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ESWT: treatment and insurance questions

Posted by Robin C. on 10/15/03 at 14:47 (134053)

Hi - I'm in Atlanta, GA and I'm in the process of getting the ESWT treatment for heel spurs/Plantar fasciitis in both feet. I've been having extreme problems with this for going on 9 months now and only found out about this treatment from my podiatrist @ 2 months ago when I first went to him* I had been seeing my othorpedic specialist initially, then he referred me to podiatrist). I've had the usual cortisone shots but not much success with that or the stretching exercises, etc. The cortisone only makes me gain more weight, which is a problem anyway. I can only walk when I first get up in the morning by using a walker. I'm just about insane at this point from the constant lack of mobility and pain.(I also have Morton's neuroma in right foot - had surgery to remove years ago but it grew back).

My insurance coverage is Aetna/US Healthcare who told the doctor's ifc they they won't pay for any part of the ESWT (we have the PPO plan).
They cover cortisone shots forever apparently, and will cover the invasive surgery but NOT the ESWT because they say it's 'experimental' though it's been FDA approved for almost 2 years. I've just been researching to get more info on the Dornier EPOS machine and process and plan to call Aetna to complain. If you have any info that will help my case with Aetna, please let me know. I noticed in one of your replies that US Healthcare pays?

Also, if you have any info on the following, I would appreciate it: I went for the ESWT treatment this past Monday (the mobile ESWT technician came to my podiatrist's office w/the Dornier machine). My podiatrist gave me multiple injections of lidocaine around my heel/ankle to numb it before the ESWT began. However, even with a pretty numb foot/heel, after a few minutes I couldn't take the pain from the therapy and they had to stop it. I could only tolerate about 50% of the frequency/strength or whatever it's called that the technician said was necessary to complete the treatment. My doctor is trying to find a facility where he can sedate me not completely under anesthesia but not just numbing the foot) and we will try again. I'm very disappointed and now I'm also confused because from what I've read about this process with the Dornier machine, the numbing of the foot isn't supposed to be necessary at all because there shouldn't be ANY pain associated with the treatment?? I was quite tense at the time(I hate shots!) and my ankles/lower legs were slightly swollen from edema. Could that have an negative effect on the process?
Any info you have would be greatly appreciated!
Robin C

Re: ESWT: treatment and insurance questions

Ed Davis, DPM on 10/15/03 at 15:35 (134060)


ESWT is not a stand alone treatment for PF. You have not discussed what else you have had done for the problem. Read Scott's Heel Pain Book on this site so you understand the full scope of treatment for this.

Usually, numbing the area is adequate to make the treatment tolerable but it does not take away all of the pain. The type of block generally used is a medial calcaneal block which does not make the area totally numb, but numb enough to do the procedure. If more is needed, an ankle block could be performed to completely numb your foot and that could be done in the office.

Re: ESWT: treatment and insurance questions

Dr. Z on 10/15/03 at 16:19 (134064)

We use a complete ankle block with a special modification to ensure complete anesthesia. Sometimes an oral and or IM sedation is needed but this is very rare.
Dr Ed is right on when he tells you to read the heel pain book. It has an amazing list of pf treatments and explanation.

Re: ESWT: treatment and insurance questions

Robin C. on 10/15/03 at 18:21 (134072)

I'd mentioned in the 1st post that we'd tried cortisone shots and I always do the stretching. Also wearing custom $350 orthotics, using ice, resting my feet, celebrex(had been taking that off/on for other problems), heat, massage, pain cremes and gels, good supportive shoes(wearing good shoes already-Morton's neuroma). Have also tried taping and to a lesser degree, night splints. I'm very tenacious about fixing problems and we only got to the ESWT as a last resort. The only thing that's outstanding is losing weight. I'm in a catch-22 since I can't exercise as usual due to the pain in both feet and modifying the diet doesn't work very well for me w/o exercise. Started eating fresh pineapple a week ago after hearing it might help w/inflammation. Anyway, thanks to both of you for the very fast responses. You're great to provide this kind of help.

Re: ESWT: treatment and insurance questions

Robin C. on 10/15/03 at 18:23 (134073)

Forgot this - I believe the doctor referred to the numbing he did as a 'block' but didn't totally work - I suggested they whack me on the head with a big stick(haha)

Re: ESWT: treatment and insurance questions

Mandy G. on 10/21/03 at 19:48 (134865)

I had Orthotripsy (Ossatron) surgery 10/17/03 and my doc put me out to have it done because he said I wouldn't be able to handle the pain. He knows me well! I had a terrible time with the injections so having anesthesia was great for me. I felt NOTHING and had no pain for several days after. I am having some now though but I hear it is normal considering the trauma that the foot went through. Maybe you could try it again......