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post ESWT

Posted by Carlyn B. on 12/26/02 at 00:15 (104005)

I suffer from a heel spur and resultant plantar fasciitis. On Dec. 18th, I underwent ESWT (Ossatron) after failed conservative treatment (night splint, NSAIDS, injections x 2). I'm now 1 week post-procedure and I'm concerned that I am not seeing the result that I expected/desired. Moveover, I'm not certain as to what I should expect, ie. when I should see significant improvement, success rate, etc. Please bombard me with information ... anything that I can do to promote healing. I continue to wear the night splint (molded plastic) but I'm considering trying a new one, perhaps with a cold pack. I am not presently taking my NSAID, Bextra, as it is my understanding that ESWT causes an inflamatory response to revascularize the area. Any recommendation for a shoe insert? or perhaps a particular shoe?? I frequently stretch but I have not tried a stretching device. Any info would be appreciated.

Re: post ESWT

RUSSELL F on 12/26/02 at 00:41 (104009)

This will sound ridiculous to you, but I, also had plantar fasciitis for approximately 1 1/2 to 2 years and was cured by wearing cowboy boots with a high-heel (must be) for a week and a half! A good friend of mine also had the same problem and the boots also solv ed his problem in the same amount of time.

I came across this information from a friend's friend, who was a chiropractor. It sounds ridiculous, but it does work. If you have any questions, you can email me at (email removed), or call me at 843-249-3875. I didn't believe it to begin with, but I was in so much pain from standing at my work---I am a pharmacist---that I was willing to try anything. Almost 2 years of misery solved with a pair of high-heeled cowboy boots! Try it, you have nothing to lose, except about $100.00 (you have probably spent 10 times that much on doctors).

Think about it. You have inflammation in the bands in your feet and what kind of shoes do you wear? Ones that will not stretch the bands in your feet very much. Now, think how high-heeled cowboy boots will stretch the same bands for a week and a half! You have to trust someone. I will even give you the name of my friend and his phone # if you like. His name is Mickey Watts, also a pharmacist from Concord, N.C. I don't have his phone # at my fingertips, but if you are interested, I will get it for you. Russell Fonvielle

Re: post ESWT

Julie on 12/26/02 at 01:59 (104011)

Carlyn, I'm sure you will hear from one of the doctors about this. I'd be surprised if they didn't tell you that one week is no time at all, and that you shouldn't expect to see improvement so quickly. Some people have, but it's more likely to take a good deal longer. Remember that the tissues have been injured. ESWT kickstarts the healing process by stimulating blood flow to the tissues, but it isn't instand magic: you need to give the process time.

Also remember that some people need more than one treatment.

Be patient. I wouldn't recommend 'doing' much at this stage. If you have been seeing a podiatrist, inserts would or should have been suggested if it was thought these were needed. Check this out, but I wouldn't do anything without advice from the doctor who knows your feet.

The ESWT section of this website will give you a lot of information. You could also scroll back on the message board and read about people's experiences - there have been thousands of posts.

Re: post ESWT

Carlyn B. on 12/26/02 at 10:05 (104020)

Yeeee haaaaa! I don't think this sounds ridiculous at all. My parents suffered in years past with heel spurs/pain and the recommended treatment during that time was a moderately heeled shoe. Looks like some methods of treatment, although not considered modern, are still effective. Thanks for responding!!

Re: post ESWT

Carlyn B. on 12/26/02 at 10:48 (104022)

Thanks for responding Julie. I hope to hear from a physician or any person who has undergone this procedure ... especially those with positive results. I was wanting to know how long I should expect the recovery process to be. I didn't realize that the procedure is repeated in some patients. I certainly hope that I don't fall into that category!! I am certain that I've done more activity than I should have since the procedure ... but it was impossible at this time of year to be inactive. For that matter, I can't think of any time of the year that is a good time to be off my feet. I have three young school age children that keep me 'hopping' both literally and figuratively. There's simply never a good time to be in poor health!! Prayers for healing to all those suffering from heel spurs!

Re: post ESWT

dave r on 12/26/02 at 10:53 (104024)

I have had the procedure done twice, for me the recovery was very painful and long. It took me 5 months to recover from the first treatment.
Its been 18 weeks since my second treatment and i can say that it hasnt helped a bit.

