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15 weeks post ESWT and need advice!

Posted by Molly H on 8/26/03 at 20:07 (128106)

Hi!
I have posted several times about various things on this board and appreciate all the advice.

I am 15 weeks post ESWT (bi-lateral) my right foot is cured! My left foot is much better but, I still have insertional heel pain. I have the option of getting a 2nd ESWT (on left) next week at 16 weeks post... but, I don't know if I should since I am MUCH better but, not cured. My fear is will it set me back again and can I still be getting better?
I am not impressed with my POD's knowledge of ESWT or ESWT recovery so I am seeking Dr. Z's, Dr. Davis and Dr. Pearl's advice.
Backround info on me I am 38 years old, competitive runner,(used to run 25 miles a week) Have had PF for almost 1 year, I am 5'4 115 lbs, wear semi-rigid orthotics (I have had orthotics for 9 yrs,)

ALL I WANT TO DO IS BE ABLE TO RUN!!!!!!!!!!!!!!!!!!

Thanks in advance for any imput!!

Molly

Re: 15 weeks post ESWT and need advice!

Dr. Z on 8/26/03 at 20:38 (128110)

Give us a percentage of improvement on the foot that you are considering re-treatment. Compare pre-eswt with present pain level. This will determine your decision

Re: 15 weeks post ESWT and need advice!

Molly H on 8/26/03 at 21:14 (128114)

Thanks for your response, Dr. Z. I would say that I am 65-70% better than before ESWT.

Re: 15 weeks post ESWT and need advice!

Dr. Z on 8/26/03 at 22:02 (128115)

Your improvement level is a normal healing progression. The average person during the one year FDA dornier follow up was about 70% at this time frame. Improvement can and does continue up to one year post eswt.

Re: 15 weeks post ESWT and need advice!

Ed Davis,DPM on 8/27/03 at 11:10 (128149)

Molly:
A second round would certainly be indicated for the side that has residual pain. We have made this modality so precious in the US that it is like rationing at times. I believe that the Canadian approach would certainly involve further treatment to achieve complete resolution.
We use up to two high energy treatments in the US per foot and that is enough to help the majority of those who need such treatment.
Ed

Re: 15 weeks post ESWT and need advice!

Molly H on 8/27/03 at 11:31 (128153)

So, Dr. Ed are you saying I should get another round of ESWT NOW? Or do you think it makes sense to wait and see for another month or so to see if I continue to improve?

Re: 15 weeks post ESWT and need advice!

Ed Davis,DPM on 8/27/03 at 11:38 (128154)

Molly:

Either choice would be okay but I would prefer getting a second round sooner than later. We deal in averages and medians when looking at things so we have to come up with numbers that reflect such -- 12 weeks is a good number and is the number which I use for decision making in whether to get further treatment.
Ed

Re: 15 weeks post ESWT and need advice!

Molly H on 8/27/03 at 23:05 (128244)

DR. ED,
Thanks for your response. By getting a second treatment would it make me start the healing process all over again?

Thanks-

Molly

Re: 15 weeks post ESWT and need advice!

Dr. Z on 9/01/03 at 17:04 (128509)

I would wait for at least a few more months so long as you are in severe heel pain. Pain is very subjective so without a hands on examination if it is very difficult to tell you what to do. If I press on the area and you pullled pain in alot of pain then I would do the procedure. We don't even know if the pf is the problem that is causing your foot pain at this stage. Wish i could examine you and then give you an opinion

Re: 15 weeks post ESWT and need advice!

Ed Davis,DPM on 9/02/03 at 21:46 (128636)

Molly:

You could consider the effect of ESWT to be a reactivation of the healing process.
Ed