Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

an ESWT study on runners!!

Posted by elliott on 12/06/02 at 10:15 (101961)

Several here have expressed curiosity in what such a study will show. Below is an abstract from that same German site I dug the other study from. Of note is that, among other selection criteria, it had a one-year minimum. The study still showed decent results at the 12-month mark, albeit lower than that for the Dornier FDA study. Of disapointment is that it doesn't say whether they were allowed to run during their recovery, and if so, how much they did.

-----

Shockwave Application for Chronic Plantar Fasciitis in Running Athletes a Prospective, Randomised, Placebo-Controlled, Double-Blinded Trial

Authors: Jan D. Rompe, Jens Decking, Carsten Schöllner, Bernhard Nafe

Institution: Department of Orthopaedic Surgery, Johannes Gutenberg University School of Medicine, Mainz, Germany

AIM:

To assess the efficacy of repeated low-energy shock wave application for chronic fasciitis in runners.

MATERIALS AND METHODS:

Forty-five running athletes with intractable plantar heel pain were enrolled in a randomized single-blind trial with a parallel-group design and blinded independent observer, to evaluate the efficacy of three applications of 2100 impulses of low-energy shock waves (Group I) compared with placebo treatment (Group II). Followup examinations were done at six months, and at one year after extracorporeal shock wave application. Symptoms had been present from one year to six years. Each patient satisfied numerous inclusion and exclusion criteria before he or she was accepted into this study. The primary efficacy endpoint was reduction of subjects´s self-assessment of pain on first walking in the morning on a visual analog scale (range, 0 - 10 points) at six months after shock wave application.

RESULTS:

After six months self-assessment of pain on first walking in the morning showed a significant reduction from an average seven to 2.1 points in Group I, and from an average seven to 4.7 points in Group II on the visual analog scale. The difference of 2.6 points between both groups was significant six months after the intervention (p= 0.0004, 95% CI: 1.9 - 3.3 points; power > 0.9). Twelve of nineteen patients (63%) of the treatment group versus six of twenty patients (30%) of the sham group reported a >50% improvement. After twelve months 81% of the patients of the treatment group versus 37% of the patients of the placebo group rated accordingly. Co-interventions remained on a comparable, low level in both groups.

CONCLUSION:

The current study showed that three treatments with 2100 impulses of low-energy shock waves were a safe and effective nonsurgical method for treating chronic plantar fasciitis in runners.

[]

Re: an ESWT study on runners!!

Carole C in NOLA on 12/06/02 at 10:40 (101969)

I agree that they should have specified whether or not the runners continued running during recovery. Maybe they matched runners in the ESWT group with runners in the control group for various factors, including how much they ran during recovery, but if so that should have been made clear.

What I find terrifically annoying is that they only chose to include 45 runners. I was under the impression that there are a lot of people with PF who are treated with ESWT, and if so I wish they had included perhaps 500 runners or so and matched them for age, weight, amount they ran, and so on.

Still, it appears to be a further indication that ESWT treatment is probably unlikely to be detrimental.

Carole C

Re: an ESWT study on runners!!

Ed Davis, DPM on 12/06/02 at 10:57 (101974)

Elliott:
I agree that it woud be interesting to know if they were allowed to run after treatment, although it may not have made a significant difference in the outcomes.
Do you have a reference for this paper as I would like to obtain a copy.
Ed

Re: an ESWT study on runners!!

elliott on 12/06/02 at 10:58 (101975)

Carole, maybe they did specify whether they ran, just not in the abstract. Knowing runners, I would suspect they did, unless asked specifically not to and told they'd be spied on for violations. :-)

Big studies on the order of 500 are usually prohibitively too expensive, so you just take what you can get. Even the Dornier study had only 150 (and one noteworthy observation is that most in that study were women, by a ratio of 4:1). Under normal circumstances, when all that is sought is a Yes or No oucome (success or not), 30 treatment and 30 control would be enough for things like convergence to a normal distribution, but not when close 90% might be getting better anyway. As you say, that makes 500 a lot more attractive.

