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eswt with or without ultra sound ?

Posted by niels l on 6/18/03 at 08:11 (122211)


I going to get my 2 round of eswt.

Is it important to locate the exact center(s) of pain with ultra sound ?

Could one argue against by saying that:
I can feel where the pain is,
The eswt is under all circumstances aimed at the insertion of the heel, The eswt is aimed at the whole area of the insertion of the heel anyway,
Eswt is not aimed else where under the feet anyway, for example at the insertion of the toes, eventhough some pain is there as well


Re: eswt with or without ultra sound ?

john h-moderator on 6/18/03 at 09:03 (122219)

Neils: When I had ESWT without the use of ultrasound the Doctor used his thumb to press and find the sensitive spots. I also marked them with an ink pen before I arrived at his office. My foot pain is very much in one area and that is where the fascia attaches to the heel on the inside of the foot and just forward of the heel. When I had ESWT using an ultra sound you could not identify any particular area that was inflamed but the Doctor was able to focus on the area I told him was painful. He also moved the focal point to a couple of other places.

Re: eswt with or without ultra sound ?

john h-moderator on 6/18/03 at 11:57 (122241)

neils: what machine will you be using for ESWT and how long has it been since your last treatment?

Re: eswt with or without ultra sound ?

niels l on 6/19/03 at 02:14 (122320)

Hi john

It was done last summer and the low energy Evotron was used. I received 4 treatments of only 100 euro pr time. He went around the whole area of the insertion of the heel and he said he would do so anyway to come around everything.

I think of using the same machine again, but it has no ultra sound device. I have another option, Mini Lith, with ultra sound, but it is twice as expensive. Thats the reason for my question.


Re: eswt with or without ultra sound ?

John Holt on 6/19/03 at 09:34 (122334)

neils: I am not familiar with the Evotron and some of our Doctors might advise you how the power output compares with other low energy machines such as the Sonoccur. Sonny from Bayshore is knowledgable in this area and maybe he can pickup on this thread. I have been treated with two high energy machines and am considering a series of three treatments with the Sonoccur low energy machine ($750) for three treatments. I will say that compared to 8 years ago when all this started I am much better. This could be the result of high energy ESWT or it may be just time and the other measures I have taken. That is one of the problems with ESWT in that you can never be sure that feeling better is the result of ESWT or other factors. So many people have reported good results with ESWT and I lean towards thinking it did have a positive effect. The reported results of Bayshore and Sonoccur are good. I know the cost of treatments for this machine in Australia and South Africa are very low. I would guess their are many of these machines in Europe and would think the price would be reasonable. There are probably more treatments for ESWT in the U.S. without Ultrasound than with. The Ossatron does not use Ultrasound. When the Orby was in in use it did not use Ultrasound and the current Sonoccur treatments in the U.S. do not use Ultrasound as I understand. When I had the treatment with the Epos Ultra it did use Ultrasound and I could clearly see the Doctor focusing on a particular area and keeping the focus there so it is an advantage.

Re: eswt with or without ultra sound ?

niels l on 6/19/03 at 10:38 (122346)

Thanks John, for your response.

I too hope a doctor would comment on the question of ultra sound or not.

By the way arent you the guy who had a surgery against hallux limitus ? I too suffer from HL and i am still cosidering surgery or not. I dont have much daily pain, only some annoyance, but i tend to believe that the HL makes it more difficult to get rid of my plantar fasciitis.

I would be glad to know how its going with your big toes ?

Re: eswt with or without ultra sound ?

john h-moderator on 6/19/03 at 10:47 (122347)

neils: I had surgery on the worst toe and it is fine now. The other one does not bother me enough to consider surgery. When I was a runner they would bother me as you push off on your toes and as you know dorsiflexing the big toe with a Hallux problem can really hurt. I do not know that I would go through a Cheilectomy in hopes of it solving my PF. It did not help me. As i wrote some doctors think there is a correlation beteen Hallux Limitus/Rigidus and PF but I have never seen one recommend surgery on the toe to cure PF. What kind of surgery did your Doctor propose doing on your toe. Ask him if he is talking about a Chelictomy or a Fusion?

Re: eswt with or without ultra sound ?

john h-moderator on 6/19/03 at 11:01 (122348)

Neils if your treatment with the Evatron consisted of going all over the area then you are not getting the advantage that ultra sound offers and that is to be able to focus and stay focused on one spot. I think some people report that the ultra sound can show a particular spot that needs treatment but in my case there was nothing to show on the ultra sound that stood out so the Doctor stayed focused on the area I told him where the pain was. He did more to a couple of other areas. It is interesting to note that some people report better with results with high energy and some people report better results with low energy so my thought is if you can afford it then if one does not work then try the other. Good luck what ever you do.

Re: eswt with or without ultra sound ?

niels l on 6/20/03 at 05:26 (122416)

John, the doc has not specified the method, but primarily from your previous posts on the method (which i have actually printed out ), i am very awaware that there are different methods to consider.

Also thanks for your comments on the ultra sound question. I think you are right and i expect to take the ultra sound option.

Re: eswt with or without ultra sound ?

Peter R on 6/21/03 at 08:54 (122528)

If the ultrasound exam did not show that your planta fascii thickness was over 3-3.5mm it was not pathological for PF. If it was not measured wrong then you did not have typical insertional plantar fasciitis and you did not totaly fit the protocall for ESWT.