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Post ESWT comments, etc

Posted by Scott Mc on 10/14/04 at 14:44 (161510)

On August 12, I had ESWT treatment to both feet with the Dornier machine. Between Septemeber 8 and 28, I toured Britain--often with a heavy pack on my back and a lighter one in my hands. I stood and walked often on city streets, including cobbly ones. I avoided long walks and hikes. My feet killled me the whole time and still do. So, I've made no progress despite the ESWT 7 weeks ago. I'm still in the 3-12 week improvement window; might I reasoably expect improvement in the next 5 weeks?

As per ESWT instructions, I use no ice and no anti-inflammatories. I stretch 2-3X/day with a 'wall stretch' or by keeping my leg straight with my foot a strap. I wear 2 loose Strassborg sox but often take them off due to pain in my big toe ligament or tendon (on top of toe).

Any hope for me? A 2nd ESWT? What's the chance that I keep reinjuring myself, as I have had PF for 3 years, now. If so, what can I avoid? Do you ever advise PF patients to get completely off their feet (bed + wheelchair or scooter) in these tough, chronic cases? Thanks for your response(s). SMc

Re: Post ESWT comments, etc

Dr. Z on 10/14/04 at 15:10 (161513)

IF you have or had the typical pf pain, which is pain when first gettng up after sitting or rest especially in the morning and there is no nerve problems etc then you have a good chance for relief. Traveling and walking for hours isn't the best post- eswt activity to engage in. You should have some level of relief at the 16 week period
What were you initial pf complains??

Re: Post ESWT comments, etc

Scott Mc on 10/14/04 at 17:11 (161523)

The pain was very typical at first but has changed over 3 years. In other words, heel pain in the morning that lessened but remained over the day. Howevever, this has become an all-day pain that get worse near the end of the day. My heel is still painful but the pain (since last year or so) now extends into the arch and ball-of-foot.

The neuropathy theory has been tossed around on this site and I must disagree. None of the 3 podiatrists that have examined me suggest nerve involvement. I have an idiopathic neuropathy in my calves and hamstrings. It feels nothing like the foot pain and a non-painful ankle separates the leg neuropathy from the feet PF. I have had many encounters with neurologists and many EMGs and NCSs re my leg pain. All have been inconclusive wastes of thousands and thousands of $$. I am refusing to waste more money on neurology.

I believe that I have a severely painful PF variant--perhaps due to reinjury or re-injuries and length of time (3 years).

Are your suggesting the ESWT healing window goes beyond 12 weeks to 16 weeks?

Re: Post ESWT comments, etc

Dr. Z on 10/14/04 at 17:36 (161528)

What did the ultrasound and or MRI show? Was there fascia pathology.?

Re: Post ESWT comments, etc

Scott Mc on 10/14/04 at 18:07 (161533)

None of the three podiatrists (all from separarate clinics and towns in Montana) have conducted or mentioned the need for ultrasound or MRI. A PT used ultrasound as a therapy.

None of the three podiatrist have noted any fascia pathology to me.

The three podiatrist bascially go on what I tell them, my response to a wide variety of treatments (minimal responses), palpations (showed inflamation), and X-rays (showed calcium 'bottons' in the arch, not beleived to be problematic.)

The three podiatrists seem to be in agreement on tests, treatments, diagnoses, and prognoses.

Re: Post ESWT comments, etc

Dr. Z on 10/14/04 at 21:45 (161552)

Scott M
I am talking about diagnostic ultrasound. We use if all the time before performing ESWT. This will show the pathology and also help to guild the treatment. At this point in time . Time is what will determine your outcome

Re: Post ESWT comments, etc

Scott Mc on 10/15/04 at 18:20 (161613)

No diagnostic ultrasound was performed, mentioned to me, or included in the notes of 3 separate DPMs from 3 separate clinics in 3 different Montana cities. So, apparently, Montana DPMs are on a 'different' page than rest of country(??).

So, I wait. I am just trying to determine if there is anything I can do (or not do) to help to reach a positive outcome for the ESWT.

Has my suggested treatment of getting completely off the feet (bed and wheelchair or scooter) ever been used--as a last resort. I'm no longer confident that the ESWT will work--will 'kick in' after 7+ weeks of nothing, or greater pain. Or, am I doing something to inhibit the ESWT's healing?

I am ready to plan desperate measures (as in getting a wheelchair--for a month or two?),as I have had PF in both feet for 3 years and no response to any of the treatments.

Re: Post ESWT comments, etc

Dr. Z on 10/15/04 at 18:34 (161615)

If you have plantar fasciosis and its been seven weeks you still have a chance to obtain pain relief. It can take at least 12 weeks for pain resolutino to beging. Rest, taping, proper shoes are helpful. Talk to your local doctor about your concerns