I think perhaps an area worth investigation. It would be far better if we could prevent P.F. before we had to get into treating it.

I personally think you should and can consider your treatment a success if you consider by having it you have still avoided surgery. Perhaps Dr. Rompe's study on higher treatment levels is the correct one to be using, but I guess the medical community is still divided on this entire issue.

If I had to advise you on one thing I would tell you before you try any surgery you try a more powerful ESWT treatment if it is available where you live. I'd try every conservative treatment possible before having my foot cut.

In Dr. Rompe's paper he did discuss the placebo effect and in some cases the spontaneous disappearance of P.F. which he said added to the difficulty of interpreting final study results.

In the end, I think people try what ever they feel most comfortable with as a treatment choice. Some get good results, some get bad and others remain the same. All of them live to see another day and try to figure out what to do next.

The most unfortunate part of having P.F. I think is that it is so debilitating without showing any outward signs and it hangs on so long. People who don't have it would understand the suffering more if bones were sticking through the skin, but when they see nothing they can't grasp the amount of pain that exists and the life style changes that have to be made. This is the part of P.F. I wish we could change. Educating employees, family and friends about it's pain level, it's course of treatment, the need to be off ones feet, and it's not all up in our heads.

Wishing you the very best in finding help for your P.F.

Re: surgery in itself doesn't hold great promise?

elliott on 9/20/02 at 11:38 (095837)

I thought chances for its success are about 90%, or about the same as for ESWT. :-)

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Re: Is anyone else confused ?

Ed Davis, DPM on 9/24/02 at 00:08 (096072)

Pete:

I would not let one flawed study lead you astray. There have been too many favorable studies and too many success stories to allow discouragement with this modality.

You may need more than one application of ESWT and remember, it works best when combined with the whole 'program' of treatment for PF....especially true with recalcitrant cases.
Ed

Re: Is anyone else confused ?

john h on 9/24/02 at 09:55 (096094)

Dr. Ed: Studies come and studies go and often they completely contradict each other after years of studies. I still think ESWT should be tried by those who conservative thearapies have failed. I have just read to many success stories about ESWT and know from my own experience that it helped and that is looking back over 3 years so the placebo effect would surely have diminished by now.

Re: surgery in itself doesn't hold great promise?

Nancy N on 9/27/02 at 05:04 (096299)

Elliott--

When I was at the point where I'd exhausted conservative treatments about a year and a half ago (just before ESWT was well known by most docs), I was told that surgery's success rate was only in the 75% neighborhood. That, plus the high possibility of complication, is enough for me to agree that surgery doesn't hold great promise--and certainly not enough for me to want to try it before trying ESWT.

Re: Is anyone else confused ?

Pauline on 9/20/02 at 09:42 (095830)

Peter,
One of the articles I read by Dr. Rompe in a recent study published in 2002 suggests that multiple small dose treatments do not appear as effective as one more powerful dose.

I believe similar studies are currently being run in Canada using the Dornier. Canada as I understand has been using Dornier equipment to give 3 lower dose treatments and is now testing it against the U.S. FDA protocol of one more powerful one.

Personally, I don't know if any of this testing will provide us with the many questions that people would like to see answered.

Right now it appears you pay your money and take your chance, but you must admit it's a conservative option to consider before having any surgery. Surgery in itself doesn't hold great promise either and you have far more complication rates when you start cutting the main support to the foot.

One approach that seems to be forgotten is prevention. No discussion or studies discussing prevention have shown up, but I think perhaps an area worth investigation. It would be far better if we could prevent P.F. before we had to get into treating it.

I personally think you should and can consider your treatment a success if you consider by having it you have still avoided surgery. Perhaps Dr. Rompe's study on higher treatment levels is the correct one to be using, but I guess the medical community is still divided on this entire issue.

If I had to advise you on one thing I would tell you before you try any surgery you try a more powerful ESWT treatment if it is available where you live. I'd try every conservative treatment possible before having my foot cut.

In Dr. Rompe's paper he did discuss the placebo effect and in some cases the spontaneous disappearance of P.F. which he said added to the difficulty of interpreting final study results.

In the end, I think people try what ever they feel most comfortable with as a treatment choice. Some get good results, some get bad and others remain the same. All of them live to see another day and try to figure out what to do next.

The most unfortunate part of having P.F. I think is that it is so debilitating without showing any outward signs and it hangs on so long. People who don't have it would understand the suffering more if bones were sticking through the skin, but when they see nothing they can't grasp the amount of pain that exists and the life style changes that have to be made. This is the part of P.F. I wish we could change. Educating employees, family and friends about it's pain level, it's course of treatment, the need to be off ones feet, and it's not all up in our heads.

Wishing you the very best in finding help for your P.F.

Re: surgery in itself doesn't hold great promise?

elliott on 9/20/02 at 11:38 (095837)

I thought chances for its success are about 90%, or about the same as for ESWT. :-)

[[[[[[[[

Re: Is anyone else confused ?

Ed Davis, DPM on 9/24/02 at 00:08 (096072)

Pete:

I would not let one flawed study lead you astray. There have been too many favorable studies and too many success stories to allow discouragement with this modality.

You may need more than one application of ESWT and remember, it works best when combined with the whole 'program' of treatment for PF....especially true with recalcitrant cases.
Ed

Re: Is anyone else confused ?

john h on 9/24/02 at 09:55 (096094)

Dr. Ed: Studies come and studies go and often they completely contradict each other after years of studies. I still think ESWT should be tried by those who conservative thearapies have failed. I have just read to many success stories about ESWT and know from my own experience that it helped and that is looking back over 3 years so the placebo effect would surely have diminished by now.

Re: surgery in itself doesn't hold great promise?

Nancy N on 9/27/02 at 05:04 (096299)

Elliott--

When I was at the point where I'd exhausted conservative treatments about a year and a half ago (just before ESWT was well known by most docs), I was told that surgery's success rate was only in the 75% neighborhood. That, plus the high possibility of complication, is enough for me to agree that surgery doesn't hold great promise--and certainly not enough for me to want to try it before trying ESWT.