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I did it again...

Posted by goose on 5/19/04 at 18:43 (150881)

had ESWT on both feet today. It was more painful this time because I only had partial numbing -last time I had a whole nerve block. The shots hurt bad and the ESWT was very uncomfortable, but I made it. My feet are swollen and bruised from the shots but otherwise okay. The tech said he has seen retreatment help reduce PF 80%-100%. Let's hope!

I plan to take it really easy for the next few weeks. Any idea of how long until I can ride my bike? They warned me about doing too much too soon. I'll keep you posted!

g

Re: I did it again...

Pauline on 5/19/04 at 21:50 (150889)

Goose,
If you're really serious about getting the most help possible from your second treatment if it were me I'd concentrate more on taking it easy allowing your foot to heal.

Sometimes thinking about things differently helps one to make good decisions. Picture a balance scale in your mind. Put rest and healing on one side and bike riding on the other. Which side out weighs the other?

Re: I did it again...

Robert J on 5/19/04 at 23:24 (150890)

Goose--

Please let us know how this second ESWT treatment turns out. As I recall, you're an atypical PF person with a marvelous insurance plan that pays for multiple ESWT treatments. This is great because you can serve as a guinea pig for atypicals and ESWT. Hey, if it works for you, it might work for others. So let us know.

Re: To Robert J

Steve G on 5/20/04 at 00:08 (150894)

I think the question with 'atypical' is whether you have pain at the insertion point. If you do, you are likely to get some benefit from the treatment, if not, then no. Although I have atypical PF, alot of my pain was in the heel, and, although, it did not cure me, I definitely benefited from the treatment.

If the pain is mainly in the arch (or the whole bottom of your foot hurts), you are not likely to see much difference

Re: I did it again...

goose on 5/20/04 at 07:08 (150895)

Thanks for the input. I do plan to take it very easy! For commuting purposes, I either rode the bus (which involved walking to and from) or I biked. So, I am trying to line up rides from my husband and family to eliminate both, however part of me is hoping that sometime this summer I can be independent. If not, oh well. Curing my PF is my main priority!

I am an atypical case. I got PF in one day after a long run and it does hurt at the insertion point however it is not a sharp pain in the heel- it is a deep ache just a bit above the heel, below the arch area. The doc measured my PF with ulta-sound and they measured R=3.8mm and L=3.6mm, down from 4mm last time. He once saw a lady who was llmm! I guess this is not far off of normal, so that is good. My pod is hopeful and so am I. Quite sore in the heel this morning from the shots but that will recover. He acts like I will run again but I know I won't. I am not going through this again! Yes, I do have great insurance, thankfully!

In better news, I am going to see Jimmy Buffet in concert tonight. I already have plans to get a piggy back ride from the parking lot to my seat where I will stay seated! But it will be fun anyway!

Thanks!
g

Re: I did it again...

Robert J on 5/20/04 at 13:07 (150910)

goose --

Your symptoms sounded exactly like mine, so I am doubly curious about the outcome. I think Steve's comments about ESWT being effective mainly at the insertion point constitute the conventional wisdom. I also think that the atypical pain at the insertion point is substantially different from classic PF. I'm talking about the dull pain of the atypical versus

Re: I did it again...

Robert J on 5/20/04 at 13:12 (150912)

goose --

Your symptoms sounded exactly like mine, so I am doubly curious about the outcome. I think Steve's comments about ESWT being effective mainly at the insertion point constitute the experience of most atypicals who've tried it, but who knows?. I also think that the atypical pain at the insertion point is substantially different from classic PF. I'm talking about the dull pain of the atypical versus the sharp pain of the classic version. Did your ESWT people try to modify their technique to take care of the under-arch pain at all? I don't even know if that's possible; just curious

Re: I did it again...

goose on 5/20/04 at 15:57 (150917)

Yes, they did try to get at where my pain is. My doc marked my sore spots and the tech tried to 'get' them. The tech has done over 400 feet and many in athletes, so is familiar with runners who have cases like mine. My thought is that if the tissue is diseased/inflammed, even if it is atypical, the ESWT should help promote healing as long as they aim for the sore spots. Even if it helps some, I will be happy with that! I will keep you posted...

Re: To Robert J

MARK L on 5/22/04 at 07:37 (151019)

Your heel should not be painful and swollen from the injections- the block given should be a Posterior Tibial or Medial Cancaneal with a very shallow injection to the sural nerve on the lateral side. These blocks, properly administered, can be effective with as little as 5cc for both sites. This puts no anesthetic into the heel or treatment area. Moreover, the location of your pain and the fact that the thickness of your plantar fascia is under 4mm leaves me wondering if you really have traction degeneration of the plantar fascia at the medial tubercle and hence the less than desirable results from ESWT.

Re: To Robert J

Pauline on 5/22/04 at 14:15 (151036)

Mark,
Your theory is an interesting one. Could you explain more about traction degeneration of the plantar fascia at the medial tubercle? How does it differ from normal P.F. in terms of symptoms? Is this the only place that it would occur or is it possible to find it the entire length of the Plantar Fascia.

