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Ice after ESWT?

Posted by dud on 6/10/04 at 20:09 (152691)

I am hearing conflicting advice on whether to use ice after ESWT. I had the procedure done last Wednesday, and my Dr. said it was OK to use ice...

I am still having pain in foot and I am only using Tylenol..and I am stretching my legs really good twice a day and that seems to be helping.

What does everyone else take for mild pain..and do you use ice..or heat treatments????

Thanks so much..

Re: Ice after ESWT?

Dr. Z on 6/11/04 at 07:55 (152715)


We use Heat for pain. Tyleno, adavil any other the counter mediation is helpful.

Re: Ice after ESWT?

MonikaA on 6/11/04 at 13:35 (152756)

I took tylenol the first week but since then nothing. I am 2 weeks out. It is sore, but I guess I'm kind of used to it now...high tolerance for pain??

Re: Ice after ESWT?

JenniferL on 6/11/04 at 14:57 (152765)

Advil is an NSAID, so wouldn't you advise not to take that?

Re: Ice after ESWT?

Dr. Z on 6/11/04 at 15:08 (152770)

Not at the dosage that is over the counter, unless you take more then the recommended dose.

Re: Ice after ESWT?

Scott D. on 6/11/04 at 22:18 (152796)

Dr. Z,

You being one who continuously promotes the exceptional success of the Dornier FDA trials, should not decide that any part of that protocol is any more important than any other. That protocol allowed NO nsaid use post ESWT, over-the-counter or not. Aspirin, afterall, is certainly over-the-counter! And while YOU may belive that heat is better than ice, it is simplt YOUR belief. For those treatment facilities that abide by the ENTIRE protocol, please do not impose your unscientific beliefs upon their patients. Unless you have a success rate of better than 92% I suggest that you leave the protocol as is..

Re: Ice after ESWT?

Dr. Z on 6/12/04 at 08:30 (152810)

Hi Scott,
I said it was what I use.!!!!! Do you know why the FDA study didn't use NSAID for 12 weeks.?? It was to show that it was the ESWT working and not any of other treatments such as NSAID. By the way my opinions are based on 25 years of experience of treating patients,conversations with leading ESWT researchs and common sense Do you know that ICE is an anti-inflamatory modality?. It causes vaso-constriction which reduces blood flow to an area. That is the science behind ice. Heat causes vaso-dilation of blood vessels and causes increase blood flow.
What is your anesthetic protocol at your clinic? If you are blocking more then just the medial calcaneal nerve and or using IV sedation then you have just changed the FDA protocol that was used. It is my opinion and by now the entire ESWT profession ( personal conversation) that most
are using a complete Posterior Tib and sural nerve block and some times
IV sedation. This is not the original protocol . In about 75% of the FDA cases patients reported pain. With the PT/Sural block protocl in our group 95% undergo have no pain when undergoing ESWT treatment . I am willing to bet that your Doctors are using both a posterior Tib and sural nerve block and probaby IV sedation.
Soott what is going on ? Only I did was give my opinion when asked

Re: Ice after ESWT?

Scott D. on 6/12/04 at 13:21 (152821)

Dr. Z..

If you were going to bet on that one you'd lose! We only block the medial calcaneal branch of the posterial tibial nerve. Not IV sedation, not a full PT block. Whoever you got that information from was way off-base.

The use of ice (we suggest a frozen water bottle rolled under the heel for 20 minutes) 4-5 times a day IS what Dornier recommends as well.

My point is that the FDA protocol works EXCEPTIONALLY well, and until some other protocol can demonstrate a higher success rate, that it might be best to leave well enough alone.

Re: Ice after ESWT?

