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ESWT--high or low energy?

Posted by Connie H on 10/15/04 at 10:51 (161579)

Hi everyone. I have bi-lateral 'significant' heel spurs (whatever that means...they looked impressive on the x-ray) and my podiatrist has recommended ESWT. I've tried physical therapy, stretching, night splints, heel cups, custom orthotics, and most recentely, 2 cortizone injections. I've been battling it for 6 years. I'm not in much pain if I don't exercise, stand around for long, or wear pretty shoes. :) I've tried bicycling, and THAT makes it worse as well. This site has been my main source of information--it's the most complete I've found. The machine available in my town is the Ossatron, and I'm waiting to see how much my insurance will pay. It's possible that for what my out-of-pocket will be, it would be cheaper to go to Canada or elsewhere in the U.S. and have treatment on the Dornier Ultra. However, I am quite confused as to which is more effective--low or high energy ESWT. Does the Dornier machine truly produce the high energy cavitation effect? If the low energy does not produce this effect, is there a higher rate of relapse with it? I know this has been discussed, but I'd like to hear from people who've had either treatment and been 'cured.' My dream is to be able to walk for fitness again. I've given up the idea of ever running again, I'd be happy to walk. Thanks in advance for any input you can give me.

Re: ESWT--high or low energy?

Ed Davis, DPM on 10/15/04 at 14:20 (161591)

Connie:
I have used high and low energy with equal effect. Each method has its proponents. The issue of 'cavitation' is a theory in terms of its need with no scientific proof either way. I feel that it is significant to note that the Europeans who have had a lot more years of experience with this modality than the US have gone largely to low energy as have the Canadians.
Ed

Re: ESWT--high or low energy?

Dr. Z on 10/15/04 at 16:54 (161600)

Ed,

Thre are alot of Europeans that use High energy instead of low energy. Cavitional effects are the accept principle by which high energy ESWT works. Scientific. They have alot of studies with ESWL that documents Cavition

Re: ESWT--high or low energy?

Dr. Z on 10/15/04 at 17:08 (161604)

Connie,
The dornier Epos ultra is an FDA high energy single treatment ESWT device. Having used this machines in a few thousand cases I can tell you that is very effective for chronic insertional plantar fascosis. This is a potential curative procedure and is a replacement for foot surgery with its disability and possible severe complications. There have never been any studies directly comparing low energy vs high energy for pf. There was just published a study in the AMA journal that showed high energy more effective then low energy in the treatment of shoulder supraspinatus tendinosis.
As for Canada this may or may not be a choice for you depending on time, travel expense and the fact that you will need to spend a few days due to the need for at least three treatment.
I do use low energy for certain tendon condition such as elbows, knees and achilles tendon however we use only high energy for PF. Dornier is the leader in orthopedic ESWT and THEY made the choice to set up a high energy single treatment for pf for FDA approval . The dornier is able to perform low, medium and high treatment . Why did Dornier choose high energy maybe its because they feel it is more curative.

Re: ESWT--high or low energy?

Connie H on 10/15/04 at 18:07 (161607)

Ed,

Thanks for responding to my question. After wading through the material, my understanding of the low energy effect is that it effects the pain receptors, sort of short-circuits them, but doesn't cause have a curative effect. Whereas the high energy treatment actually causes the body to begin healing, and 'cures' the problem. Your post seems to support my conclusions. Am I wrong?

Also, I am in Texas. Does anyone had successful treatment in Texas that you could recommend to me? I'd prefer to have the treatment locally, for follow up.

Re: ESWT--high or low energy?

Dr. Z on 10/15/04 at 18:15 (161609)

Connie,
I am sure that Ed will respond but I will give you my explanation with your question. Yes it does interfere with pain reception and it does causes an neurogenic inflamatory response which will increase blood flow to the pf tissue. Here is where I feel high energy is better. Why?. IF the tissue is a true fascosis degenerative condition that an increase in blood flow will help the tissue heal but what is needed isa of growth of blood vessels which is what is obtained with cavition and neovascularization. what is needed to obtain a curative action. I just had a patient come to my office today from Houston due to our experience very resasonable costs. If you want information about our ESWT program just let me know by e-mailing Dr. Z at (email removed) I know the costs in Texas and so far we are the best.

Re: ESWT--high or low energy?