Re: post ESWT

Carlyn B. on 12/26/02 at 11:02 (104027)

Dave, thanks for your response. I have few questions if you don't mind. First, when you say it took 5 months to recover, do you mean that you eventually became pain free? that the procedure was eventually a success? Second, was your second treatment on the same foot?

Re: post ESWT

dave r on 12/26/02 at 11:10 (104028)

Hi Carolyn, i had alot of pain from the first treatment. My pain levels increased from the treatment. It took 5 months to get back to where i was before the treatment. The second procedure was for the same foot. For now i can say that the treatment was not a success. But you must realize that there are alot more people that are helped by this. there is about 5% to 15% of people that dont get any relief from whatever they try. I just happen to fall into that category. Surgery is my next option that i am pursuing.

Re: post ESWT

Carlyn B. on 12/26/02 at 11:35 (104029)

Thanks for sharing Dave. Keep me posted on your surgery.

Re: post ESWT

john h on 12/26/02 at 12:14 (104032)

Dave R: What kind of PF surgery are you considering? Open, minimal invasive, Baxter Procedure, Enodoscope? I would be sure and be selective on who I let do this procedure as I am sure you will. Ask a lot of questions such as how many have you done, what percent have had a full recovery.How many have had adverse lasting side effects, how much of the fascia do you typically release, what is your protocol after surgery, ask him if he has any patients you could talk with who have had surgery. My personal opinion is I would not do a endoscopic procedure and this is based on various medical articles I have read. Good luck and keep us informed if you go for surgery. I am like you in that if all else fails then surgery is a better option than living a life of pain as many people are cured by surgery..

Re: post ESWT

dave r on 12/26/02 at 12:34 (104034)

John, as you know i have been around on this board for 2 years now. I have had pf for the better part of 6 years. I like yourself have tried everything from herbal remedies to voodoo! Although i am able to have some good days each week, i clearly have alot more days with high pain levels. I am not as far along as you are in my recovery. I am still unable to participate in any activity or daily walks. I have pf in both feet but my right foot is clearly worse than my left. My left foot is very manageable and for the most part doesnt bother me. if i was able to reach a certain point where i had more of an active lifestyle and still have some pain i would be happy with that. that has been a goal for a long time. I put off surgery all these years because i was deathly afraid of it getting any worse. I always thought that this would just go away. Now i am not afraid of surgery at all. I have been to many doctors over the years for this. And there are only a FEW that i can say that i really trusted. The doctor that i am seeing now performs alot of foot surgery. he is a foot surgery specialist and to me 'seems to have it together'. He only does the traditional open procedure, he typically releases 40% of the fascia. He doesnt usually do more than that.Everyone is different and he wont know till he sees how healthy the fascia is. He claims 80% succes. there are complications;infection, long recovery, cuboid syndrome, hammertoes blh,blah ,blah. As you know surgery does help many people, and it does cause a few to have permanent disabilty. I havent been able to spend more than 15 minutes on my feet with out paying for it later. And i would like to be able to take my dogs for a walk at the end of the day.

Re: post ESWT

Dr. Z on 12/26/02 at 16:19 (104048)

There are usually three pattern post eswt treatment.

1. complete immediate pain relief
2. Gradual pain relief with almost complete resolution up to sixteen weeks post eswt
3 No change in pain for at least eight to twelve weeks
4. Some patients will need additional ESWT treatment after sixteen weeks if zero pain relief

Re: post ESWT

Carlyn B. on 12/26/02 at 16:46 (104049)

Well, I the first pattern is not the case, but at least there's hope for recovery down the road. Any recommendations re activity? shoes??

Re: post ESWT

john h on 12/27/02 at 08:22 (104091)

Dave I surely relate to your condition and yes I would and did have surgery on one foot. My greatest concern like yours was to be made worse. I could deal with it not working and told the Doctor as much. He was an MD Orthopedic Foot and Ankle Surgeon and told me of the numerous surgeries he had performed for this condition only one was worse and she was a diabetic and had complications from that disease. I did go for the Baxter Procedure as it is the least likely to make you worse because very little fascia is released. Of course the downside of that procedure is it may be if you do not release enough fasica you still have the tension on the fascia. After reading many articles on surgery most seem to come up with a cure rate of between 75-80%. When I had my surgery I had at the same time on the same foot Tarsal Tunnel and a Cheilectomy on the great toe. Still I was off crutches in two weeks and back to work in 3 days with a non eventful recovery. Looking back I think I should have taken it a little slower but I never was in any great pain. The toe was by far the worst of the lot as they removed some bone spurs. In any event after 6 years I support your decision because you want your life back. My very best. Keep us informed.

