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To ESWT or not??? Seeking advice!

Posted by Mary R. on 1/23/04 at 21:25 (142766)


I'm currently deciding whether to have the ESWT or not. I have had PF in both heels ever since I delivered my second child. (8 months) I am a healthy, active 28 year old stay-at-home mom and have a toddler and young baby to run after. I am still nursing my baby so I can't try the cortisone shots. I wear orthotics everyday, I stretch, exercise and try to rest but don't have much down-time with kids!!! I play basketball and do aerobics and lift weights in order to lose the baby weight I put on during pregnancy. I am so tired of foot pain and my podiatrist's suggestion is the ESWT. Would anyone suggest NOT doing it? I certainly can't afford to be off my feet with two little ones and I can't/won't stop nursing until my daughter is at least 12 months. Just wondering if this is something I should steer clear of until later or if it sounds like a good idea? Also, how long will I need to stop exercising? I love playing ball so I hope it's not long! Thanks for all the responses in advance!

Mary :)

Re: To ESWT or not??? Seeking advice!

Rehana M on 1/24/04 at 00:14 (142770)

I highly recommend EZ RUNNER custom fluid silicone orthotics!
The orthotics are so comfortable and allow your Plantar Fasciatis to
feel almost immediate relief.Of course it takes a little time to see permanent results.In my case i was able to run the first day 6 miles with no adjustment period,and even if i didn't have a problem, purchasing these
orthotics has created less foot fatigue.Since it is not such a costly
endeavor and if you are not satisfied,
you can get your money back!

Sincerely Rehana.

Re: To ESWT or not??? Seeking advice!

Julie on 1/24/04 at 02:47 (142771)

Mary, I'm sure you will get a professional response to your question about ESWT. If you are a candidate for it, it may well be a good idea for you. But you also need to consider that just about all your activities - aerobics, basketball, and possibly even stretching, depending on what stretching you are doing, are making it very difficult for your feet to heal. PF is a repetitive motion injury and the injured tissues need rest in order to heal. Impact exercise is really contra-indicated.

Obviously you have to be on your feet a lot to look after your babies, but apart from that you should stay off them as much as you can. You clearly feel you need to continue exercising, and of course that's important for your health and well-being. But see if you can't switch to something non-weightbearing: swimming is probably best, but the recumbent bike seems to be all right for many people. As for stretching, you need exercises that are targeted at strengthening the muscles of your feet. The yoga foot exercises I've posted here have been helpful, and Mike Wilmot's Foot Trainer is excellent.

Read the heel pain book for information about PF and treatments for it. Most people recover with conservative treatment (which includes rest) and ESWT, if all else has failed, is the preferred option before considering surgery. The thing is, you don't know if 'all else has failed' unless you give treatments a chance to work, and that does mean rest: i.e. staying off impact sports.

Re: To ESWT or not??? Seeking advice!

Dr. Zuckerman on 1/24/04 at 07:41 (142773)


ESWT is an excellent non-invasive procedure, that will keep you ambulatory. There are very specific indications for this procedure. You must have insertional plantar fasciitis and your pain must be when you sit and then try to walk . This is usually in the AM or in the middle of the nite when you get up to feed the baby and or go to the bedroom. Please feel free to ask any question that you may have

Re: To ESWT or not??? Seeking advice!

BrianG on 1/24/04 at 19:28 (142790)

Hi Mary,

I believe that you are still in that 1 year period that you will be most likely to cure your PF, by conventional means. Unless your insurance is willing to pay for the ESWT, I'd wait 4 more months. BUT, as Julie mentioned, your going to have to give up some of your activities. I know thats not what you want to hear, but it's the truth. The aerobics, basketball, etc, are all high impact sports for your heels. The sports, along with your pregnancy most likely contrubuted to your PF. It's time to take a break from your sports, rest your feet, ice a couple times a day, and tape if necessary. Can I tell you how long this will take, no. Everyone heals at different rates. I can tell you that if you keep up with all your activities (like I did) you run the posibility of having PF for 10 years, or much longer.

I didn't have this website unfortunatly, and I thought I could just walk through the pain, big mistake. I now have chronic pain 7x24, and am unable to work. You don't want to join my club!!!

Good luck

Re: To ESWT or not??? Seeking advice!