Does any one test help determine or confirm the diagnosis of this condition?

Re: To Robert J

goose on 5/22/04 at 14:57 (151040)

Hi,

What does that mean? How is treatment and/or recovery different?

Re: To Robert J

Dr. Z on 5/22/04 at 15:56 (151044)

Pauline,

The fact that the thickness of the plantar fascia is normal is one factor that is used to confirm if there is plantar fasciitis present. You must rule out other causes such as local nerve entrapment, TTS, etc. I just upgraded my ultrasound machine that will show the plantar fascia in 3-D view. It will also allow me to determine if there is blood flow which indicates inflamation. It is amazing the advantages with ultrasound. The unit I now have is as good if not better then an MRI for soft tissue evaluation. I oould even see a stress fracture and check the age of the injury by blood flow measurement.

Re: To Robert J

MARK L on 5/22/04 at 18:57 (151046)

It was simply a way to describe what has happened to the plantar fascia and where it has occured. The fascia has lost it's ability to strech when the foot pronates, (flattens), and this occurs where it attaches to the heel. This is the condition that the studies focused on.
Maybe Dr Z or Ed would like to edit this if they think it's not clear enough.

Re: To Robert J

Pauline on 5/22/04 at 21:17 (151051)

Dr. Z,
I thought when P.F. is present the thickness of the actual P.F. is thicker than normal thus accounting for the presence of inflammation. The thicker the P.F. the more inflammation.

Am I understanding correctly in your first sentence? 'The fact that the thickness of the P.F. is Normal is one factor that is used to confirm if there is Plantar Fascittis present.'

I thought during the discussions on the advantages of using a machine that had the ultrasound component was that it could be used to measure the increased P.F. thickness caused by having P.F. and thus confirm the diagnosis. Then after ESWT treatment it could be used again to measure the decrease in swelling of the P.F. showing improvement.

Is this incorrect?

Re: To Robert J

Dr. Z on 5/22/04 at 21:33 (151052)

It should read that it is one factor to confirm that it is absent not present.
Since there is no inflamatory process going on with plantar fasiosis the post eswt changes are actually the replace of abnormal tissue.
In the acute phase of plantar fasciitis there is swelling and some of the increase thickness is due to swelling. When there is a fasciosis present there is a poor blood supply to the area and thus no inflamatory process.

What I like about the new generation of ultrasound devices is that I can determine if there is a blood supply to the area. This would mean that you can make that determination without going thru multiple treatments which may or may not work. You could also determine your type of treatment sooner.. The test would determine the vascular to the plantar fascia

Re: To Robert J

Pauline on 5/22/04 at 21:40 (151053)

So it sounds possible that in a person with an atypical case of P.F. the fascia has not only lost it ability to stretch where it attaches to the heel, but possibly along it's entire length.

I wonder now just how much flexibility is there in a healthy P.F, it's degree of flexibility.

What is so confusing and frustrating is the fact that there are many people with very flat feet yet not all of them suffer from P.F. regardless of how flat their feet are? They walk in flip/flops all day long and never seem to have a problem. The same with people that are grossly over weight. Some look too big for their feet to support them, yet still they don't have P.F. Their P.F's. must be super stretched to be so flat or flattened by their weight yet no P.F. I'm certain that each of us have seen people like this at a mall and wonder why they don't suffer from P.F.

Re: To Robert J

Pauline on 5/22/04 at 21:50 (151054)

Thanks. Glad I caught that so it could be corrected. It didn't sound quite right after all the P.F. thickness discussions that were posted so I thought I'd check.

Re: I did it again...

TamaraP on 5/26/04 at 05:07 (151264)

I'm curious about where you got your ESWT treatment? I'm in the US Air Force and stationed overseas, but would come back and pay for treatment if I thought it would help. I have the atypical type of PF with the deep ache and no pain in the mornings. I'm trying casting right now, but am not sure it's really working. What are you refering to when you in talk about the insertion point, I'm not familiar with this term?

Re: I did it again...

Pauline on 5/26/04 at 16:36 (151333)

Tamara,
You may not have to come back. Here is a recent post from Sunny who himself have been treating patients for a long time. It's a response to
another poster looking for treatment overseas.

Re: ESWT in Europe view thread
Posted by J. P. (Sunny) Jacob on 5/11/04 at 20:12

Oliver L.,
As recommended elsewhere, Dr. Rompe is a Professor of Orthopedics at the Faculty of Medicine, University of Mainz, Germany, my Alma mater. He is one of the leading researchers in ESWT. However, I am not certain if he is involved with an ESWT clinic that treats patients on a routine basis.
You may also check with a clinic operated by Dr. Dahmen, another well experienced orthopedic surgeon who does ESWT treatment on a regular basis. This clinic is in Hamburg, Germany. Dr. Dahmen also recommends 3-session (low intensity) treatment several days apart, with light physiotherapy. His website is http://www.eswt.com
If you need more details regarding this you can contact me by email at (email removed)
Posted to Category: ESWT