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ESWT with PF or nerve involvement?

Posted by Chris B on 6/14/03 at 12:44 (121861)

I've had PF for 2.5 years in one foot and have gone from an active person to a virtual shut-in. At first it was classic, then for the past 2 years my first steps in the morning are the best, and pain begins after I've been up for 10 minutes. I can walk short distances 50 yards, then have to sit for an hour. Beyond that its cane or crutches. I've tried physio & 3 different orthotics. These days I feel some pain at insertion point, but often right across my heel on the other side. A year ago a sports doc told me that because its lasted so long then perhaps there must be nerve involvement along with the PF. On his recommendation I've had dignostic ultrasound and nerve conduction test. Ultrasound shows medial band thickness of 5.8mm indicating 'mild to moderate' PF, but would this be enough to explain the severity of my case? Nerve conduction showed no significant impairment of tibial, medial or lateral nerve other than slight latency. I have no numbness or tinels sign. The doc who did the test said I don't have TTS but cautioned that conduction test is often unreliable for proving nerve entrapment. So no one seems quite sure if the nerve is involved or not.

Does this sound familiar to anyone?
My orthopod knows very little about ESWT but thinks it may not work if there's nerve entrapment involved.
I'd appreciate advice. Am I a likely candidate for ESWT or not?

Re: ESWT with PF or nerve involvement?

SteveG on 6/14/03 at 13:44 (121865)

If you have tried all the other conservative treatments, I would definitely get ESWT. This could help reduce the width of the fascica and help with your symptoms.

Re: ESWT with PF or nerve involvement?

Alice W. on 6/14/03 at 21:38 (121888)

Another post that claims that ESWT reduces platar fascii width- IT DOESN'T MAKE A SIGNIFICANT DIFFERENCE

Re: ESWT with PF or nerve involvement?

Tim V. on 6/15/03 at 01:25 (121900)

Well I don't know about the thickness of the fascia, but ESWT significantly
reduced/elminated the firm very observeable bump in my medial notch area.

Whatever was thick or swelled sure did return to normal size. This occurred
over a period of 3 or 4 months post treatment.

Re: ESWT with PF or nerve involvement?

Dr. Z on 6/15/03 at 13:49 (121925)

It will get rid of your pain. Here are the important clinical tests that can help to predict relief with ESWT
1. Pain on examination of the plantar fasci where it inserts into the bottom of the heel
3. Limping and or pain after sitting for any length of time.
4. Abnormal ultrasound ( that you have)
5. No other cause for the pf. ie arthritis, nerve damage,

I have seen ESWT reduce the thickness of the plantar fascia over time however I can't conclude that this is important or relates to pain relief with all patients but I have definitely seen pain with relief and reduction of the plantar fascia over time