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Activites after the ESWT

Posted by Janice N on 4/27/04 at 08:57 (149625)

After you got home from the ESWT what where your activites limited to? I dont know what to expect? Do you still ice, take anti inflamm. pills? Do you walk on your foot or rest it? I know the dr will answer some of these ????? But what were your experiences? and did you have a local injection to numb your foot before it was done? I read on some sites dont inject and some said to inject.

Re: Activites after the ESWT

MARK L on 4/27/04 at 17:00 (149648)

Regional block used with FDA approved Dornier and Ossatron high energy ESWT. With the Ossatron IV sedation is also required. Very little to no discomfort during therapy if regional block is administered effectively

Low Energy ie Siemans Sonocur, multiple treatments, no regional block usually needed but long term results are in dispute- NOT FDA Approved for Plantar Fasciitis

Post therapy- no NSAID's, icing limited to the first day or so, a day or two of rest with limited walking- not necessary to be totaly off your feet.
No barefoot walking- use orthotics if you have them as much as possible- continue stretching on a daily basis- both legs calf, achilles and plantar fascia

In short- continue with all the conservative therapies your doctor has been prescribing except for the cortisone injections and NSAID's

These are general recomendations and will vary somewhat from doc to doc

e-mail me ((email removed)) if you want to discuss this with me at length- I can put you in touch with those who have had extensive experience providing FDA APPROVED HIGH ENERGY ESWT

Re: Activites after the ESWT

Dr. Z on 4/27/04 at 18:08 (149650)


You have given excellent advice and a very concise review. I do want to add from my personal experience one minor and one major addition.
We use heat to increase circulation( minor) but I will allow and use nsaid after 6-8 weeks as needs.
I do know that nsaid are contraindication for LOW energy ESWT but I see no reason to use nsaid ONLY if needed after eight weeks. This is very rare and is rarely needed due to most patients being either pain free or vastly improved within this period of time but there are going to be patient in pain and will need nsaid. until healing has finished. The inflamatory stage of healing is completed by this time so this is no real concern if the ESWT doctor does have to use nsaid.
If you recall I asked Dr. Rompe his opinion about the use of nsaid in high energy. You can search for his answer, if this is helpful for your ESWT doctors

Re: To Dr. Ed. Activites after the ESWT

Pauline on 4/27/04 at 20:36 (149659)

How do you feel about one of our posters who appears to give authoritative ESWT information, has yet, in your words 'identified themselves' but asks posters to contact them privately to be directed to the most experienced
ESWT center.?

I would think you might have some concerns about this form of advertisement. Maybe all the doctors posting here should have some concern.

Re: To pauline

MARK L on 4/27/04 at 20:55 (149661)

When are you going to stop promoting problems on this board? Every time I try to be helpful you respond with some viscous attempt at discrediting what I have to say. By the way- what are your credentials that make what you post valid? I don't remember ever seeing a statement from you that adds any credibility to your nasty backhanded posts. If you ever took the time to read my posts you'de find out that I did identify myself.
If I wanted to commercialize this board I would have posted commercial solicitations instead of inviting people to contact me privately. Doesn't Dr Z ask people to contact him at his office and I find that very professional.

Re: To pauline

Dr. Z on 4/27/04 at 21:19 (149666)


I doubt if Dr. Ed will answer you. It was my understanding that anyone could post information that they believe to be correct from their own experience. This is the WWW and the rules are different.
People will read, believe, accept and contact whoever they want to . It isn't anyones obligation to comment unless they want to out of their own free will ie Dr. Ed
Pauline why don't we all believe and accept that people have a free will to accept, understand or reject any and or all information given by anyone posting including you,me and Mark L. So lets move on if that is your choice !!

Re: To pauline

Pauline on 4/27/04 at 21:23 (149667)

Did you happen to see the post where Mark L identified himself?

Re: To pauline

Dr. Z on 4/27/04 at 21:28 (149668)

There was a post where Mark talked about where he lived and what he does
I think he stated he lived in West Virginia. I though he was just joking at the time so if went in one ear and out the other.

Re: To pauline

Pauline on 4/27/04 at 22:18 (149676)

Then everyone should know who Mark is, not just me. I remember a post where he said he would never identify himself. Makes me wonder then why it was so important to him that I post who he was if everyone already knew his identity. A little strange don't you think?

Re: To Dr. Ed. Activites after the ESWT

Ed Davis, DPM on 4/27/04 at 22:28 (149677)

At the risk of being repetitive, I have given my opinions to both you, ScottR and other readers concerning the actions of some who speak authoritatively on this board without identifying themselves. I can understand why, at times, an industry insider might want to be anonymous.
To some degree, I am considering the poster's attitude. 'Phantom Bill' was a fountain of accusations and misinformation. Mark, while having gotten into arguments with you, has been generally civil and non-accusatory. Noting his post above,again, I would simply suggest that you and Mark call a truce at this point as generating an ongoing feud on the board is fruitless and, at some point, will cause a moderator to step in again. I am all for discussing and debating principles of treatment and general ideas but as individuals, we barely know the other person, so spending too much effort personalizing issues does not get us anywhere.

Re: Activites after the ESWT

Ed Davis, DPM on 4/27/04 at 22:36 (149678)

When you discuss Sonocur, you state that long term results are 'in dispute.' I am not aware of any such disputes or any evidence to suggest that high energy ESWT has better long term results that low energy ESWT.
It is true that only two specific high energy machines, Ossatron and Dornier are approved by the FDA but the FDA has made the machines class 3 devices (necessary for sustenance of human life) and, as such, you will see the FDA clearance/approval process to be painfully slow. The FDA carries limited credibility in the eyes of many professionals -- keeping in mind that many drugs are used more 'off label' than via FDA approved uses by American physicians. We have seen a natural evolution in Canada and Europe away from high energy to low energy as those countries have had the advantage of almost a decade more experience with this modality than the US. Most researchers I have discussed these issues with are focused on the total energy delivered to tissue as opposed to how much energy is delivered at a specific time.

