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What did I do wrong?

Posted by Julie C. on 6/09/03 at 20:36 (121412)

I had my second round of ESWT on April 24th with the Dornier (the first one was Dec 10th with he Ossatron). After the first treatment, the only real improvement was that there seemed to be some residual numbness for 10 days! I took several days off, went back to work for 3 days and then was out for 2 weeks with back injury. Two weeks out of work and flat on my back in bed and I did not see much improvement. I have been very discouraged with the results of the second treatment....I might be 50% better, but it had gotten so bad that I would have rated it a 12 on a scale of 1-10! I've had PF (only in the left foot) most recently since Fall, 2001 and have tried orthotics, shots, physical therapy, night splints....did I miss something? I keep reading about ESWT working so well for so many people so.....why not me!? I know this sounds like a rhetorical question, but it's not. And what are my options at this point? I'm asking the Heelspurs.com doctors because I have just moved to a new city and who and when I hook up with for treatment will be determined by what I decide to do next.

Thanks, Julie C.

Re: What did I do wrong?

Pauline on 6/09/03 at 22:12 (121416)

Julie,
Unfortunately I don't have an answer for you, but I know for a fact after reading several posts here that your not alone. Many people have had ESWT treatment with Dornier, Ossatron and Sonocur and many have come back to post little if any results.

I think most of us are very disappointed because we had set our hopes and prayers on ESWT being the magic bullet that would finally take away the pain and return our lives to normal again.

The results of many posters have not come close to matching the numbers given to us in FDA studies and several people feel those studies should be opened again because we just don't seem to be seeing the same results in pain reduction and cure rates as they were stated.

I never had ESWT, but I can imagine the extra frustration that you've experienced after spending the money and not having your expectations met.

Some here would say any improvement is something while others have gone back time and time again for additional treatments, as many as 4 to 5, seeing to become totally pain free.

I think many of us are wondering what happened to those good results from the time these machines went through the FDA studies to the time treatments were made available to the public?

The only suggestion I have is not to give up. Keep posting and know that your not alone. Others here know what your going through and will help to keep your spirits up with encouragement.

Somedays you have to take what little positive there is with P.F., knowing that it's not a life threatening disease, and be thankful and on others days you can give yourself permission to feel all the anger, frustration and despair that this condition causes, but above all never give up.

Sorry I can't offer you more, but I'll gladly add you to my prayer list. My own case of P.F. lasted over 3 years so I know first hand what your going through. I'm sure others will have more to say.

Re: What did I do wrong?

Dr. Z on 6/09/03 at 22:43 (121417)

Hi

Where are you living now?. The real question that first needs to be addresed is do you have plantar fasciitis or something else in addition to pf. How long has it been since your second treatment.
It is very difficult to determine what is going on . I would be very happy to examine your foot and give you my opinion. I may be able to help you to some degree with your answers to the some of these few questions

Do you limp in the AM or after sitting for a period of time. ? Was there pain on palpation at the insertion of the plantar fascia. How long has it been since your second ESWT treatment?

Re: What did I do wrong?

Dr. David S. Wander on 6/11/03 at 16:14 (121576)

I agree with Dr. Z. Although not all patients have success with ESWT, other causes should also be investigated. Have you had an MRI? Have you had any blood tests to rule out arthritic/rheumatic conditions? Have you seen a rheumatologist? There are many reasons for heel pain, and many doctors simply see what they are looking for, and don't go beyond that tunnel vision. Check out other causes (if you haven't already) prior to considering additional ESWT.

Re: What did I do wrong?

Julie C. on 6/11/03 at 21:25 (121606)

Dr. David,

Basically you told me what I suspected; I am needing a fresh perspective. I did have a bone scan which was consistent with PF. I have not had other testing. As an RN, I understand that many kinds of doctors could order the blood testing, but in your opinion, should I start with GP or internal medicine doctor, go to another podiatrist or an orthopod?

Thanks, Julie C.

Re: What did I do wrong?

Julie C. on 6/11/03 at 21:37 (121607)

Dr. Z,

I am in Chapel Hill, NC where the list of podiatrist is a ga-zillion long and that doesn't include next door in Durham or Raleigh. As I said in my last post my last ESWT was April 24 (I know, just a mere 6-7 weeks ago and it 'can take up to 12 weeks to show results'). I do everything within my power NOT to limp because that leads to a whole other set of problems I don't need BUT I have pain in the morning, after sitting and sometimes while sitting. My maximum impulse point of pain is at the classic point associated with the posterior heel spur at the instep radiating to the center (sole) of the heel. If any improvement has been noted it is to the center of the heel. The max pain point is virtually no better. There is mild tenderness on palpation of the center of the sole of the heel but if you were to apply moderate pressure to the instep spot I'd be likely to kick you into tomorrow (inadvertently of course). I don't believe your clinic is anywhere close enough for me to pop in for a visit but thanks anyway. I just wonder if open procedure is the only thing left and if so, what is the conventional wisdom regarding the length of convalescence, etc.? Is there anything else out there?

Thanks, Julie C.

Re: What did I do wrong?

Mar on 6/12/03 at 07:29 (121625)

Julie -

Just one comment on your title 'What did I do wrong?' Nothing! That was the greatest comment my ESWT pod gave me when I wasn't getting any better. I was sure it was my fault and he was kind enough to reassure me that I was doing nothing wrong. So don;t blame yourself. Some of us just don't respond to the treatment. The success rate is not 100% unfortunately. Some day we will find another solution to this pain. Good luck -- Mar

Re: What did I do wrong?

Dr. David S. Wander on 6/12/03 at 07:55 (121627)

I'm not sure why a doctor would order a bone scan for plantar fasciitis, other than suspecting a calcaneal fracture. However, a bone scan is very sensitive, but not very specific, therefore in my opinion is not very useful. An MRI will show changes in the calcaneus (heel bone) as well as any disrutption or pathology of the soft tissue structures, including the plantar fascia. An MRI will also show changes consistent with certain rheumatic conditions. My only caution is that the MRI must be read by a radiologist with a specialty of musculoskeletal MRI/imaging. It does make a big difference. As far as blood tests go, any of your doctors can order the tests, including your present podiatrist. The tests may be negative, and the MRI may be negative, but it is certainly prudent to have these performed prior to considering surgical intervention.

Re: What did I do wrong?

Julie C. on 6/16/03 at 20:45 (122049)

Dr. Wander,

I appreciate the advice. I have moved recently so continuing with my podiatrist of the last 4 years is not really an option. He had ordered the bone scan to rule out a fracture of the calcaneus. I have had a stress fracture before and I spend 8 hours a day on my feet as an OR nurse. It has been suggested to me that perhaps taking an extended period of time off from my job may be necessary in order to affect a full healing of the PF but I can't help but wonder if it wouldn't just start right back up again once I returned to work. And frankly, if I could afford 6 months off, why would I be working in the first place?! So, I am living in Chapel Hill, NC and working at UNC Hospital and Duke University Medical Center in the 'City of Medicine' is right next door, so where do I go from here? Podiatry? Orthopedics? Voodoo? Can you recommend anyone in this area?

Thanks again,
Julie C.