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post eswt and othodics

Posted by jeannie m on 9/29/04 at 21:41 (160711)

I had eswt two weeks ago and i am a waitress. My archs kill me with othodics but my heels hurt without them. I just had custom othodics come back that were adjusted for being too high but they hurt my arches. I bought some smaller softer dr scholl inserts in the meantime but my feet just seem to hurt no matter what i do. My doctor says i do not want to cause a new problem and to just wear good shoes but heard that orthodics are important . It has been 2 weeks since the eswt and the pain is unbearable. I am so worried i will not get better. Any advise would be appreciated

Re: post eswt and othodics

BenLee on 9/29/04 at 22:23 (160714)

Hey, I'm in the same position. I can wear shoes where my heel hurts or with orthotics, my arch's hurt. But the thing is, I have 2 bad knees as well and with the orthotics, my knees don't hurt. With the other shoes, my heels hurt and my knees get messed up if I'm not wearing a brace so I figure that I should stick with the orthotics that make my arch's hurt. I think this may be due to the fact that it's possible both of our arche's have partially collapsed but it's my understanding that orthotics are supposed to correct this? Anyway, I figure I should stick with the orthotics simply because it obviously puts my knees in proper alignment and hopefully my feet will adjust to them.

Re: post eswt and othodics

BenLee on 9/29/04 at 22:24 (160715)

oh and, btw, I'm and a month past ESWT and I am improving, it's just really slow.

Re: post eswt and othodics

Ed Davis, DPM on 9/29/04 at 22:38 (160717)

jeannie:
Return to your doctor for further adjustments. Pay attention (or ask your doc to pay attention to) the amount of backward motion of your foot on your leg (dorsiflexion) as patient with tight heel cords may compensate by flattening their arches and have more difficulty tolerating arch height in an orthotic.
Ed

Re: post eswt and othodics

Ben Lee on 9/30/04 at 13:28 (160772)

I am currently using the powerstep which causes pain in my arch but prevents it in the heel. Are you saying that I should get a different orthotic (possibly custom) that would prevent pain in my arch as well? I figured after time the pain in my arch would subside because it would raise again.

FYI, I got ESWT from Excellence in Shock Wave Therapy about a month ago and am doing better but the arch pain seems to be my main hinderance now.

Re: post eswt and othodics

Ed Davis, DPM on 9/30/04 at 15:18 (160782)

Ben:
Again, please have your doc check the amount of dorsiflexion in your ankle. If it is restricted, you will always feel like the arch is high on almost any device.
Ed

Re: post eswt and othodics

Dr. Z on 9/30/04 at 16:25 (160786)

Hi Ben

Glad you are doing so well. Who was your physician at Excellence Shockwave Therapy?

Re: post eswt and othodics

Tina H on 9/30/04 at 21:19 (160800)

Jeannie- I had to stop wearing my 'hard core' as I call them, orthotics immediatley after ESWT. My doctor told me that some people's post ESWT inflammation prevents them from wearing the hard orthotics and it's overkill at that time when the arch is so sore. She gave me a pair of powersteps to wear during that time. You can find info about them here. Anyway, I wore them for about 5 weeks and I slowly eased back into the orthotics. I now wear my orthotics all the time. Incidently, my ankle still swells from time to time. Not sure why but the doctor didn't seem concerned and said it's normal post ESWT. tina

Re: post eswt and othodics

Pauline on 10/01/04 at 10:45 (160828)

Tina,
Your post made me think of a question and it is this: What really is a 'normal' reaction following ESWT treatment?

We've seen many post ESWT patients report everything from really bad pain and bruising and you are saying your ankle swelling. In my opinion, doctors appear willing to call any reaction following an ESWT treatment 'normal', but I think the question that needs answering is what reactions can expected and are quite normal and which ones as in your case 'ankle swelling' may not be a normal reaction but something quite different.

I'm not a doctor, but maybe one here can comment on what folks having this treatment can really call 'normal' reactions following it.

When first advertised no one was suppose to have any reaction. They went from treatment to work, but thats not what we commonly hear today from many of those who have had the treatment. So what is 'normal'?

Re: post eswt and othodics

supertwin on 10/01/04 at 13:15 (160835)

I agree with Pauline - that patients need to know what is a 'normal' reaction to ESWT. I'm 3 weeks post ESWT, on both feet - and am having terrible pain. I'm not walking without crutches, and am lucky to have a wheelchair to use. I cannot go back to work, and my feet hurt 10 times worse than they ever did in the 13 months I dealt with pf pain. My doctor told me I am the first patient he's done that has ever felt this much worse. I'm very discouraged as well. I think some people may just not heal very well, or fast, and my foot doctor thinks possibly something else is going on with me medically - however, I've had every test for every disease possible, as well as nerve testing, and as far as all my other doctors can tell, I'm very healthy - so, it cannot be explained. I'm trying to stay positive, but, the amount of pain I have right now makes it hard. Sometimes we just know our bodies, and my feeling is it's going to be a long, long recovery.