Re: post ESWT

john h on 12/27/02 at 08:24 (104092)

Dr. Z I did find some immediate pain relief when we did the Big O. Probably to much pain relief because I stepped up my activity substantially. Bad idea.

Re: post ESWT

dave r on 12/27/02 at 11:07 (104105)

John, thanks for the kind words. I apreciate them very much. I am waiting for the results of a bone scan that i had done two weeks ago. If they come back negative then i will have the surgery. I can except the fact that i will be very inactive for a few months. heck, i use crutches to get around now when i have bad flare ups. I know you understand where i am coming from. My biggest concern over the surgery is nerve entrapment from scar tissue and having later column pain. If you know of any way to help prevent scar tissue from 'going crazy' then i will gladly consider it.
I will presumably take four to five thousand mg of vitamin c for a few months, i have heard that can help prevent scar tissue from forming. I will also be very careful in what i do. I still dont know how long i will be off of work for it. i am assuming it will be at least a month. I sit at a desk all day so i think i could come back to work soon after. I would like to be on the 'road more traveled instead of the road less traveled'.

Re: post ESWT

john h on 12/28/02 at 18:23 (104184)

I think if you have surgery you undoubtedly have scar tissue howerver with scar tissue than forms on the area of the heel and you constanly walking around I would think that much of the scar tissue would be broken up. Is that right or wrong doctors?

Re: post ESWT

Ed Davis, DPM on 12/29/02 at 11:10 (104212)

Carlyn:

There can be a a short term analagesic effect that occurs with ESWT but the long term effect is caused by revascularization and remodelling of the plantar fascia; a process that takes up to 12 weeks.

ESWT is a treatment used after al 'conventional' treatments have been exhauste. It does not substitute for other treamtents. For example if your foot mechanics cause too much tension on the plantar fascia, that needs to be addressed. You line of questioning suggests that your doctor needs to provide you with substantially more information about your problem.
Ed

Re: post ESWT

dave r on 12/30/02 at 07:56 (104267)

Boy, you would sure think that walking around would help.

Re: post ESWT

RUSSELL F on 12/26/02 at 00:41 (104009)

This will sound ridiculous to you, but I, also had plantar fasciitis for approximately 1 1/2 to 2 years and was cured by wearing cowboy boots with a high-heel (must be) for a week and a half! A good friend of mine also had the same problem and the boots also solv ed his problem in the same amount of time.

I came across this information from a friend's friend, who was a chiropractor. It sounds ridiculous, but it does work. If you have any questions, you can email me at (email removed), or call me at 843-249-3875. I didn't believe it to begin with, but I was in so much pain from standing at my work---I am a pharmacist---that I was willing to try anything. Almost 2 years of misery solved with a pair of high-heeled cowboy boots! Try it, you have nothing to lose, except about $100.00 (you have probably spent 10 times that much on doctors).

Think about it. You have inflammation in the bands in your feet and what kind of shoes do you wear? Ones that will not stretch the bands in your feet very much. Now, think how high-heeled cowboy boots will stretch the same bands for a week and a half! You have to trust someone. I will even give you the name of my friend and his phone # if you like. His name is Mickey Watts, also a pharmacist from Concord, N.C. I don't have his phone # at my fingertips, but if you are interested, I will get it for you. Russell Fonvielle

Re: post ESWT

Julie on 12/26/02 at 01:59 (104011)

Carlyn, I'm sure you will hear from one of the doctors about this. I'd be surprised if they didn't tell you that one week is no time at all, and that you shouldn't expect to see improvement so quickly. Some people have, but it's more likely to take a good deal longer. Remember that the tissues have been injured. ESWT kickstarts the healing process by stimulating blood flow to the tissues, but it isn't instand magic: you need to give the process time.