[]

Re: an ESWT study on runners!!

elliott on 12/06/02 at 11:36 (101979)

Shucks! Dr. Ed, I had plans to milk the German site study by painful study for all the stony silence it was worth, but since you're asking now, here is a link to the site:

http://www.ismst.com/events/2002_winterthur_abstracts%20-%202.htm#ESWT%20after%20Arthrodesis%20of%20the%20Lower%20Ankle%20Joint%20-%20Necessity%20of%20Preliminary%20CT-Scan

I dug up two of the authors' email addresses from Pubmed:

(email removed)

schoelln@mail.uni-mainz.de

Shprecken ze Doitch? :-)

That German site has lots of other fascinating ESWT abstracts of varying quality worth reading: several studies showed success for lateral epicondolitis (including the FDA study, which showed the crossovers to have greater satisfaction than the original group!) as well as one showing absolutely none at all over random; success for nonunions and stress fractures; whether one's plantar fascia dimensions are altered upon successful ESWT treatment (answer: Yes); ESWT performed on bilateral chronic PF patients; results on low-energy ESWT for PF with and without local anesthesia (without was much better!); does MRI show changes after ESWT? (answer: No, even for successful treatment); does gait analysis change after ESWT? (answer: No, even for successful treatment).

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/06/02 at 14:55 (102000)

Elliott:
Thank you for the references. I'll get as much mileage out of it as I can.

I would not expect gait analysis to pick up any significant changes since ESWT does not effect any significant biomechanical issues. I would be curious to see before and after ultrasound measurements (could be done by MRI but ultrasound is much less expensive) to see if the plantar fascia is thinned after ESWT. My preliminary impression is that the answer is 'yes' but would wait approx. 6 months to take the post-ESWT measurement. I had mentioned this to Dr. Z a while back. I don't know if he has obtained a diagnostic ultrasound machine since he is using Dornier. If he comes on this discussion I will try to convince him to obtain one. The diagnostic ultrasound machines have gone digital in the last year or two with significantly improved image quality and plunging price tags--- if this trend continues, I think almost all docs who are treating musculoskeletal conditions should own one.
Ed

Re: an ESWT study on runners!! Dr. Z

Dr. Z on 12/06/02 at 17:33 (102014)

I have found decrease thickness and swelling with sequental ultrasound evaluations usually at the six to eigh week post eswt time frame

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/06/02 at 18:53 (102016)

Dr. Z:

Have you made any observations several months after ESWT?

Ed

Re: an ESWT study on runners!! Dr. Z

Dr. Z on 12/06/02 at 19:07 (102022)

YES. I don't have any one year evaluations. My gut feeling is that the tissue does change and reduce in size as the pain reduces and healing take places.Patients really love to see the changes. I hope that I can start to make consistent healing time phase with ulrasound testing

Re: Question re biomechanical issues

Julie on 12/07/02 at 02:52 (102044)

Ed, you remind us that ESWT does not effect significant biomechanical issues.

Suppose you have a patient with PF that was caused mainly by a biomechanical fault. And say that person is significantly helped by ESWT and thinks 'I am cured'. Isn't it likely that although the tissues have healed and the pain is gone or greatly diminished, the biomechanical fault that caused the original PF will likely cause a recurrence?

Would you (and Dr Z) therefore counsel the patient to continue to address his biomechanics with orthotics on a long term basis?

It would be interesting - in the future, I know it's too soon - to track relapses due to overconfidence, or to lack of understanding of why one developed PF and why ESWT helped.

Re: an ESWT study on runners!!

john h on 12/07/02 at 10:06 (102066)

Article in USA Today this week about problems within the FDA and testing. It indicated that statistaticians rather than Doctors were running the place and as a result many possible drugs/treatments were not reaching the market or taking way to many years to reach the market. Apparently Doctors are not being allowed to apply logic and other factors in the testing process. The FDA should never be taken as the final answer or solution it is the best we have to offer at the moment. Like any bureaucracy it tends to perpetuate itself and change comes very slowly if at all. We need some original thinking there as well ast stats.

Re: an ESWT study on runners!! Dr. Z

john h on 12/07/02 at 10:22 (102069)

Dr. Ed: speaking of gait analysis I have spent a lot of time walking behind people at our helth club observing how people walk. I have observed people walking with horrible foot strikes and in a manner that you would think they have to have damaged feet. Since I see them regularly I know they have no foot problems which begs the question is the way we walk really that important in the develpment of PF. If we have been walking in some strange manner for 50 years and you suddenly develop PF it does not make sense that now you develop PF from foot mechanics. I think for runners and I am confident in my case that I started a lot of uphill and downhill ruunning which led to achilles tendonitits and then later to PF. Of course continuuing to run when PF was not very bad surely made me the chronic case I am today.

