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2. eswt treatment -- High or low energy ??

Posted by niels l on 6/10/03 at 11:11 (121446)


Last summer I received 4 times of low energy treatment, and with positive results. The Evotron (little brother to Ossatron)was used.

The more 'steady' pain reduction came after 4-5 months. The first 4 months there were many ups and downs. Now i would say that pain has been reduced with 50- 70%, but i am experiencing set back again.

The big question - if it is time for eswt at all- is whwther to go for high or low energy...I have responded quite positively to low, but not been cured. Is the best low+low or low+high ?


Re: 2. eswt treatment -- High or low energy ??

Ed Davis, DPM on 6/10/03 at 12:54 (121459)


Where did you have the Evotron used?

I use both high and low energy protocols and feel that there is insufficient evidence to favor one over the other. If you have had success with the Evotron, I would be inclined to repeat it use.


Re: 2. eswt treatment -- High or low energy ??

Pauline on 6/10/03 at 14:35 (121470)

Dr. Ed,
What about relapse following ESWT? Several posters have made comments that would indicate they got some relief then were hit by set backs that lead to a relapse.

Re: 2. eswt treatment -- High or low energy ??

Ed Davis, DPM on 6/10/03 at 15:10 (121473)


Good question -- there a a number of things to consider here.

First, it is important to be clear as to what we mean by a relapse. There are two things that it is not. Patients undergoing ESWT may note an analgesic effect that eases pain the first week or so after ESWT. The pain that is noted after the analgesic effect wears off, often the second week, is simply a return to the previous state and not a relapse. The process of 'cure' is not necessarily marked by steady improvement but by net gains that occur over a period of time -- these 'ups and downs' should not be confused with a relapse.

I would consider a true relapse to occur after say, about 12 weeks has gone by, the patient sees a net benefit but then gets worse. We don't know how often that occurs but I am sure that we will see more of it as the numbers of patients recieving ESWT increases. I would like to hear from European providers who have a longer history with such patients.

Keep in mind that ESWT treats a specific aspect of the PF triad -- tissue quality. I emphasize to patients that ESWT is not a substitute for conventional treatments. My concern is that if patients or providers get too enthusiastic and move away from the 'basics' then recurrence or relapse is something to be expected in a number of patients.


Re: 2. eswt treatment -- High or low energy ??

Dr. Z on 6/10/03 at 15:40 (121479)


I would even go so far as to say that you may have an increase in pain at times after 12 weeks due to going back to an activity that your pf isn't ready for. I have found a true relapse rare after a patient has complete pain relief from ESWT 12 weeks post ESWT. I have seen the patient develop other pain from increased use of the feet.

Re: 2. eswt treatment -- High or low energy ??

Pauline on 6/10/03 at 15:44 (121480)

How would you tell the difference? One's going to use their feet and if the pain returns to the plantar fascia area how do you separate the two?

Re: 2. eswt treatment -- High or low energy ??

Dr. Z on 6/10/03 at 16:09 (121484)

The time period is one factor and if the pain is in a different area that was treated. For example I have a pain free pain post three months come in with some level of pain . The pain was in the mid plantar fascia not in the insertinal area. This isn't a relapse. The patient started doing more biking and trend mill working out. The pain wasn't terrible but it was there. This is a problem that I know will go away with actually an orthosis adjustment. His orthotic posting were worn out.
You can see other areas of pain in the foot post-eswt due to compensation . Once you have complete fascial healing at the insertions these problem due leave the foot.

Re: 2. eswt treatment -- High or low energy ??

niels l on 6/11/03 at 02:50 (121516)

Hi dr Ed and Z and pauline, and thanks for your responses

I think i will go for another round of low energy.

It was done i Germany. The cost was 100 euros pr time.

I have read in other posts that intervals of one week between the treatments are the best. Is that correct and is it important that the intervals are not longer ?

The intervals on my first session were 2-4 weeks. Can that have reduced the positive impact of the treatment ?

Regarding supplementary conservative treatment, i must say i have given up, almost. After 3 years of totally resultless trying any conservative treatment i have lost faith in that. However, i still wear my worn out orthosics. I have hallux rigidus and a high arch. Any advice is appreciated.