Mary R. on 1/24/04 at 22:26 (142793)

Thank you for your suggestion! Where would I find such a thing? Are they custom fitted thru the podiatrist? I really hate to give up exercising and if these can help, I'm all for it!!

thanks for your comments!
Mary :)

Re: To ESWT or not??? Seeking advice!

Mary R. on 1/24/04 at 22:31 (142794)

Thank you Julie for your response! And thanks for the info! I had no idea that PF was a repetitive motion injury. My podiatrist has never mentioned that to me, nor suggested me cutting back on anything! It was never even brought up really! He just said, 'Yep, you've got PF and let's make you some orthotics!' It's not getting any better and so he's suggestion EWST. I called my insurance and they will cover it but I certainly don't want to do anything that will make it harder to get better or more difficult to be a good mom and homemaker!

I'll definitely try the yoga exercises. what is Mike Wilmot's Foot trainer? And what heel pain book do you suggest?

How long are we talking about avoiding impact sports? And would lifting weights be impact? Load-bearing but impact, I'm not sure?!

Mary :)

Re: To ESWT or not??? Seeking advice!

Mary R. on 1/24/04 at 22:48 (142797)

Thank you Dr. Zuckerman! I've read about people experiencing 'set-backs' or worsening after the procedure and wasn't quite sure what that meant!? Is there truly no down time? I can't afford to be off my feet and with two little ones it's nearly impossible while my hubby is working. And how long are we supposed to avoid impact sports afterwards? What about low impact aerobics?

What is the distinction of 'insertional PF'? Yes, my pain is definitely worse first thing in the am and when i've been sitting for a while.

Should orthotics be helping it at all? It doesn't seem to have gotten any better? My arches are now burning and my ankles are starting to be sore. Also, when my podiatrist taped my foot it felt perfect a day or two later. Wouldn't taping it more often help? Okay, and just one more question if you don't mind...what type of shoes are best to wear the orthotics in? Currently, I just have the type for athletic shoes and so I've been wearing those day in and day out with very little exception. I didn't know if maybe the shoes were contributing to my feet not healing faster/aching feeling all over my feet? I'm wearing New Balance women's running shoes... i think 640's?

Thanks for your help!
Mary :)

Re: To ESWT or not??? Seeking advice!

Mary R. on 1/24/04 at 22:57 (142798)

Hi Brian-
thanks for your advice! No, I definitely don't want to hear that I have to give up my exercise...I certainly don't want to suffer with this much longer though! How do I tape myself? I would love to know because that really helped when my podiatrist did it!

I'm sorry to hear about your chronic pain. That is scary and I do want to avoid that! my ins DOES cover EWST, thank goodness. And unless I hear of some really awful experiences I'm all for getting rid of this for good.

What irks me is that my pod never mentioned anything other than orthotics, cortisone shots (which i can't do as i'm still breastfeeding my baby) EWST and surgery. No mention of stretching, good shoes, rest, ice, massage, avoiding sports...nothing! I really hate that! Thank heavens for this website! i'm getting some great info!

Thanks for your response!
Mary :)

Re: To ESWT or not??? Seeking advice!

Julie on 1/25/04 at 02:21 (142801)


The heel pain book is available on this website. Just click on the blue words: heel pain book. It will give you a great deal of information - and knowledge, as we know, is power.

There are podiatrists and podiatrists. Yours has been giving you very short shrift: no wonder you're irked. He really ought to know better, and if you want to get over your PF you ought to find another. A good practitioner will be more forthcoming with treatment modalities that address the cause of your PF, and will work with you until you are better. You certainly ought to have been given advice about your level and kind of activity.

Well, you've had it now, and it's up to you what you do about it. No-one can answer the question 'how long off impact sports'? It takes as long as it takes, and although I don't want you to be unduly pessimistic, you might find it takes a good while in your case as you are limited in the amount of rest you can give your feet because of the children. Carrying them is also a factor: you're asking your feet to bear more weight.

You'll find instructions for taping in part 2 of the heel pain book. You may find it helpful: I regard taping as one of the major factors in my recovery. My PF resolved three years ago, within six months: I was lucky to find this website, and to have a good podiatrist. I gave up all recreational walking for that time, but everybody has their own healing time and no-one can tell you how long it will take. All I can say is that staying away from weight-bearing exercise is the most important thing for you to do, for however long it takes.

