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ESWT/Achilles/Neovessels

Posted by alexb on 11/04/04 at 08:23 (162922)

I have had AT problems for years - it has hobbled my running down from about 80 miles a week to under 10. Because of that, besides my daily stretching/strengthening and such, I like to read articles ...

I was intrigued by the following article that suggests that sclerosing the neovessels that are present in many AT patients seemed to resolve the condition in almost everyone who had neovessles. And the researchers found a strong relationship between presence of neovessels and AT pain.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12925869&dopt=Abstract

fulltext:
http://publications.uu.se/umu/fulltext/nbn_se_umu_diva-140.pdf

So, I thought about ESWT. I've never had ESWT done because I am dubious of the efficacy of it for AT (perhaps I've been overly swayed by the position papers of the various insurance companies)... But I understand that a lot of folks feel that ESWT works by cavitation which causes neovascularization. Well, in AT it seems that the problem is that the are neovessels where there should be none in healthy ATs. So, is it possible that ESWT may help AT by cavitating the neovessels and allowing normal healing to work because it may be doing the same thing to the neovessels that sclerosing did to them? So, in other words, has anyone looked at CDV ultrasound of an AT both pre and post ESWT to see if the ESWT gets rid of the neovessels?

Or do I have no idea what I'm talking about and have taken research on both sides out of context? (Always a possibility as I was a chemistry major so I'm not exactly used to reading medical research).

So, I guess, what do you think about sclerosing the noevessels in AT versus ESWT --- what have been the results of your patients with chronic AT (either insertional or not and with/without a retrocalcaneal spur) after ESWT?

Re: ESWT/Achilles/Neovessels

Ed Davis, DPM on 11/04/04 at 10:32 (162932)

alexb:
The term 'neovessels' or 'neovasculariztion' refers to the formation of new blood vessels as a result of ESWT. It is thus not the new blood vessels that are being affected by ESWT but the neovascularization is a potential end effect of ESWT. As far has HOW ESWT achieves neovacularization, that is unclear -- we don't know if the cavitation phenomenon is a necessary precursor to neovascularization.
Ed