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RE: Another ESWT question - just curious

Posted by Mar on 3/05/03 at 17:18 (111920)

As I understand it, ESWT reinjures the fascia so it can grow back healthy. PF as i understand it is a result of microtears and scar tissue that forms from the injuries. What prevents scar tissue from reforming after ESWT? Just curious. Mar

Re: RE: Another ESWT question - just curious

DrMan on 3/05/03 at 19:59 (111935)

You are correct ESWT does reinjure the plantar fascia in a very controlled manner. In addition it affects the bone at the attachment of the fascia and the calcaneous. This is the enthesis, so this is called plantar fascia enthesopathy. Also, you are correct in that fasciitis is micro tears in the fascia and some scar tissue does form. However, scar tissue does not constitute healing. Scar tissue is actually the lack of actual healing. ESWT actually instigates the inflow of a number of chemical agents that causes new blood vessels to form (neo-vascularization). This causes ACTUAL healing to occur. This is the same principle as with the use of ESWT on the healing of non-union bone fractures. The extracorporeal shock wave causes the reactivation of bone cells and blood vessels across scar tissue that forms interposed in a fracture site. Bone then forms where there used to be scar tissue. It's complicated but ESWT caused good tissue to form where there used to be bad tissue. I hope this information is useful in answering your question.

Re: RE: Another ESWT question - just curious

Mar on 3/06/03 at 05:32 (111973)

DrMan -

Thanks -- very clear and makes sense. Now what do you suppose is happening when the ESWT is not successful? Is it that reinjury from walking is taking place all over again, even with orthotics? Or that there is a pain signal that never shut off? Or that something else in the body causes inflammation? Or we don't know??? I appreciate any thoughts. I try to UNDERSTAND as much as I can - it helps me to handle things and try to figure out the next course of action. Thanks - Mar

Re: RE: Another ESWT question - just curious

DrMan on 3/06/03 at 07:30 (111974)

You're correct, we don't exactally know. However, from what we know about proximal plantar fasciopathy, the reason for ESWT failure could possibly be because the origin of the pain was from another source or the stress on the fascia was too great to allow healing. This is an entire lecture in itself. Just for your info, the condition we are treating is actually not plantar fasciitis, because this means inflammation, the condition is actually proximal plantar fasciopathy, meaning injury or damage, not necessarily with inflamation, in fact probably there is a lack of inflammation. ESWT actually insites a new local inflammatory response, therefore, fasciitis, which should result in healing. OK

Re: RE: Another ESWT question - just curious

Mar on 3/06/03 at 08:50 (111982)

Very interesting. So there can be pain without inflammation? Can there be inflammation without pain? Mar

Re: RE: Another ESWT question - just curious

Shell D on 3/06/03 at 09:14 (111985)

Your questions and responses are very interesting! Thanks for the info.
I had ESWT done the last week of December and it's been WONDERFUL for me.
I would highly recommend it.
Shell D.

Re: RE: Another ESWT question - just curious

Rose M on 3/06/03 at 12:55 (112019)

GReat questions and responses! Made things very clear, and coincides with my experience post ESWT. Each day is a different experience. It really does feel as though parts of the foot has been injured, but the discomfort feels different than it did before. I find that I may have one day of considerable discomfort, followed by a day of considerable improvement. Rather than a continual, unrelenting PF pain, this feels more like an injury that is healing, one day at a time.

Re: RE: Another ESWT question - just curious

DrMan on 3/06/03 at 21:43 (112072)

In medicine there are conditions termed 'clinical' and sub-clinical'. This means either enough pathology to cause symptoms or not enough to cause symptoms, respectively. Inflammation without pain could best be exemplified in the arteries where plaque is building up causing a low grade inflammation of the arterial wall, without symptoms, sub-clinical. Until either angina or the big one hits, then it is clinical Also, in the plantar fascia, the bone spur on the calcaneous builds up secondary to chronic pull of the fascia. This is sub-clinical inflammation because the development of the spur does not necessarily hurt, not until the inflammation becomes clinical (bad enough) then, well, you know what it feels like. AS far as pain without inflammation, well thats what we are discussing here. There is minimal to no inflammation at the plantar enthesis (attachment of the fascia to the calcaneous) because the problem has been going on for so long the body stopped trying to heal it. Inflammation is the body's way of healing something, if the healing stops the problem can still exist.

Re: RE: Another ESWT question - just curious

Mar on 3/07/03 at 05:38 (112090)

OK - now what about inflammation that continues and continues? Like the sesamoiditis and surrounding tissue inflammation that I have had for 2 years since bunion surgery. Is there no way to shut off that inflammatory response?

As to my PF - I still have some inflammtion according to the ultrasound I had a week ago. But what can be done to get rid of it or if there is no inflammtion, how do we get the body to heal again and stop the pain response?

Thanks for your explanations - they are very interesting and clear.