Also remember that some people need more than one treatment.

Be patient. I wouldn't recommend 'doing' much at this stage. If you have been seeing a podiatrist, inserts would or should have been suggested if it was thought these were needed. Check this out, but I wouldn't do anything without advice from the doctor who knows your feet.

The ESWT section of this website will give you a lot of information. You could also scroll back on the message board and read about people's experiences - there have been thousands of posts.

Re: post ESWT

Carlyn B. on 12/26/02 at 10:05 (104020)

Yeeee haaaaa! I don't think this sounds ridiculous at all. My parents suffered in years past with heel spurs/pain and the recommended treatment during that time was a moderately heeled shoe. Looks like some methods of treatment, although not considered modern, are still effective. Thanks for responding!!

Re: post ESWT

Carlyn B. on 12/26/02 at 10:48 (104022)

Thanks for responding Julie. I hope to hear from a physician or any person who has undergone this procedure ... especially those with positive results. I was wanting to know how long I should expect the recovery process to be. I didn't realize that the procedure is repeated in some patients. I certainly hope that I don't fall into that category!! I am certain that I've done more activity than I should have since the procedure ... but it was impossible at this time of year to be inactive. For that matter, I can't think of any time of the year that is a good time to be off my feet. I have three young school age children that keep me 'hopping' both literally and figuratively. There's simply never a good time to be in poor health!! Prayers for healing to all those suffering from heel spurs!

Re: post ESWT

dave r on 12/26/02 at 10:53 (104024)

I have had the procedure done twice, for me the recovery was very painful and long. It took me 5 months to recover from the first treatment.
Its been 18 weeks since my second treatment and i can say that it hasnt helped a bit.

Re: post ESWT

Carlyn B. on 12/26/02 at 11:02 (104027)

Dave, thanks for your response. I have few questions if you don't mind. First, when you say it took 5 months to recover, do you mean that you eventually became pain free? that the procedure was eventually a success? Second, was your second treatment on the same foot?

Re: post ESWT

dave r on 12/26/02 at 11:10 (104028)

Hi Carolyn, i had alot of pain from the first treatment. My pain levels increased from the treatment. It took 5 months to get back to where i was before the treatment. The second procedure was for the same foot. For now i can say that the treatment was not a success. But you must realize that there are alot more people that are helped by this. there is about 5% to 15% of people that dont get any relief from whatever they try. I just happen to fall into that category. Surgery is my next option that i am pursuing.

Re: post ESWT

Carlyn B. on 12/26/02 at 11:35 (104029)

Thanks for sharing Dave. Keep me posted on your surgery.

Re: post ESWT

john h on 12/26/02 at 12:14 (104032)

Dave R: What kind of PF surgery are you considering? Open, minimal invasive, Baxter Procedure, Enodoscope? I would be sure and be selective on who I let do this procedure as I am sure you will. Ask a lot of questions such as how many have you done, what percent have had a full recovery.How many have had adverse lasting side effects, how much of the fascia do you typically release, what is your protocol after surgery, ask him if he has any patients you could talk with who have had surgery. My personal opinion is I would not do a endoscopic procedure and this is based on various medical articles I have read. Good luck and keep us informed if you go for surgery. I am like you in that if all else fails then surgery is a better option than living a life of pain as many people are cured by surgery..

Re: post ESWT

dave r on 12/26/02 at 12:34 (104034)

John, as you know i have been around on this board for 2 years now. I have had pf for the better part of 6 years. I like yourself have tried everything from herbal remedies to voodoo! Although i am able to have some good days each week, i clearly have alot more days with high pain levels. I am not as far along as you are in my recovery. I am still unable to participate in any activity or daily walks. I have pf in both feet but my right foot is clearly worse than my left. My left foot is very manageable and for the most part doesnt bother me. if i was able to reach a certain point where i had more of an active lifestyle and still have some pain i would be happy with that. that has been a goal for a long time. I put off surgery all these years because i was deathly afraid of it getting any worse. I always thought that this would just go away. Now i am not afraid of surgery at all. I have been to many doctors over the years for this. And there are only a FEW that i can say that i really trusted. The doctor that i am seeing now performs alot of foot surgery. he is a foot surgery specialist and to me 'seems to have it together'. He only does the traditional open procedure, he typically releases 40% of the fascia. He doesnt usually do more than that.Everyone is different and he wont know till he sees how healthy the fascia is. He claims 80% succes. there are complications;infection, long recovery, cuboid syndrome, hammertoes blh,blah ,blah. As you know surgery does help many people, and it does cause a few to have permanent disabilty. I havent been able to spend more than 15 minutes on my feet with out paying for it later. And i would like to be able to take my dogs for a walk at the end of the day.