Insertional PF means that your plantar fascia has begun to pull away from the point at which it inserts at the calcaneus (heel bone). This is on the medial side of the heel, an inch or so away from the back of the heel. There is a picture at the beginning of the heel pain book. If this spot is pushed, the pain will be intense. I expect your podiatrist did this: it's the basic diagnostic test.

Brian has told you the bad news: that PF can and does become chronic if not taken seriously and treated correctly. It can also lead to other foot ailments, and it concerns me that you are now having pain in your arches and ankles. Please find another doctor - and inform yourself by reading the heel pain book.

Re: To ESWT or not??? Seeking advice!

Julie on 1/25/04 at 02:34 (142802)


I see I didn't answer all your questions. Mike Wilmot's foot trainer is an exercise tool for strengthening the intrinsic muscles of the feet. Look at his website: http://www.foottrainer.com for details. It is a very good product.

Rehana's post about EZ Runner orthotics is, I'm afraid, a bit of spam of the sort that occasionally appears here.

Light weights are probably all right. I'd be inclined to avoid the heavy stuff.

There are many styles of New Balance shoes. Some are more appropriate for PF than others. Your new podiatrist :) should be able to advise you - or you may get some ideas from other posters here or from our resident pedorthist, Richard. Ask a question on the Inserts, Orthotics, Shoes board.

Now I am going to stick my neck out and say that I sense from your posts that it is going to be difficult for you to change your activity level and that is understandable because you love your chosen activities. You want to 'do something' that will make PF go away quickly, and ESWT has been suggested. I have no doubts about ESWT as a great treatment for PF. But you, as the patient, have to take responsibility for how you treat your feet, and I don't think there is any point in your having ESWT unless you are prepared to do that.

I hope this doesn't sound harsh: I don't mean it to be. In more than three years here I have 'met' I don't know how many people who deeply regret running, or walking, or working, through the pain. I don't want you to join their ranks.

Re: To ESWT or not??? Seeking advice!

Julie on 1/25/04 at 02:49 (142803)

Mary, I gave you the url for the Foot Trainer website. I've just had another look at it, and you should read the whole section on plantar fasciitis. It's relatively brief, and a very good resume of the basic things you should know. When you get to the site, click on Plantar Fasciitis and then on each of the subheadings in turn.

Re: To ESWT or not??? Seeking advice!

Dr. Zuckerman on 1/25/04 at 08:00 (142805)


Insertional means where the plantar fascia attaches to the bottom on the heel bone. ESWT isn't indicated for plantar in the arch or in the ball of the foot.
An orthosis must fit into the shoe and not make your arch or heel slip out.
Make sure you take out the insoles already present in the shoe for a proper shoe fit
It does take time for the orthosis to adjust your foot- about six weeks
Taping is an excellent treatment and so is proper stretching.
Maybe it times to get a second opionion if you feel you aren't getting all the advice you want from your doctor.

Re: To ESWT or not??? Seeking advice!

Dr. Zuckerman on 1/25/04 at 08:02 (142806)

Great advice

Re: YES TO ESWT!!!!!!

Lauren on 1/27/04 at 15:22 (142969)

I had eswt six months ago and am 100% cured. I even got reimbursed by my insurance company for half!! I was told I am the first Cigna patient to get reimbursed!! I had the sonocur treatment (low power) on the right foot and ossitron (high Power) on the left. The left was treated post surgery. The surgery was a failure. I highly reccommend ESWT. I suffered for three years and walked on my toes all the time!! I had the procedure done by Dr. Peter Wishney In NJ. Good Luck....

Re: YES TO ESWT!!!!!!

Dr. Z on 1/27/04 at 18:49 (142987)

Glad you did great. Dr. Wishnie has been using the dornier epos since we first introduce it in New Jersey also two years ago. Dr. W is an excellent heel pain specialist

Re: YES TO ESWT!!!!!!

Jen L on 1/27/04 at 20:44 (142995)


I am puzzled by your post. As far as I was told, Dr. Wishnie uses Dornie machine only and this is consistent with Dr.Z's comment. Did you get one of your feet treated by Dr.W and the other with low energy Sonocur by another doc? If so, how can you compare the different treatments? I know you are cured, but is there any difference in respect to the time it takes to feel the full effect etc.?
Thank you for your input.

Re: Julie!

