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After ESWT, then what?

Posted by Glen C on 10/13/03 at 14:36 (133870)

I had an Ossatron treatment in JUN 2003 after being diagnosed with PF in SEP 2002. Prior to the treatment I visited a podiatrist, physical therapist, massage therapist, chiropractor and orthopaedist (who performed the ESWT treatment). I had also used several store bought orthodics, a night splint for several weeks and had a cortizone shot. I had also stretched for weeks, applied ice/heat contrasts, and picked up marbles with my toes.

My question concerns the post-treatment regimen following ESWT. I was not given any specific instructions (stretching, use of orthodics, etc.) following my initial treatment. My improvement was minimal at best. I understand that a benefit of EWST is increased blood-flow to help heal the tissue damage. What is a recommended post-ESWT regimen that will foster this healing?

Re: After ESWT, then what?

Ed Davis, DPM on 10/13/03 at 15:20 (133871)

Glen:
The important thing to consider is that ESWT is not generally a stand alone treatment. Please read Scott's Heel Pain Book to make sure that you have done all that needs to be done for your PF. Depending on the biomechanics of your feet, a custom orthotic may be needed -- to what extent has that been assessed?
Ed

Re: After ESWT, then what?

Glen C on 10/13/03 at 15:46 (133877)

I have not been formally assessed for a custom orthotic, however, the chiropractor indicated that my affected leg is 3/4 inch shorter than the other leg. Might that be a factor addressed with a custom orthotic? (I will read the book, thanks.)

Re: After ESWT, then what?

Donald Iain Scott on 10/14/03 at 05:26 (133927)

G'Day,
If I can give a few suggestions to help-
Heat bags - To help improve circulation. Under NO circumstances are you to use ice as it will cause restriction of the blood vessels and reduce healing.

Footwear - If footwear is short or narrow they will cause more problem or leg length difference orthopaedic footwear may be necessary. Range from $250.00AUD to the skys the limit

Ointment - In Australia we use HIRUDOID - it is a vasodilator it also promotes healing

Orthotics - Depending on your requirements functional orthotics will balance your feet back to neutral.

Donald Iain Scott
Podiatrist
ESWT Therapist
Australia

Re: After ESWT, then what?

Ed Davis, DPM on 10/15/03 at 15:23 (134057)

Glen:
Leg length discrepancies are addressed via lifts incorporated into a shoe or orthotics. A complete biomechanical exam may be in order.
Ed

Re: After ESWT, then what?

Glen C. on 10/16/03 at 13:34 (134137)

Interesting...I've noted from other sources (ESWT clinics) that ice IS recommended. That seemed odd to me since increased blood circulation was an objective. The HIRUDOID cream is apparently not available through a US source, although I did find a web site that ships from NZ. Also, I found an oral vasodilator marketed to body builders. Do you have any experience with such a product?

Re: After ESWT, then what?

Donald Iain Scott on 10/17/03 at 06:13 (134258)

Glen,
If the diameter of the blood vessel is reduced via vasoconstriction(or by the use of ice), how can the body get sufficient oxygenated blood to the site of injury.
Heat packs are a medium to help with dilating the blood vessels, thus promoting oxygenated blood flow to the site and removing deoxygenated blood away from the site of injury.
I cannot recommend and oral vasodilator, you only need a topical vasodilator from the chemist. Ask them for a heparinoid
Apart from Hirudoid, Lasonil is another heparinoid.

If you go to search and look up Allan Gottliebsen from Melbourne Australia you will see that he only recommends heat after treatment.

Donald Iain Scott

Re: After ESWT, then what?

Glen C on 10/17/03 at 17:24 (134423)

Thanks Ed. Is this type exam usually conducted by an orthopaedist, or will a podiatrist be able to do it?

Re: After ESWT, then what?

Ed Davis, DPM on 10/17/03 at 20:40 (134462)

Glen:
Both professions could but podiatrists generally have more interest in this area.
Ed

Re: After ESWT, then what?

Dr. Z on 10/17/03 at 22:43 (134491)

Glen,

The shortness is a major contributing factor with pf pain. A complete biomechanical examination needs to be done.