Re: Question re biomechanical issues

Dr. Z on 12/07/02 at 10:35 (102072)

Hi

Very good point. I feel it is important to council the pateint on all asapects of what caused the problem in the first place. Cross training , better running surfaces if they are a runner, Better shoes, correct biomechanical problems if needed. Stretching, weight control if needed. I usually will ask the pateint in the beginning what do you think caused the problem and either re-enforce or explain why I don't think that the patients reason is the correct reason or only part of the reason

Re: Question re biomechanical issues

Julie on 12/07/02 at 12:16 (102083)

Thanks, Dr Z. That sounds good practice. I wonder how many of your patients follow your advice once they're better?

What concerns me about any 'cure', whether effected by ESWT, orthotics, or whatever, is that most people are likely to get overconfident once they feel better, and stop doing the conservative things they were doing that made them better.

I've been 'cured' now (in quotes because I don't mistrust the concept of 'cure') for well over a year and a half. But you'll never see me with my feet in anything but my orthotics, or my Birks (maybe I'll even get to dance with John some day :)

I believe, having followed the discussions about ESWT for the past two years, that it is the treatment of choice once the usual modalities have failed (though I suspect they mightn't fail quite so often if appropriately and correctly prescribed and followed). But there would seem to be dangers in regarding it as a 'magic bullet', because if it deals mainly with inflammation and tissue quality, the third leg of the triangle, flawed biomechanics, is still lurking.

Re: Question re biomechanical issues

Julie on 12/07/02 at 12:23 (102088)

That should have been 'I mistrust the concept of cure'. I rewrote the sentence and forgot to take the 'don't' (which preceded 'like') out.

I miss the editing facility! ScottR?

Re: Question re biomechanical issues

Ed Davis, DPM on 12/07/02 at 12:36 (102090)

Julie:
I would definitely counsel the patient on biomechanical issues. Keep in mind that since ESWT is used for 'intractable' PF, my patients (and hopefully the patients of others) who are getting ESWT already have had any abnormal biomechanics treated. Eventually, as use of the modality becomes more routine, we are likely too see over or misuse. ESWT is a relatively painless and passive modality so it takes little convincing, outside of financial issues, to have patients accept treatment.
Ed

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/07/02 at 12:44 (102094)

John:

Gait is one thing that is so often ignored. It is interesting to see that once patients are educated at what to look for, they start paying a lot of attention to this area.

The effects of abnormal gait or abnormal biomechanics are additive and cumulative. Our bodies can be very resilient and tolerate abnormal stresses and strains for years before pain develops. Patients often attribute the onset of PF to a minor event -- that event did not cause the PF but was the 'straw that broke the camel's back.' The whole field of what we now term 'cumulative trauma disorders' is still in its infancy.
Cumulative trauma disorders with relatively short time periods between the activity causing a problem and onset of symptoms (eg. carpal tunnel syndrome) can be easier to define. Studies are difficult to structure since CTD's occur over potentially very long period of time. Much information comes from retrospective analysis, looking at incidences of pathology in certain industries.
Ed

Re: an ESWT study on runners!!

Ed Davis, DPM on 12/07/02 at 12:46 (102095)

John:

Absolutely right! Please don't let Bill read this.
Ed

Re: an ESWT study on runners!! Dr. Z

Julie on 12/07/02 at 14:49 (102109)

But John, it DOES make sense that foot mechanics have caused PF. These things take time. You may see lots of people walking horribly, and if they don't have PF, or a tendinitis, it means only that they don't have it YET.

Re: an ESWT study on runners!! Dr. Z

john h on 12/07/02 at 16:38 (102119)

Julie- dpes ot tale 60 years plus of bad bio mechanics before PF sets in? I like to think it was to much running over time and the sudden change to running like a billy goat in the hills.

Re: an ESWT study on runners!!

elliott on 12/07/02 at 18:34 (102136)

Dr. Ed, if you manage to obtain the entire ESWT study on runners, I'd be very grateful if you could forward me a copy. I'm still a runner in my mind, if not my feet. Thanks.

Re: an ESWT study on runners!! Dr. Z

Julie on 12/08/02 at 02:14 (102191)

John, I don't know how long it takes (how long is a piece of string?). As we know, each individual case is made up of a mixture of individual components/causative factors. Mine was brought on by a lifetime of overpronation on flattish feet, plus advancing age, until a lower back strain caused a protruding disc that impinged on the sciatic nerve and finally triggered PF. With a different mixture of factors (e.g. no pronation + back injury, e.g. pronation - back strain) PF might not have happened.