Mary R. on 1/28/04 at 13:56 (143064)

Thanks for all your help and your suggestions and answers to my questions! What a godsend you are!

I am reading the heel pain book! Great information! All I see in regards to taping is pictures? Is that right?

I've been staying off the basketball and high-impact aerobics. I wonder if yoga is okay? And I'm checking on swimming pools in our area! Definitely don't want this to progress or worsen!

And I'm scheduled to go see another podiatrist to get a second opinion and see what she suggests about getting better!

Thanks again Julie!
Mary :)

Re: Dr. Zuckerman

Mary R. on 1/28/04 at 14:02 (143065)

Dr. Zuckerman-
Thanks for all the advice! I took the insoles out of my shoes (was never even mentioned by my pod) and WHAT A DIFFERENCE!! Maybe part of the achy feeling in my feet was due to squishing my feet in there?! I did put a Dr. Scholls insole UNDER the orthotic (size of half my foot-no padding on top) cause the inside of the shoe felt a bit rough...is that okay to do? It's much thinner and flimsier than the NB insole!

I'm going to see another podiatrist in a few days! Hoping to get another and more detailed opinion!

Thanks for all your help-
Mary :)

Re: YES TO ESWT!!!!!!

Mary R. on 1/28/04 at 14:04 (143066)

Thanks for your suggestion! I am definitely thinking about it! I hate the pain! Glad everything worked out for you!
Mary :)

Re: To ESWT or not??? Seeking advice!

BrianG on 1/30/04 at 21:10 (143287)

Hi Mary,

A lot of Pods still do not want to educate themselves to the advantages of ESWT, or many of the the other solutions that you mentioned. I have one myself, at the HMO that I belong to. I wished I could have proved to him it worked, but so far I haven't had the relief.

As far as taping, there are a couple of suggestions. You could go back to your Pod and have him tape you. Watch carefully, and take notes if you feel you have to. You can also look around this web site for 'Scott's Book'. It has a section of 2-3 different ways to tape. You can also use the 'search' feature, but I'm not sure how long that will take.

Good luck

Re: Julie!

Julie on 1/30/04 at 21:50 (143292)

Hi Mary

I caught a glimpse of your latest post the other day and then lost it before I could respond. Now Brian's has led me back to it.

I wish I could tell you that 'yoga is ok'. Yoga has been an important part of my life for over 30 years. It has been a constant support and source of strength and healing, for me and for those I have taught for the last 16 years. So I would certainly like to be able to recommend it to you, but the fact is that many, if not most, ordinary classes wouldn't be useful.

The physical activity is really only one aspect of yoga; there is much more to it, but most classes teach only the postures, and many of the 'systems', or 'styles' of yoga aren't suitable for someone with foot pain. The Iyengar system involves a lot of standing work, the Ashtanga Vinyasa system is dynamic and too fast for you to be able to decide whether something is going to hurt you before you've hurt yourself, and the same goes for Bikram Yoga which is very popular in the States. If you could find a remedial class, one specifically designed for people with problems of one sort or another, then yes, it would be worth trying. Otherwise I really think you should stick with gentle, non-weight-bearing exercise.

Relaxation and meditation, which are important aspects of yoga, would certainly be helpful. You could search out a teacher and a class where these are emphasised, or investigate the many CDs and audio cassettes that are available.

Yes, as far as I can recall the taping section in the heel pain book (which, by the way, is the 'Scott's book' Brian mentions) does consist of just pictures, no verbal instructions. But if you do a search on ' taping'. or ' tape', you will find many past posts, including many by me, that give advice about how to do it. The most important thing is to get the tension right: too loose and it won't support, too tight and it will hurt! It's the angle at which you hold your foot while taping that determines the tension, and that you need to experiment with. I would also suggest that you use a good medical grade tape which is less likely to irritate the skin than an industrial tape. And be careful how you remove it - peel it slowly back. 'Ripping' it off can take your skin with it.

Glad you're staying off the impact sports and seeing another pod.

Best of luck - with your positive and sensible attitude I'm sure you'll conquer PF.

Re: Julie!

Julie on 1/30/04 at 22:22 (143295)

Mary, there is actually plenty of information on taping in the heel pain book. It's so long since I've read/needed it that I'd forgotten. You can search the book yourself, but here's a link to most of what's there: