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plantar fasciitis

Posted by Dottie O on 9/02/04 at 08:05 (159140)

I had the ESWT done 8 days ago. Some friends of mine had it done and had instant relief (cure). Mine has not helped as of now. I realize that it can take up to 3 months...but my friends were put under anesethic...i was not...Could this be the difference that they were given a high dose and I was not...I was given 2 shots in the heel to numb it.

Re: plantar fasciitis

Pauline on 9/02/04 at 08:56 (159149)

If your friends treatment was done in a hospital setting ie. surgical center chances are they were treated by an ESWT machine called the Ossatron. If yours was done in a doctors office with two shots chances are the machine used was the Dornier Espos.

Both machines are FDA approved to be used in treating Plantar Fasciitis and they are both high power machines and suppose to provide the same type of results. The conclusion on this site may not be a conclusion at all because it appears everyone having ESWT treatment does not necessarily end up with the same result.

Hopefully you will see some improvement in the days to come and if not can make arrangements for a second or even a third treatment because sometimes additional treatments are needed.

Give yourself somemore time and communicate with your doctor. Later on if your results are less than satisfactory he may even suggest a second treatment to you.

There is also the possiblilty that he/she has access to use of both machines in which case you could perhaps have additional treatment trying the other one. The costs of course would be different because of the anesthesia use and a surgical center.

For right now keep the faith, keep your doctor informed and keep updating us on how you are doing. Weeks from now you may be telling us you're pain free too.

Re: plantar fasciitis

Bill, jr on 9/02/04 at 09:06 (159152)


The Dornier EPOS is used in surgery centers and in podiatrist's offices so you cannot conclude that Dottie's friends were treated on an Ossatron. They may have been treated on an Epos Ultra.

Dottie should ask her friends if they saw the machine before they were put under. If so, what did the machine look like? Alternatively, where were they treated since people on this site might know which machine their surgery center/hospital is using.

Re: plantar fasciitis

Dr. Z on 9/02/04 at 09:32 (159155)

IF you had any type of anesthesia whether local, IV etc you had a high energy treatment.

Re: plantar fasciitis

Pauline on 9/02/04 at 10:24 (159158)

In addition Dottie could also just call her friends and ask them what machine was used. If they don't know perhaps they would consider contacting their doctor and finding out for her. This would eliminate all guessing or any assumptions for Dottie.

I hope Dottie sees improvement soon.

Re: plantar fasciitis-- ESWT response time

Ed Davis, DPM on 9/02/04 at 14:44 (159166)


ESWT takes an average of 12 weeks to provide its effects. There is a period of time, for about one week after the treatment, that patients get a temporary respite of the pain (post-stimulation hypoalgesia) but that is not the permanent effect.

My philosophy and experience is that all of the machines work with approximately equal effectiveness for plantar fasciitis. There are debates on this subject, many of which you can find on this site. I tend to place a lot of confidence in the European experience and the research of scientists such as Jan Rompe, PHD or the University of Mainz, Germany.
The theory is that it is the total amount of energy delivered to the tissue that creates the effect (1200 mj/mm squared), not whether it is given at a quicker high dose or a lower dose and extended over a short period of time.

Re: plantar fasciitis-- ESWT response time

Dr. Z on 9/02/04 at 14:54 (159168)


It takes at least 12 weeks for the effect . The FDA studies at 12 weeks showed about 60 percent of the patients reported an excellent and or good pain resolution . As time passed the pain resolution improved.
High energy works differently then low energy. With low energy there is hyperstimulation, with high energy there is a cavitational effect whereby there is direct micro-tear to the degenerative tissue. You must have high energy to achieve a cavitational action. I have spoken with Dr. Rompe about this difference.

Re: plantar fasciitis-- ESWT response time

Ed Davis, DPM on 9/03/04 at 11:07 (159227)

Then there is RSWT - Radial Shock Wave Therapy, with definitely no cavitation effect. We may or may not consider it a variant of ESWT. Is the cavitation effect needed to effect a cure?

Some hyperstimulation hypoalgesia, I believe, occurs with all forms; low, medium, high energy that is why the poster noted what she interpreted as a 'week cure' in a friend.

Re: plantar fasciitis-- ESWT response time

Dr. Z on 9/03/04 at 13:06 (159237)

I agree but my point was that only high energy creates the cavitational effects.
It is my belief that fasciosis can only be cured with cavitational effects in the long term prognosis.

