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General Q and ESWT vs Iontophoresis

Posted by Scott Mc on 7/13/04 at 14:19 (155325)

I have had PF in both feet for about 2 years and had about every treatment (rest, taping, icing, orthotics, anti-inflammatories, 2 cortisone shots, night splints, stretching, PT, massage, ultrasound). I had it 15 years ago and orthotics and cortisone got rid of it in a month. Is is tougher 2nd time around and when in both feet?

Two DPMs have told me that surgery would not help on such high-arched feet and recommend ESWT. I have ESWT scheduled but BCBS refuses to cover it--I will appeal but costs continue to mount (travel, motels, physician fees, etc.) A PT friend of mine swears by iontophoresis but it is seems rarely covered as a treatment for PF. How about a brief discussion of iontophoresis (compared to ESWT)? Are insurance companies denying iontopharesis also? What are my options at this point (beside going broke getting the ESWT)?

Re: General Q and ESWT vs Iontophoresis

Ed Davis, DPM on 7/13/04 at 14:24 (155328)

Iontophoresis is a means to get cortisone through the skin without use of a shot; it does so gradually. ESWT uses shock waves to induce the body to heal the fascia -- very different.

Do some shopping around because prices for ESWT vary, some docs have payment plans (Dr. Z has one) and there is always the option of going to Canada where the fees are lower -- see the ESWT board. Where do you live?

Re: General Q and ESWT vs Iontophoresis

Dr. Z on 7/13/04 at 14:32 (155329)


Iontophoresis is a form of physical therapy. It places a local steriod and sometimes acetic acid into the tissue. If the tissue is degenerative it will have very little potential in helping you. If your pf is inflamed it could help. The problem is the depth of penetration of the medication
into these areas. It is much better with tendons that are close to the skin and the plantar fascia isn't close.
ESWT is used to micro-trauma the tissue to stimulate healing by breaking down the degenerative tissue and allowing the body to re-heal the area
So if the tissue is inflamed which is what we call fasciitis then ionophoresis could be useful. If the tissue is degenerative which is what we call plantar fasciosis then ESWT can be used to microtrauma the degenerative tissue. The method by which it does this is called cavitation.
This is where the ESWT soundwaves hit the tissue which is made up of water it then forms water bubble on a cellular level and this creates the micro-trauma or a stress forces on this specific area.
What should you do?

IF you have first step pain when you sit and then get up and there is discrete pain at the plantar fascia insertion, and all nerve entrapment have been ruled out , and the ultrasound and or mri is abnormal then I would have ESWT.
We offer ESWT at a very fair price and I would be happy to send you information just e-mail Dr. Z at (email removed). I would be also be happy to continue this discussion. Feel free to ask any questions.
You have some difficult dicisions to make!!

Re: General Q and ESWT vs Iontophoresis

Scott Mc on 7/13/04 at 14:43 (155332)

Thanks, but why would cortisone thru via iontophoresis be a better treatment than a cortisone injection (of which I've had 2--each effective for only a few days)? Also, I guess I'm asking, which is generally considered more effective -- ESWT or iontophoresis? As I live in Montana, availability of machines is limited to a truck-mounted Ossatron that shows up in Missoula every couple months. I have already made the $1250 payment arrangements with the Ossatron folks (HTO) and now the orthopaedist (again, no choice--he's the only one available) is wanting his payment. Without insurance coverage, seems like traveling further would just continuing to adding to my costs.

Re: General Q and ESWT vs Iontophoresis

Ed Davis, DPM on 7/13/04 at 19:59 (155357)

Good point. If you did not have a good response to a cortisone injection, I would not expect ionto to have a good response. Use the search feature to look at what I call the 'treatment triad.' If there is a large inflammatory component, that is early PF or acute PF, then anti-inflammatories are more likely to help.

Considering your location, if the $1250 is 'all inclusive,' it is a pretty good deal and travel costs from your locale are unlikely to save you much. Ossatron is often done in a surgicenter so there are surgicenter and anesthesia costs involved usually. If that is not the case in your situation, your out of pocket costs seem reasonable.