Re: post ESWT

Dr. Z on 12/26/02 at 16:19 (104048)

There are usually three pattern post eswt treatment.

1. complete immediate pain relief
2. Gradual pain relief with almost complete resolution up to sixteen weeks post eswt
3 No change in pain for at least eight to twelve weeks
4. Some patients will need additional ESWT treatment after sixteen weeks if zero pain relief

Re: post ESWT

Carlyn B. on 12/26/02 at 16:46 (104049)

Well, I the first pattern is not the case, but at least there's hope for recovery down the road. Any recommendations re activity? shoes??

Re: post ESWT

john h on 12/27/02 at 08:22 (104091)

Dave I surely relate to your condition and yes I would and did have surgery on one foot. My greatest concern like yours was to be made worse. I could deal with it not working and told the Doctor as much. He was an MD Orthopedic Foot and Ankle Surgeon and told me of the numerous surgeries he had performed for this condition only one was worse and she was a diabetic and had complications from that disease. I did go for the Baxter Procedure as it is the least likely to make you worse because very little fascia is released. Of course the downside of that procedure is it may be if you do not release enough fasica you still have the tension on the fascia. After reading many articles on surgery most seem to come up with a cure rate of between 75-80%. When I had my surgery I had at the same time on the same foot Tarsal Tunnel and a Cheilectomy on the great toe. Still I was off crutches in two weeks and back to work in 3 days with a non eventful recovery. Looking back I think I should have taken it a little slower but I never was in any great pain. The toe was by far the worst of the lot as they removed some bone spurs. In any event after 6 years I support your decision because you want your life back. My very best. Keep us informed.

Re: post ESWT

john h on 12/27/02 at 08:24 (104092)

Dr. Z I did find some immediate pain relief when we did the Big O. Probably to much pain relief because I stepped up my activity substantially. Bad idea.

Re: post ESWT

dave r on 12/27/02 at 11:07 (104105)

John, thanks for the kind words. I apreciate them very much. I am waiting for the results of a bone scan that i had done two weeks ago. If they come back negative then i will have the surgery. I can except the fact that i will be very inactive for a few months. heck, i use crutches to get around now when i have bad flare ups. I know you understand where i am coming from. My biggest concern over the surgery is nerve entrapment from scar tissue and having later column pain. If you know of any way to help prevent scar tissue from 'going crazy' then i will gladly consider it.
I will presumably take four to five thousand mg of vitamin c for a few months, i have heard that can help prevent scar tissue from forming. I will also be very careful in what i do. I still dont know how long i will be off of work for it. i am assuming it will be at least a month. I sit at a desk all day so i think i could come back to work soon after. I would like to be on the 'road more traveled instead of the road less traveled'.

Re: post ESWT

john h on 12/28/02 at 18:23 (104184)

I think if you have surgery you undoubtedly have scar tissue howerver with scar tissue than forms on the area of the heel and you constanly walking around I would think that much of the scar tissue would be broken up. Is that right or wrong doctors?

Re: post ESWT

Ed Davis, DPM on 12/29/02 at 11:10 (104212)

Carlyn:

There can be a a short term analagesic effect that occurs with ESWT but the long term effect is caused by revascularization and remodelling of the plantar fascia; a process that takes up to 12 weeks.

ESWT is a treatment used after al 'conventional' treatments have been exhauste. It does not substitute for other treamtents. For example if your foot mechanics cause too much tension on the plantar fascia, that needs to be addressed. You line of questioning suggests that your doctor needs to provide you with substantially more information about your problem.
Ed

Re: post ESWT

dave r on 12/30/02 at 07:56 (104267)

Boy, you would sure think that walking around would help.