Re: post eswt and othodics

Dr. Z on 10/01/04 at 14:00 (160836)

Hi
It is very difficult to determine what is normal without knowing what was the condition your foot before ESWT. I would suggest getting an MRI if you are on crutches. It is important to re-evaluate your foot cause being in so much pain isn't typical or normal for ESWT

Re: post eswt and othodics

Dr. Z on 10/01/04 at 14:09 (160837)

Tina,
Ankle swelling could be normal if you have venous insufficieny. The problem with what is normal depends on what pateint population we are talking about.
Do you have ankle swelling at any time in your life if so when would be my first question. Do you have problems with your viens that you know of.
In the FDA study the typical reaction was black and blue and swelling along with some pins and needles.
Here is what I see from my experience with the dornier epos.
1. Complete relief immediately
2 Some improvement with gradual reduction of heel pain over weeks to months
3. No immediate relief then gradual improvement after eight or more weeks
4. Need for 2nd ESWT treatment
5. Pain few days. Pain if you over do it
6 Most patients return immediately to work. Some can't
7 Never saw Black and Blue
8. Never saw severe swelling
If I think of any more I will post again

Re: post eswt and othodics

supertwin on 10/01/04 at 15:27 (160845)

Dr. Z. I have thought of asking my doctor about an MRI, but have wondered what an MRI would show at this stage of my recovery. If an MRI shows inflammation - wouldn't we expect that since that is what eswt does to the tissue? Is there cases of eswt causing damage that could be seen on an MRI? What then?

Re: post eswt and othodics

Dr. Z on 10/01/04 at 15:40 (160846)

I want to rule out other tendon damage ie posterior tib tear., stress fracture, joint surface damage. I am sure your treating ESWT has examined all of these possiblities.

Re: post eswt and othodics

Pauline on 10/01/04 at 16:55 (160852)

Did you ever go back for additional post ESWT xrays or an MRI to see if anything is physically wrong? I'm not a doctor, but you might want to see if you've developed any broken bones.

Having as much pain as you're describing certainly doesn't sound very normal based on Dr. Z's post. Maybe it's even time for a second opinion if your own doctor doesn't have a clue what could be causing you sooooo much pain. Some pain I think we could agree upon, wheelchair and crutches
pain---I don't know about that. Like you I'd want some answers and I'd want at the very least a new set of xrays.

Re: to dr. Z swelling vs Bextra??

Tina H on 10/01/04 at 21:06 (160862)

No, I've never had swelling problems at all before ESWT however, I do take Bextra and it causes edema in 2% of people taking the medication. I wonder if it could be this? I have notced a correlation between taking Bextra and swelling, althought what puzzels me is that it's only in the ankle of the foot where I had ESWT. I took a Bextra last night and today and tonight that ankle is swollen. If I lay off of the Bextra, it still swells a little but not as much. I'm very confused about the swelling, not sure what to do about it if anything. Don't know if I should lay off the Bextra or not. I like my doctor but I feel rushed when I see her. I asked her about it and she said some people have swelling and it takes awhile to go away. One thing that has bothered me is that I never had MRI's or x-rays before I had ESWT. My doctor did look at old x-rays, taken 3 years before. I quess she was so sure about the diagnosis and I was too so I never really thought about the tests until I started visiting this site. Should I be concerned about the swelling? Tina

Re: To Pauline what's normal my hypothesis

Tina H on 10/01/04 at 21:19 (160863)

I think what bothered me the most about the whole ESWT experience was that the literature presents scientific data on pain cessation, non-invasive procedure etc. but what is typically given patients mentions nothing about the fact that it could hurt more after, that you have to stop icing and taking anti-inflammatories etc. I learned about that as I was leaving the doctor's office. It makes sense to me that it could hurt more, lets just be up front about this! After all the procedure if I understand it correctly, puts little holes in your fascia in an attempt to change the chronic inflammation to acute so it's logical that you might be more sore and along those lines then it's not farfetched to think that there might be swelling. It wouldn't have changed my mind about having the procedure, but my timing might have been different. I wonder, just a hypothesis, and I'll see how I'm doing in a few weeks to answer my own question, but those people with more pain post ESWT, do they fair better in the long run? Meaning there was a better job of converting the chronic inflammation to very sore acute inflammation. This is my theory. So in 3 weeks I'll be at 12weeks post ESWT and if that's the case I should be better! We'll see. What do you think? You know a lot about this topic. Tina

Re: to dr. Z swelling vs Bextra??

Dr. Z on 10/01/04 at 21:43 (160864)

Hi
I don't think it is the Bextra. If you have underlying venous ( vien) problems the ESWT will cause swelling. It should resolve but also should be evaluated ie doppler lower extremity ultrasound. If you press on the swelling is there a deep depression into the skin? It is my opinion that all ESWT patients must have an ultrasound to confirm plantar fasciitis and to rule out a tear in the fascia. Should you be concerned. I can't answer this without see you foot. If there is a deep depression when you press on the skin. This needs additional evaluation and testing

Re: To Pauline what's normal my hypothesis

Dr. Z on 10/01/04 at 21:50 (160865)

You learned about this after the leaving the doctors office. Your doctor is just as important as the procedure. I have stated that the doctor is the key when having ESWT. How often is your doctor seeing you?

