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Question for the doctors, please

Posted by Heather on 8/14/04 at 13:27 (157852)

I had bilateral orthotripsy 2 weeks ago after years of plantar fascitis. The first week, my feet felt a little sore, and then it started to feel better. However, the last week, it has been feeling worse than it did prior to the proceedure. Driving a car long distances and just standing in place at church are sooooooo painful. Is this typical after surgery? Does my pain suggest that the surgery was unsuccessful? I have been doing calf stretches, via heels off a step? Is it okay to use ice after the proceedure?

Re: Question for the doctors, please

Dr.David Wander on 8/14/04 at 14:36 (157855)

It is not unusual following ESWT for patients to experience periods of immediate improvement followed by a temporary recurrence of the symptoms. This often cycles from relief, to discomfort, to relief, etc. That's why we tell patients to wait for 16 weeks to determine whether the treatment is successful. It also depends on the type of ESWT you've had. In your message you asked whether discomfort was typical following surgery, but you've stated that you've had orthotripsy which would imply you've had ESWT (surgery on the 'spur' is osteotripsy). My comments are based on ESWT treatment. Dr. Z is strongly in favor of heat on the area, and Dr. Weil (in Chicago) is opposed to heat and uses ice. Both of these doctors have significant experience. I personally am not a big fan of heat. The idea behind ice is to reduce inflammation, and ESWT is basically causing an acute inflammation, that's why Dr. Z likes heat because it increases local circulation and does not compete with the inflammatory response. I like to use ice because I believe it has an analgesic effect and the short term use probably will not interfere with the overall inflammatory effect of the ESWT. You MUST ask your doctor for his/her preference.

Re: Question for the doctors, please

Dr. Z on 8/14/04 at 14:36 (157856)


Pain relieve from ESWT can take on many different ups and downs. Here are some things to take a look at . Are you wearing different shoes at church. Are you increasing your activity? If you haven't increased your activity have you doctor take a look for your piece of mind. we use heat. It is analgesic and increases blood flow to the area.
Talk to your treating doctor about this pain. Let him examine you. It takes a few months up to one year for complete pain relief in a few cases. You so early post eswt. Still have your doctor examine you. You doctor should knokw what needs to be done at this stage to help relieve any pain that can be normal.

Re: Question for the doctors, please

Dr. Z on 8/14/04 at 14:46 (157859)

Dr. Wander,

Excellence Shockwave Therapy's Protocol is to use heat in all cases except when there is alot of pain especially the sharp type post ESWT.
I haven't asked Lowell Weil Sr. in years what he is using. I know they use the osaatron which does causes alot more post eswt pain due to alot of the energy going into bone. The dornier epos has ultrasound target ability which avoid avoid contact
I agree that it is important to ask the treating doctor. Excellence gives a post-eswt instruction sheet explaining what to expect post eswt and what to do I call it the who what where. I will add that both ice and heat create an analgesic effect. Patients will respond to each modality differently. It heat feels better use it. If ice resolve pain use it, but I use heat first in all cases.

Re: Question for the doctors, please

Heather on 8/14/04 at 14:54 (157862)

Thank you both so much for your responses. I am actually 'stylin' at church by wearing nice clothes and my size 9 tennis shoes with inserts...lol. My follow up appt is next Friday, so I will ask the podi his opinion. I called last week and the 'nurse' told me to do 'whatever I was doing for pf prior to the surgery', but I had done some of each over the years. Unfortunately, prior to the proceedure/ESWT, I hadn't seen the doctor for 8 months and I barely remember him at the proceedure thanks to the general anesthesia. Yes, to clarify, I had the ESWT. Your explanations were very helpful because I didnt know the full recovery time, and had read somewhere that people can resume normal activity quickly. It is not bad when I walk, but standing in place is painful. It was also good to read that recovery is not a straight path of improvement, because so far that has not been my experience. Thank you again!

Re: Question for the doctors, please

Heather on 8/14/04 at 16:07 (157874)

Dr. Z,
1. How can I get a copy of the 'excellence post-eswt instruction sheet/protocol'?

2. My husband used to massage my feet or I would use a 'massager' before ESWT, is that okay now too?

I looked at my discharge sheet and all it says is
No vigorous exercise x 3 weeks and no anti-inflammatories and return for follow up visit in 3 weeks.

Re: Question for the doctors, please

Dr. Z on 8/14/04 at 16:56 (157880)


I am the ESWT medical director for Excellence Shockwave Therapy Group. We have trained over two hundred doctors in ESWT protocol with the dornier epos ultra. This instruction is given to all the doctors that Excellence trains. I would contact the company via their web site http://www.eswtusa.com . Ask for a copy of the post-eswt instructions and the what to expect sheet.
I would allow my patient to use a massager on their feet so long as its not in the area of the ESWT treatment area.
ESWT is an excellent non-invasive treatment but it can take time for pain resolutoin. It is very important to address biomechanics with either proper shoes and or orthosis. Addressing shortnes of the achilles tendon is very important.