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eswt needed all over heel

Posted by Peter F on 2/11/03 at 14:35 (108822)

I have had eswt twice now 4 weeks apart on different areas of the heel-each time it hit the tender spots and they felt better after a week (honestly!) .However I still have heel pain because there are several spots involved in the heel (and the other areas of fascia as stated in my last post.
2 quick questions

A) How on earth does it work after only 1 week? (not placebo_i can press as hard as I like and the tender area has gone)

B) I know people mention 2-3 episodes of eswt only but if it works on each spot does it matter if several attempts are made on different areas ? (my fascia seems like a jigsaw of tender spots with different pieces needing treatment)

N.B just incase anybody thinks I am a millionaire-eswt is quite cheap in the uk-£180 per episode

Re: eswt needed all over heel

Dr. Z on 2/11/03 at 19:47 (108857)

It disrupts the nerve receptors, thus blocking pain . If can be used on multiple spots

Re: eswt needed all over heel

Peter F on 2/12/03 at 07:47 (108910)

thanks-I'll keep having different parts done-anything to avoid the knife

Re: eswt needed all over heel

Mar on 2/12/03 at 12:27 (108925)

I thought ESWT was done only at the insertional point of the fascia? Mar

Re: eswt needed all over heel

peter f on 2/13/03 at 03:59 (108988)

there are various insertional points over my heel and they are all inflammmed-If Sadam wants to really hurt the west he should give us all a free squash court and let the game ruin our lives like it has mine

Re: eswt needed all over heel

Mar on 2/13/03 at 05:23 (108990)

Peter -

You wrote: 'there are various insertional points over my heel and they are all inflammmed'??? Do we all have various insertional points??? Because mine are all inflammed then too!!! But the ESWT docs seem to talk only about 1 insertional point -- am I right docs? Mar

Re: eswt needed all over heel

Julie on 2/13/03 at 06:15 (108993)

The 'insertion point' is the point at which the plantar fascia connects with (inserts in) the calcaneus. There is only one (I believe).

That doesn't mean that ESWT can't be applied at different points. However, Dr Z has always said it is most effective for insertional plantar fasciitis (i.e. the 'classic' type, where the pain is localised at the insertion point).

Re: eswt needed all over heel

Dr. Z on 2/11/03 at 19:47 (108857)

It disrupts the nerve receptors, thus blocking pain . If can be used on multiple spots

Re: eswt needed all over heel

Peter F on 2/12/03 at 07:47 (108910)

thanks-I'll keep having different parts done-anything to avoid the knife

Re: eswt needed all over heel

Mar on 2/12/03 at 12:27 (108925)

I thought ESWT was done only at the insertional point of the fascia? Mar

Re: eswt needed all over heel

peter f on 2/13/03 at 03:59 (108988)

there are various insertional points over my heel and they are all inflammmed-If Sadam wants to really hurt the west he should give us all a free squash court and let the game ruin our lives like it has mine

Re: eswt needed all over heel

Mar on 2/13/03 at 05:23 (108990)

Peter -

You wrote: 'there are various insertional points over my heel and they are all inflammmed'??? Do we all have various insertional points??? Because mine are all inflammed then too!!! But the ESWT docs seem to talk only about 1 insertional point -- am I right docs? Mar

Re: eswt needed all over heel

Julie on 2/13/03 at 06:15 (108993)

The 'insertion point' is the point at which the plantar fascia connects with (inserts in) the calcaneus. There is only one (I believe).

That doesn't mean that ESWT can't be applied at different points. However, Dr Z has always said it is most effective for insertional plantar fasciitis (i.e. the 'classic' type, where the pain is localised at the insertion point).

Re: eswt needed all over heel

Mar on 2/13/03 at 11:07 (109042)

Thanks Julie -- I'm going to ask my pod about doing it again on the outside of the foot -- medial, I think, fascia -- I forgot the name of it - have to check the anatomy again! Mar

Re: eswt needed all over heel

Dr. Z on 2/13/03 at 17:30 (109088)

There are three insertional bands that attach to the bottom of the heel. With the dornier you treat all three bands by going from the side of the foot. Alot of times I will position the focused shockwave into more then one band. The seond most treated band is the lateral band. The most common
band is the medial band.

Re: eswt needed all over heel

Mar on 2/13/03 at 18:02 (109094)

Ah yes -- lateral band - that's the one I mean -- on the outside of the foot. (Lateral means side -- I should have remembered that!) Thanks -- I'll ask my doc about ESWT there, if i get another treatment. Mar

Re: eswt needed all over heel

Dr. Z on 2/13/03 at 18:16 (109095)

I am sure you had ESWT on the lateral band already. The dornier epos treats the lateral band. If there was trigger point insertional pain the focal point was directed at the lateral band

Re: eswt needed all over heel

Mar on 2/13/03 at 18:19 (109097)

The trigger point was directed at the insertional point of the main fascia - like inside the foot behind the arch (and was not moved from that point). Mar

Re: eswt needed all over heel

Dr. Z on 2/13/03 at 18:46 (109101)

You don't have to move anything to treat the lateral band. The water bladder is deflated to treat that specific lateral band. You wouldn't realize that it is being treated . You foot and the shockwave head are still on the inside of the foot as you described

Re: eswt needed all over heel

Mar on 2/13/03 at 20:14 (109109)

Ok - I get it. But how come you said 'Alot of times I will position the focused shockwave into more then one band.' ? Mar

Re: eswt needed all over heel

Dr. Z on 2/13/03 at 21:03 (109110)

I will do this. This may be difficult to picture. The focused shockwave is 5mm by 20mm in depth. So there is going to be some level of shockwave all the way across the bottom of all of the insertional bands.. The shockwave moves from medial to lateral. Now if there is another very painful trigger point of pain you deflate the water to positon the center ( highest energy) at that spot. This is done when there is two discete areas of pain before the treatment began. I will place a red mark at the areas that are vey painful. This is usually the medial band and sometimes the lateral band. Even if the focused area of shockwave isn't moved there is going to be some level of high energy going into the lateral band. When I place my finger on the outside of the foot the power is too intense too
keep my finger in that spot. This indicates that the shockwave is moving completely across the bottom . It is important to deflate and move the center of the focused energy if you have two areas of serve pain with physical pre-eswt examination . I hope I am explaining myself. It is something that is better explained with diagrams and or pictures. The most important aspect of what I am saying is that some degree of high energy that is focused is going thru some part of the lateral band whether I move the center of focused energy at all

Re: eswt needed all over heel

Dr. Z on 2/13/03 at 21:06 (109111)

One more thing. It is very possible that you had the center of focused energy moved into the lateral band during your first or second treatment.
I will try to find out if possible. Ask your Dr. W if that is what he did.
I will take a look at the treatment records and see what I can come up with

Re: eswt needed all over heel

Julie on 2/14/03 at 03:37 (109117)

Thanks for the correction, Dr Z. I will remember: three insertions. I knew there were three bands, but thought they all merged at the one insertion point.

Re: eswt needed all over heel

Mar on 2/14/03 at 05:43 (109120)

Dr Z --

Thanks -- this is very clear -- I can picture what you are saying. Thanks for trying to check my records also - I appreciate that. I really don;t think the center was moved though because I watched the whole thing. And also after the doc did the first foot, he positioned the machine on the second foot and the tech did the second foot right at that spot. Also, the doc continues to claim that my pain there is compensatory pain??? I'll check and you'll check -- thanks! ;-) Mar

Re: eswt needed all over heel

Dr. Z on 2/14/03 at 08:11 (109126)

Interesting. I will check it out.