Re: Activites after the ESWT

Dr. Z on 4/27/04 at 22:53 (149680)

Is there any evolution from high energy to low energy in Europe and Canada? Most of the literature and European doctors I have spoken with use low energy, and never started with low energy It appears that high energy is a USA method. Yes started with research in Europe but developed in the USA market. An example is the Dornier Epos. Used in Europe in the low energy mode and then dornier requested a one treatment high energy protocol,that has taken off in the USA.
With my research I don't know of any European doctors using the dornier in the high energy mode.
I think the debate isn't high vs low but is there a difference in results if you spread out the total amount of energy or should you place 1300 mj/mm2 in one session two session or three sessions. That is where the research needs to be placed.
It is interesting that the recent comparison between low and high energy for calcification of shoulders shows high energy to more sucessful so this disproves our assumption that the total amount of energy is more important or at least it disapproved the theory for shoulders.
I still tend to favor the total amount of energy theory.

Re: Activites after the ESWT

Ed Davis, DPM on 4/28/04 at 00:23 (149683)

Keep in mind that all machines are manufactured in Europe. It is possible that some were aimed only at the US market. I don't beleive that HMT still nmanufactures the Ossatron, only the Reflctron.

Re: Activites after the ESWT

Dr. Z on 4/28/04 at 07:00 (149692)


I just would like to understand why only high energy in the USA market.

Re: Activites after the ESWT

MARK L on 4/28/04 at 07:16 (149693)

'Dispute' might have been a little strong- What a I really should have said was that I concluded from the studies that I have read that the results of low energy therapy appeared to me to be less effective than high energy. Maybe I let my bigger, faster, harder, is better type of mentality color that determination a bit.
Putting all that debate aside I feel very strongly that the results in general make the use of ESWT valid as a extension of the accepted program of conservative therapy. At a point in a patients treatment for Plantar Fasciitis that the patient is refratory and the doctor concludes that the next step to take is surgical intervention, then ESWT should be tried.

Re: Activites after the ESWT

Moderator on 4/28/04 at 08:19 (149699)

It would be nice, Mark, if you preface your posts by stating if you are a physician or not. The only problem here is that we do not know the professionalism behind your comments. We know what type of education the doctors have but we know nothing about you.

If you are a physician, fine.
If you are a person who likes to read about ESWT, fine.
If you are a technician in an ESWT clinic, fine.

Just please give a little background as to your extensive and informative knowledge of ESWT. Thats all we ask.

Re: Activites after the ESWT

MARK L on 4/28/04 at 09:01 (149701)

I am not a physicain. I am a scientist who has done medical reaseach, although not very recently. I am now a real estate developer who owns property that houses some medical facitities and among them a podiatrist that I have become friends with. A friend had ESWT with this doctor, provided by one of the largest ESWT service companys in the USA and it was very successful. I then became very interested in ESWT and have learned as much about it and the procedure as I could. My partners, the podiatrist, and I are discussing buying ESWT equipment and starting an ESWT clinic and service company. It only takes money and a medical director and we have unlimiteed sources of both. I am the poor guy in the company- most of my partners spend on a vacation what it costs to buy a Dornier or Ossatron.

Re: Activites after the ESWT

Moderator on 4/28/04 at 09:33 (149702)

Thank you Mark. That helps alot. :)

Re: To pauline

Angela A. on 4/29/04 at 09:18 (149757)

This board used to be SO very helpful and still is so some degree, but why all the back stabbing? Aren't we here for the same purpose. Like everything on the web, you take what you want from it...Does it really matter where someone is from? Let's get back to the original question..............

Re: Activites after the ESWT

Ed Davis, DPM on 4/30/04 at 19:13 (149853)

Dr. Z:
There is plenty of low energy ESWT in the US market, used on label for lateral epicondylitis and off label for PF. Keep in mind that Sonorex marketed their machines only to orthopedic surgeons so a lot a number of orthopods are using their technology. They did not market to me -- I basically went after them, traveling initially to Vancouver with a patient to see the technology. I was very impressed by what I had seen. I was amazed by how many US citizens including pro athletes had traveled to Vancouver for treatment.

Re: Activites after the ESWT

Dr. Z on 4/30/04 at 19:20 (149854)

I understand that Siemans only markets low energy. What I would like to know is why Dornier who makes a low, medium and high energy ESWT devices and happens to be the world leader for ESWT/ESWL chose high energy in the US market. It just an obseravation that I have no real answer for,that is why I asked the question.

Re: Activites after the ESWT

Ed Davis, DPM on 4/30/04 at 19:21 (149855)

Understood. Yes, we in the US tend to have an inherent bias toward 'bigger=better.' Considering what I have seen in Vancouver, my personal experience and the expereince emanating from Europe I have come to the conclusion that the difference in efficacies are not significant.
That being said, there needs to be and will be, eventually, a lot more research comparing efficacies of various energy levels and protocols among different body regions. I have seen some absolutely remarkable results in achilles tendoinosis with low energy. Tendinosis is, essentially, a pre-rupture condition that is difficult to cure by 'conventional' means. There seems to be a general concensus that high energy is to be used if PF release surgery has been attempted and failed.

Re: Activites after the ESWT

Dr. Z on 4/30/04 at 21:29 (149865)


How many total mj/mm2 are you using for achilles tendinosis?