Ed Davis, DPM on 10/16/04 at 00:45 (161630)

Connie:
Dr. Z does have more experience than most docs with the treatment. If you want to say local a couple of provider 'finders' include http://www.unitedshockwave.com and http://www.sonorex.com
Ed

Re: ESWT--high or low energy?

Connie H on 10/16/04 at 08:34 (161636)

Dr. Z & Dr. Ed.

It's really great of you to take so much time here! I have another question about the procedure. When I asked my pod. about how the targeting is done with ossatron--me being anesthetized and no ultrasound to guide it, he said 'it's impossible to miss--the head on the machine is so big, there's no way to miss'. When I talked to Dr. Z's office (very nice & helpful by the way) she said the beam of waves is very narrow--the person for Pain Free in Canada said it's only a few mm's wide. Is there a big difference between the ossatron machine and the others, or does my pod. not know what he's talking about. His retreatment rate is 1 in 6, out of 36 total, so that does not raise my confidence in him at all.

Another question. About a year ago, I tried taping my feet following Scott's instructions, and I soon began having pain in the BACK of my heel. I quit that right away, but it's still there. I think I have achilles tendonitis. Can that be treated simultaneously? Should it be done later? It doesn't seem to hurt it to stretch.

Re: ESWT--high or low energy?

Dr. Z on 10/16/04 at 08:54 (161637)

Connie,
You are able to guild the precise narrow shockwave beam at the area of plantar fasciosis pathology. While viewing the ultrasound you can move the target( aiming device) toward the areas that need treatment. The ossatron will be moved in a 360 degree circle to cover the entire area. The ossatron sound wave entered the bone, fascia possible nerve, arteries due to the very wide area it is covering. The dornier treats from the side will have the ability to direct the sound wave only in the degenerative aress.
Pain free's Sonocur is very similiar to the dornier in that it has ultrasound. It directs the sound wave with the patients's feed back from pain. The treatment is without any anesthesia, with mulitple low energy sessions.
The Dornier has FDA approval for Plantar fasciitis in the USA. The Sonocur in the USA is not approved for plantar fasciitis however it is approved for chronic elbow tendonitis.
Which technique is better ? I can only explain my experience and that is with the dornier.
Dornier is both a low, medium and high energy ESWT machine. It has the ability to use almost all ESWT treatment protocols for Plantar fasciitis.
I asked Dornier Medtech why didn't they apply for FDA approval for Pf for low energy since their machine has the ability. They told me years ago that they felt that high energy was more effective. They started with low energy in Europe and Canada. So what is the answer without confusing you
Go with your gut feeling but have ESWT before you even think about surgery.
I wish you luck with your future ESWT treatment.

Re: ESWT--high or low energy?

Dorothy on 10/16/04 at 15:07 (161651)

Not a doctor and butting in to your question, I will tell you that I have periodic problems with the Achilles tendon, as well as other issues. You might consider the Foot Trainers and you might want to try some self-massage on the Achilles area. I began doing a sort of modified version of the massage techniques that were described here with the all the conversations about Dr. Sandell, to the best of my understanding of them and, as I said, modifying them. It doesn't cure the problem, but it does seem to relieve it each time - so far anyway. Good luck to you.

Re: ESWT--high or low energy?

Connie H on 10/18/04 at 08:56 (161723)

Dorothy, are you saying the massage seems to relieve it, or the foot trainers? Have you had ESWT? If so, did it help? Have you tried the foot trainers? I'll search the archives for that massage technique, and thanks for stepping in and answering. I'm hoping for input from everyone--not just the Docs!
Connie

Re: ESWT--high or low energy?

Dorothy on 10/18/04 at 09:14 (161724)

Connie H -
Massage and/or Foot Trainers. I have used and do use both and think both are helpful. I have not had ESWT. I think the Foot Trainers are a very helpful tool for these problems and recommend their use, based on my own experience with them. If you do a search under Foot Trainers or Personal Foot Trainers here, you will find many posts. They look odd and I was skeptical - but they worked and they help. The owner/inventer posts here from time to time and will answer your questions either through this website or through his own, http://www.foottrainer.com . Also, as far as Achilles tendinitis specifically - I have found that alternating between low shoes, e.g. 'sneakers', and shoes with slight elevation, e.g. clogs, helps - although not always, but usually.
Best wishes ~