So yes, if your biomechanics are faulty (are they?) I suppose it could have taken you 60 years of running on pronating feet, and then your billy-goat up-and-down caper was the last straw. (The repetitive impact of running, though, must be a PF factor even in people whose biomechanics are perfect, and perhaps that was so in your case. But we can't generalise on the basis of our own experience.)

The classic protest of the person who 'suddenly' suffers a prolapsed disc is: 'All I did was bend over to get the roast out of the oven and I couldn't straighten up!' But that bend was simply the last straw, after a lifetime of whatever postural misalignment/misuse that really caused the problem. I think the same holds true in many cases of PF, certainly those in which poor biomechanics are a causative factor.

Anyway, I wasn't talking about you in my previous post, but about the people you've (and we've all) observed walking badly but who don't have PF. That may only mean they don't have it (or some other problem) YET. In other words, that 'last straw' has yet to happen for them.

But for their sake, let's hope it doesn't.

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/09/02 at 18:34 (102433)

Julie:
Good examples. How many times I have heard people say that all they did was bend dwon to pick up a piece of paper when they ruptured their disc!
Ed

Re: an ESWT study on runners!!

Carole C in NOLA on 12/06/02 at 10:40 (101969)

I agree that they should have specified whether or not the runners continued running during recovery. Maybe they matched runners in the ESWT group with runners in the control group for various factors, including how much they ran during recovery, but if so that should have been made clear.

What I find terrifically annoying is that they only chose to include 45 runners. I was under the impression that there are a lot of people with PF who are treated with ESWT, and if so I wish they had included perhaps 500 runners or so and matched them for age, weight, amount they ran, and so on.

Still, it appears to be a further indication that ESWT treatment is probably unlikely to be detrimental.

Carole C

Re: an ESWT study on runners!!

Ed Davis, DPM on 12/06/02 at 10:57 (101974)

Elliott:
I agree that it woud be interesting to know if they were allowed to run after treatment, although it may not have made a significant difference in the outcomes.
Do you have a reference for this paper as I would like to obtain a copy.
Ed

Re: an ESWT study on runners!!

elliott on 12/06/02 at 10:58 (101975)

Carole, maybe they did specify whether they ran, just not in the abstract. Knowing runners, I would suspect they did, unless asked specifically not to and told they'd be spied on for violations. :-)

Big studies on the order of 500 are usually prohibitively too expensive, so you just take what you can get. Even the Dornier study had only 150 (and one noteworthy observation is that most in that study were women, by a ratio of 4:1). Under normal circumstances, when all that is sought is a Yes or No oucome (success or not), 30 treatment and 30 control would be enough for things like convergence to a normal distribution, but not when close 90% might be getting better anyway. As you say, that makes 500 a lot more attractive.

[]

Re: an ESWT study on runners!!

elliott on 12/06/02 at 11:36 (101979)

Shucks! Dr. Ed, I had plans to milk the German site study by painful study for all the stony silence it was worth, but since you're asking now, here is a link to the site:

http://www.ismst.com/events/2002_winterthur_abstracts%20-%202.htm#ESWT%20after%20Arthrodesis%20of%20the%20Lower%20Ankle%20Joint%20-%20Necessity%20of%20Preliminary%20CT-Scan

I dug up two of the authors' email addresses from Pubmed:

(email removed)

schoelln@mail.uni-mainz.de

Shprecken ze Doitch? :-)

That German site has lots of other fascinating ESWT abstracts of varying quality worth reading: several studies showed success for lateral epicondolitis (including the FDA study, which showed the crossovers to have greater satisfaction than the original group!) as well as one showing absolutely none at all over random; success for nonunions and stress fractures; whether one's plantar fascia dimensions are altered upon successful ESWT treatment (answer: Yes); ESWT performed on bilateral chronic PF patients; results on low-energy ESWT for PF with and without local anesthesia (without was much better!); does MRI show changes after ESWT? (answer: No, even for successful treatment); does gait analysis change after ESWT? (answer: No, even for successful treatment).

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/06/02 at 14:55 (102000)

Elliott:
Thank you for the references. I'll get as much mileage out of it as I can.