Re: plantar fasciitis-- ESWT response time

Dottie O on 9/03/04 at 17:45 (159248)

Have you guys got this figured out yet...i also have tendonitis on top of my foot (between the ankle bones) from limping so much I guess...i have 3 friends that two of them had it in both feet...cured immediately...maybe i am in the 20% that it does not work on...help!!!!!!!

Re: plantar fasciitis-- ESWT response time

Dottie O on 9/03/04 at 17:47 (159249)

I also overheard the DR. say it was large...7.5 whatever hat means

Re: plantar fasciitis-- ESWT response time

Bill, jr on 9/03/04 at 18:00 (159250)

Dr Davis,

I was looking at a JAMA article where Rompe was one of the authors. The title of the article is 'Extracorporeal Shock Wave Therapy for the Treatment of Chronic Clacifying Tendonitis of the Rotator Cuff' It appeared in the November 19, 2003 issues of the JAMA. The authors concluded, and I quote, 'high energy ESWT appeared to be superior to low-energy ESWT'.

It looks like we are finally seeing double blind, placebo controlled studies comparing high energy, low energy, and placebo. It is interesting that this study found a larger treatment effect for high energy ESWT compared to low energy ESWT and that it was conducted by doctors that have studied low energy ESWT.

Dr. Davis, since you believe that ESWT performs the same for all regions of the body, does this study pursuade you the high energy ESWT performs better than low energy for plantar fasciitis?

I think that Dr. Z's explanation of the cavitation effect may explain the results observed in this study.

Re: plantar fasciitis-- ESWT response time

Pauline on 9/03/04 at 19:01 (159252)

Interestingly enough they conclude one thing and say the other one paragraph higher. Go figure.

From the JAMA article.

'Patients who received high-energy ESWT also had significant 6-month CMS improvements compared with those who received low-energy ESWT (P<.001). We found similar results for both the 3-month and 12-month CMS comparisons, as well as for self-rated pain and radiographic changes at 3, 6, and 12 months'.

Re: plantar fasciitis-- ESWT response time

Dr. Z on 9/03/04 at 19:08 (159253)


Your quote concludes what Bill Jr. just stated , not the opposite. Please explain what you mean that they conclude one thing and they say other. They conclude that high energy is better in this study and then then they state this. It was better at 3 months, 6 months , 12 months.
Another interesting point in this article is that both the high and low energy treatments were done under IV sedation.

Re: plantar fasciitis-- ESWT response time

Dr. Z on 9/03/04 at 19:10 (159254)


I am not sure what question you would like for me to explain. Please help me out.

Re: plantar fasciitis-- ESWT response time

Dr. Z on 9/03/04 at 20:32 (159256)

That is the thickness of your ultrasound plantar fascia measurements that were taken. If you have this done during the procedure then the machine used was the dornier epos ultra. Ultra stands for ultrasound

Re: High energy ESWT is better!

Bill, jr on 9/03/04 at 23:39 (159260)


Please read the article. It was careully reviewed by the editors at JAMA. I'm sure that you will find that it was conducted properly and was consistent in its statements.

Your quote says that high energy ESWT had better CMS improvements than low energy ESWT at 6 months and 3 months and 12 months. High energy ESWT also had better results than low energy ESWT when looking at self-rated pain and radiographic changes at 3, 6 and 12 months.

To put it another way, high energy ESWT had better CMS improvements, lower self-rated pain and more significant radiographic changes than low energy ESWT at 3, 6 and 12 months.

As I said before, the article is significant because it is a double blind, placebo controlled study. When measuring pain it is important to conduct double blind placebo controlled studies in order to eliminate the treatment effecgt.

I want to repeat my previous point because I think it is important! This article shows that ESWT works for chronic calcifying tendonitis of the rotator cuff and there is a measurable difference between high energy ESWT and low energy ESWT and high energy ESWT performed better!

Re: plantar fasciitis

Dottie O on 9/04/04 at 08:08 (159271)

My friends used the ossatron machine...it was done in a hospital setting...as was mine

Re: plantar fasciitis

Pauline on 9/04/04 at 12:09 (159297)

As posted before it takes time to determine if your tratment will be effective or not. Did you ever find out what Machine your doctor used now that you know that your friends were treated with the Ossatron. If not why not try to find that out if your curious to see if the same machine was used.

Since everyone is different, you cannot compare your response to your friends.

After the waiting period if you had treatment with either machine I believe you can try a second treatment. Some people have even had third treatments seeking to become pain free.

That determination will be up to you, but in the mean time I think the best thing that you can do is to keep your doctor informed of your progress and wait for him to help you determine if a second round of ESWT would be helpful.