Re: pre and post ESWT pain procedures

sonnyt on 10/01/04 at 21:51 (160866)

My Podiatrist wants to do my procedure in his office vs. outpatient surgery center? Is this the right place?
He has givning me three(3) 1mg pain pills and said to take two(2) 1 hour before the procedure an to bring the third (3) pill with me.???Does this sound right?
He then would inject me for a heel block for the painless procedure??/
He also said I would not need any post op pain pills?
The articles I have read reccommend Tylonel #3 for post op?
Please help me decide what to do or should I change physicans?

thanks and I hate pain and needles
sonnyt

Re: pre and post ESWT pain procedures

Dr. Z on 10/01/04 at 22:37 (160870)

Hi
We are ptobaby talking about the dornier epos ESWT equipment. I have done over one thousand in the office. If you are in good health that is the place to do this procedure
I don't prescribe a narcotic post ESWT. If you are really scared of needles then go to an ASC and have them use sedation. This is rare but if you must you must.

Re: pre and post ESWT pain procedures

sonnyt on 10/01/04 at 22:44 (160871)

No Sir, I beleive its the hi power Ossa Tron method and machine
Thanks

Re: pre and post ESWT pain procedures

Lori S. on 10/02/04 at 00:47 (160874)

If it is being done in his office, I doubt it is the Ossatron. I just had ESTW on Wednesday with the Dornier Epos. Prior to the procedure I was not given any pain meds. You are supposed to be off anti-inflamitories for at least 7 days before..... They put the nerve block shots in ( much easier than cortisone shots), and did the procedure. It is now friday, and I havent even taken a tylenol. But the doc did send me home with a scrip for pain meds in case i need them. So far, so Good. The Ossatron is usually in the hospital, surgical center- its a large machine. My feet ache a little, but they are better than before the procedure. I realize, this may be the calm before the storm, BUT.... I am happy with my decision to try this. I dont want anyone cutting my feet open.

Re: to dr. Z swelling vs Bextra??

Tina H. on 10/02/04 at 07:41 (160881)

No there is not a deep depression when I press in, it bounces back as soon as I remove my finger. My doctor did use the ultrasound on my foot just before doing the ESWT and confirmed the thickened fascia. Not sure if that guiding ultrasound for the ESWT is the same as one used for diagnosis by an ultrsound technician. Would my podiatrist be the one to evaluate this further or should I go to a different type of doctor? Thank you, Tina

Re: to dr. Z swelling vs Bextra??

Dr. Z on 10/02/04 at 09:59 (160889)

Hi Tina

E-mail at (email removed) so we can further discuss this

Re: To Pauline what's normal my hypothesis

Pauline on 10/02/04 at 10:48 (160893)

Tina,
The point you bring up is an interesting one and perhaps one that we should be following on this site. You are certainly correct when you say the post pain experience seem to run from 0 to 10 and above if numbers were given out by posting patients.

The difference, I'm not sure, but I do know the doctor has the ability to turn the power up or down and maybe some do depending on the case at hand. Maybe not everyone is receiving full power so to speak.
Just throwing that idea out.

Where and what the waves hit could be another reason for additional pain perhaps. I'm not a doctor, nor do I provide ESWT but I do read this site and know that posters like yourself have several different post ESWT experiences and like you mentioned some that people were not aware would happen.

When I saw my very first advertisement for ESWT I thought boy this sounds great. A painless 10 minute treatment and you walk out cured and back to your job. That was the picture that I painted then, that certainly isn't the picture I hold now.

Re: post eswt and othodics

BenLee on 10/02/04 at 17:21 (160904)

Umm, I forget the guy's name who actually did the ultrasound. But I had it done at Ocean Orthopedics in Toms River NJ. He was an older guy if that helps.

Re: post eswt and othodics

BenLee on 10/02/04 at 17:24 (160905)

When I had ESWT, both my feet swelled up badly and I could barely walk. The foot of mine's swelling subsided in a few hours but the right foot lasted into the night. The next day, my right foot still hurt a little but all swelling was gone after 2 days.

Re: post eswt and othodics

Dr. Z on 10/02/04 at 18:36 (160906)

His name is Phil. He is one of the tech. There are alot of Foot Orthopedic docs within the Excellence Shockwavea Therapy Network

Re: pre and post ESWT pain procedures

sonnyt on 10/03/04 at 14:33 (160934)

Thanks Dr Z , I will ask my Podiatrist about the actual machine and take my chances with local heel block injection.

Re: post eswt and othodics

Lynn F. on 10/04/04 at 20:55 (160981)

Just thought I'd mention, Phil did mine also! (hope he's good!! :o)