I would not expect gait analysis to pick up any significant changes since ESWT does not effect any significant biomechanical issues. I would be curious to see before and after ultrasound measurements (could be done by MRI but ultrasound is much less expensive) to see if the plantar fascia is thinned after ESWT. My preliminary impression is that the answer is 'yes' but would wait approx. 6 months to take the post-ESWT measurement. I had mentioned this to Dr. Z a while back. I don't know if he has obtained a diagnostic ultrasound machine since he is using Dornier. If he comes on this discussion I will try to convince him to obtain one. The diagnostic ultrasound machines have gone digital in the last year or two with significantly improved image quality and plunging price tags--- if this trend continues, I think almost all docs who are treating musculoskeletal conditions should own one.
Ed

Re: an ESWT study on runners!! Dr. Z

Dr. Z on 12/06/02 at 17:33 (102014)

I have found decrease thickness and swelling with sequental ultrasound evaluations usually at the six to eigh week post eswt time frame

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/06/02 at 18:53 (102016)

Dr. Z:

Have you made any observations several months after ESWT?

Ed

Re: an ESWT study on runners!! Dr. Z

Dr. Z on 12/06/02 at 19:07 (102022)

YES. I don't have any one year evaluations. My gut feeling is that the tissue does change and reduce in size as the pain reduces and healing take places.Patients really love to see the changes. I hope that I can start to make consistent healing time phase with ulrasound testing

Re: Question re biomechanical issues

Julie on 12/07/02 at 02:52 (102044)

Ed, you remind us that ESWT does not effect significant biomechanical issues.

Suppose you have a patient with PF that was caused mainly by a biomechanical fault. And say that person is significantly helped by ESWT and thinks 'I am cured'. Isn't it likely that although the tissues have healed and the pain is gone or greatly diminished, the biomechanical fault that caused the original PF will likely cause a recurrence?

Would you (and Dr Z) therefore counsel the patient to continue to address his biomechanics with orthotics on a long term basis?

It would be interesting - in the future, I know it's too soon - to track relapses due to overconfidence, or to lack of understanding of why one developed PF and why ESWT helped.

Re: an ESWT study on runners!!

john h on 12/07/02 at 10:06 (102066)

Article in USA Today this week about problems within the FDA and testing. It indicated that statistaticians rather than Doctors were running the place and as a result many possible drugs/treatments were not reaching the market or taking way to many years to reach the market. Apparently Doctors are not being allowed to apply logic and other factors in the testing process. The FDA should never be taken as the final answer or solution it is the best we have to offer at the moment. Like any bureaucracy it tends to perpetuate itself and change comes very slowly if at all. We need some original thinking there as well ast stats.

Re: an ESWT study on runners!! Dr. Z

john h on 12/07/02 at 10:22 (102069)

Dr. Ed: speaking of gait analysis I have spent a lot of time walking behind people at our helth club observing how people walk. I have observed people walking with horrible foot strikes and in a manner that you would think they have to have damaged feet. Since I see them regularly I know they have no foot problems which begs the question is the way we walk really that important in the develpment of PF. If we have been walking in some strange manner for 50 years and you suddenly develop PF it does not make sense that now you develop PF from foot mechanics. I think for runners and I am confident in my case that I started a lot of uphill and downhill ruunning which led to achilles tendonitits and then later to PF. Of course continuuing to run when PF was not very bad surely made me the chronic case I am today.

Re: Question re biomechanical issues

Dr. Z on 12/07/02 at 10:35 (102072)

Hi

Very good point. I feel it is important to council the pateint on all asapects of what caused the problem in the first place. Cross training , better running surfaces if they are a runner, Better shoes, correct biomechanical problems if needed. Stretching, weight control if needed. I usually will ask the pateint in the beginning what do you think caused the problem and either re-enforce or explain why I don't think that the patients reason is the correct reason or only part of the reason

Re: Question re biomechanical issues

Julie on 12/07/02 at 12:16 (102083)

Thanks, Dr Z. That sounds good practice. I wonder how many of your patients follow your advice once they're better?

What concerns me about any 'cure', whether effected by ESWT, orthotics, or whatever, is that most people are likely to get overconfident once they feel better, and stop doing the conservative things they were doing that made them better.

I've been 'cured' now (in quotes because I don't mistrust the concept of 'cure') for well over a year and a half. But you'll never see me with my feet in anything but my orthotics, or my Birks (maybe I'll even get to dance with John some day :)

I believe, having followed the discussions about ESWT for the past two years, that it is the treatment of choice once the usual modalities have failed (though I suspect they mightn't fail quite so often if appropriately and correctly prescribed and followed). But there would seem to be dangers in regarding it as a 'magic bullet', because if it deals mainly with inflammation and tissue quality, the third leg of the triangle, flawed biomechanics, is still lurking.