Dr. Z on 6/12/04 at 13:41 (152822)

I agree that the actual protocol works well. I don't agree that the blocking of just the medial calcaneal nerve works well. According to the FDA results 75% of the patients experienced pain DURING the patient. When you block Post Tib and the sural nerve the pain level is reduced to almost nothing in most cases.
I have never had Dornier recommend any ice vs heat vs nothing. There will be difference of opinion but my advice as I stated before is based on experience, personal communication with ESWT experts and common sense.
There is probaby no difference between ice and heat with ESWT but in theory heat is what you want. If ice feels better use ice if heat feels better use heat, if you feel better take your pick.
Stating that the use of heat is not scientific is false and that is what I take exception to .
I can understand why you did jump on this topic. The patient was from your clinic. All patients should take the advice of the treating ESWT clinic and or doctor.
If you trust you doctor/clinic to perform your procedure you should trust the advice that you were given to follow after the procedure

Re: Ice after ESWT?

MARK L on 6/12/04 at 16:16 (152831)

Better be careful Dr. Z before Scott calls the ESWT police and tells them you you have violated the protocall. Bt the way Scott-isn't your operation the one that raided a competitors website, got the names of their certified podiatrists, and harrased them with phone calls, letters and faxs? I'll apoligize if your aren't that operation but be careful with issuing a denial as I could have proof.

Re: Ice after ESWT?

John M on 6/12/04 at 17:22 (152833)

Scott, I admit that I'm no expert in any of this, but you don't seem to be anything but a troll looking to stir the pot. If you have a personal vendetta against someone, talk them directly via email as it's getting more and more difficult to 'ask the doctors' anything without you chiming in playing devil's advocate

Re: Ice after ESWT?

Dr. Z on 6/12/04 at 18:27 (152840)

Lets move on from this. I think the most important point from this thread is that a patient should follow the protocol that he or she has received from their treating ESWT physician.

Re: Ice after ESWT?

Pauline on 6/12/04 at 20:40 (152844)

Perhaps what you are saying to Scott should hold true for Mark as well.
I find it interesting that no matter what Mark says it's alwaly held sacred while others are charged. As I see this thread there were 3 players in this play to be held accountable Dr. Z, Scott, & Mark. Not just Scott.

Re: Ice after ESWT?

Dr. Z on 6/12/04 at 21:34 (152849)

I think you should use ice not heat. It will cool things down. Lets end this thread it serves no purpose.

Re: Ice after ESWT?

Pauline on 6/12/04 at 21:47 (152851)

Dr. Z,
It was just my point of view. The 3 of you work it out.

Re: Ice after ESWT?

Dr. Z on 6/12/04 at 22:42 (152853)


And I gave my point of view. This all started with a poster asking a question.
Now lets place some ice on this thread and move on!!

Re: Ice after ESWT?

John M on 6/12/04 at 23:10 (152856)

I apologize for my earlier comments... they weren't so much directed at Scott as the general feeling of constant wars and bickering on the board and it's getting harder and harder to wade through the arguements to find real usefull information. Again, Scott, I apologize for my earlier remarks.

Re: Ice after ESWT?

Pauline on 6/13/04 at 13:14 (152888)

It not just a matter of bickering anymore it also the 'dirty' little secrets that are thrown out as angry posts escalate. I think more goes on behind the scene than most people realize and it gets dumped out sooner or later. To that end, perhaps readers learn something.

Re: Ice after ESWT?

Donald Iain Scott on 6/15/04 at 03:45 (153010)

To All,
Dornier has stated I so have I, 'That patients are only to apply HEAT to the treatment site after ESWT'. The reason is that it acts as a vasodilator to increase the movement of oxygenated blood into the region, thus to promote healing. Go back and do searches and you will see that ice is contraindicated in cases of ESWT. I do not suggest the use of a blow torch, but a wheat pack heated for 3 minutes and applied to the site.

**WARNING WARNING** If patient is a diabetic they must test for temperature abnormalities on their body when using heat packs

Some people seem to have short memories

Good luck (dud) talk to the practitioner who treated you for ESWT.

Donald Iain Scott
ESWT Therapist