Re: Question re biomechanical issues

Julie on 12/07/02 at 12:23 (102088)

That should have been 'I mistrust the concept of cure'. I rewrote the sentence and forgot to take the 'don't' (which preceded 'like') out.

I miss the editing facility! ScottR?

Re: Question re biomechanical issues

Ed Davis, DPM on 12/07/02 at 12:36 (102090)

Julie:
I would definitely counsel the patient on biomechanical issues. Keep in mind that since ESWT is used for 'intractable' PF, my patients (and hopefully the patients of others) who are getting ESWT already have had any abnormal biomechanics treated. Eventually, as use of the modality becomes more routine, we are likely too see over or misuse. ESWT is a relatively painless and passive modality so it takes little convincing, outside of financial issues, to have patients accept treatment.
Ed

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/07/02 at 12:44 (102094)

John:

Gait is one thing that is so often ignored. It is interesting to see that once patients are educated at what to look for, they start paying a lot of attention to this area.

The effects of abnormal gait or abnormal biomechanics are additive and cumulative. Our bodies can be very resilient and tolerate abnormal stresses and strains for years before pain develops. Patients often attribute the onset of PF to a minor event -- that event did not cause the PF but was the 'straw that broke the camel's back.' The whole field of what we now term 'cumulative trauma disorders' is still in its infancy.
Cumulative trauma disorders with relatively short time periods between the activity causing a problem and onset of symptoms (eg. carpal tunnel syndrome) can be easier to define. Studies are difficult to structure since CTD's occur over potentially very long period of time. Much information comes from retrospective analysis, looking at incidences of pathology in certain industries.
Ed

Re: an ESWT study on runners!!

Ed Davis, DPM on 12/07/02 at 12:46 (102095)

John:

Absolutely right! Please don't let Bill read this.
Ed

Re: an ESWT study on runners!! Dr. Z

Julie on 12/07/02 at 14:49 (102109)

But John, it DOES make sense that foot mechanics have caused PF. These things take time. You may see lots of people walking horribly, and if they don't have PF, or a tendinitis, it means only that they don't have it YET.

Re: an ESWT study on runners!! Dr. Z

john h on 12/07/02 at 16:38 (102119)

Julie- dpes ot tale 60 years plus of bad bio mechanics before PF sets in? I like to think it was to much running over time and the sudden change to running like a billy goat in the hills.

Re: an ESWT study on runners!!

elliott on 12/07/02 at 18:34 (102136)

Dr. Ed, if you manage to obtain the entire ESWT study on runners, I'd be very grateful if you could forward me a copy. I'm still a runner in my mind, if not my feet. Thanks.

Re: an ESWT study on runners!! Dr. Z

Julie on 12/08/02 at 02:14 (102191)

John, I don't know how long it takes (how long is a piece of string?). As we know, each individual case is made up of a mixture of individual components/causative factors. Mine was brought on by a lifetime of overpronation on flattish feet, plus advancing age, until a lower back strain caused a protruding disc that impinged on the sciatic nerve and finally triggered PF. With a different mixture of factors (e.g. no pronation + back injury, e.g. pronation - back strain) PF might not have happened.

So yes, if your biomechanics are faulty (are they?) I suppose it could have taken you 60 years of running on pronating feet, and then your billy-goat up-and-down caper was the last straw. (The repetitive impact of running, though, must be a PF factor even in people whose biomechanics are perfect, and perhaps that was so in your case. But we can't generalise on the basis of our own experience.)

The classic protest of the person who 'suddenly' suffers a prolapsed disc is: 'All I did was bend over to get the roast out of the oven and I couldn't straighten up!' But that bend was simply the last straw, after a lifetime of whatever postural misalignment/misuse that really caused the problem. I think the same holds true in many cases of PF, certainly those in which poor biomechanics are a causative factor.

Anyway, I wasn't talking about you in my previous post, but about the people you've (and we've all) observed walking badly but who don't have PF. That may only mean they don't have it (or some other problem) YET. In other words, that 'last straw' has yet to happen for them.

But for their sake, let's hope it doesn't.

Re: an ESWT study on runners!! Dr. Z

Ed Davis, DPM on 12/09/02 at 18:34 (102433)

Julie:
Good examples. How many times I have heard people say that all they did was bend dwon to pick up a piece of paper when they ruptured their disc!
Ed