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Bad manners

Posted by Jan R. on 11/09/04 at 10:58 (163330)

Dear colleagues,
dear patients:

I have been following this board for quite a while.

Allow me to be straight: I am bored to read discussions of low-energy versus high-energy again and again.

Right now, you should accept that from the roots of ESWT two trees have grown, a low-energy tree in Europe, and a high-energy tree in the US. Nobody has data to favor the first over the second or vice versa.

The only thing that I am aware of is that in the beginning of ESWT all effects (and side-effects) were related to high-energy treatment. With more sophisticated techniques, and with increasing knowledge of what to look after, there is mounting evidence that even low-energy applications result in favorable effects on tendons and sensory nerves.

So, let´s talk data, not personal opinion, not business. If you cannot provide data, keep silence, please.

Allow me to be straight once more: For heaven´s sake, stop offending and attacking each other. Is this typical for the American way of life? Of a society built on faith and religion? Honestly, I feel pure disgust when reading many of your messages.

My recommendation: Know everything you talk about. Don´t talk about everything you know.

Best wishes

Re: Bad manners

Dr. Z on 11/09/04 at 11:19 (163333)

Dr. Rompe,

Do you know if the German Health Services ever finished and made new conclusions with regard to the effectiveness of ESWT after first discontining govt. funding for this treatment back in 1998.
My reason for this question is I want to learn so that I can help to avoid loss of ESWT treatment payments from insurance companies in the USA.
We are in a difficult period with one manufactor applying for FDA approval ( High Energy ) and another not applying ( low energy pf treatment).
There must be a solution to this situation because I see insurance companies using our division to just stop covering treatment period. This will leave alot of people without ESWT care.

Re: Bad manners

Ed Davis, DPM on 11/09/04 at 11:30 (163336)

I can only appeal to the moderator of the board ScottR or Scott R to consider dealing with those who are actively involved in the industry but make derogatory comments from the point of anonymity. Obviously, this is a free and open forum but feel that it will be up to the moderator/owner to decide when an individual has overstepped his bounds in making derogatory comments.

Re: Re:

Jan R. on 11/09/04 at 13:29 (163352)

The problem with the German Approval Board is that they decide on a treatment as a whole.
They donīt care that there are high-energy and low-energy protocols. They donīt care that there are various treatment regimes leading to positive and negative results.
They care, however, that there are inconsistent results. They use negative studies to reject ESWT as a whole. As in the US they using our division to stop covering treatment.
Meanwhile, most patients have to pay treatment on their own.

Re: Bad manners

Scott R - moderator on 11/09/04 at 14:17 (163355)

As always, if you see a message that doesn't belong, copy and paste the URL of the offending message in an email to (email removed), or reply to the message and include 'scottr' somewhere in the message.

The primary posting guideline has always been 'be nice'. Posting irrelevant messages is not nice. Discussing the message board itself is not good unless it is to call my attention to a particular post or poster.

OK, let's get back to discussing the relevant topics at hand.

Re: Bad manners

Connie Moody on 11/09/04 at 20:39 (163396)

and please, for us patients, we would love to be exposed to more professionalism and are so interested in people's successes and approaches toward PF without being privvy to your hostility toward one another....Our 'sails of optimisim' are quickly 'sinking'
We count on your varied opinions and approaches without the nastiness.
Connie M (a patient trying to make the most of recovery time!)

Re: Bad manners

Ed Davis, DPM on 11/09/04 at 22:24 (163406)


If it was up to me we would see all the great work being done in ESWT and savor in all the success stories. But, unfortunately, we have to fend off a barage of criticisms generated by competition between companies.
I think that all you have seen here from the providers of the services, myself, Dr. Z, Sunny Jacob, David Lowy extol the virtues of the services and success stories. The providers have little interest in the infighting between the companies. Nevertheless, this forum allows anonymous indidiaulas to come here, often manufacturers reps (in my opinon) to criticize competing technologies so the providers are constantly being thrust into a defense mode. I have pleaded with the manufacturerers and large organizations not to infight as this is a technology in its infancy with phenomenal promise. But as long as we are forced to defend what we do, we will have to do so.

Connie, I will simply ask that you ask the moderator, Scott R to attempt to lessen the negativity or appoint a moderator who aggressively controls the board. I don't like to abridge freedom of speech but I do see infighting taking way too much space on this board. I try to place myself in the position of a patient with PF and would be confused if I read all of the 'debate' on this board. One option is to come to the 'Askthe Doctors' board where we don't quite have the influx of individuals with agendas not consistent with healing the patient.

Re: Bad manners

Connie Moody on 11/09/04 at 22:30 (163408)

Thank you! However, I have decided to leave this post (may try the 'Ask the Doctors'). Maybe you all need this type of post between yourselves and perhaps restrict us 'patients' to safer, more postive boards. Am sure a certain amount of your debating is critical to the 'successes' but we patients do not need to be privvy to the manner in which you are debating...I will seek support and encouragement elsewhere; however, I HAVE benefited in the past. Thank you for the opportunity.
Connie M

Re: Bad manners

Ed Davis, DPM on 11/09/04 at 22:34 (163410)

Coonie and Scott R:
I remember that there was a board here once which was reserved for 'professionals' in the field. Perhaps re-establishing that should be considered as we need to be concerned about whether we are educating or confusing the public here. Certainly, in a doctor/professional board, I would ask for some type of registration so that readers who venture in understand the qualifications of those who post.

Re: New Idea- Scottr

Dr. Z on 11/10/04 at 08:21 (163426)


You just came up with a SOLUTION. Let's have a separate thread called ESWT technology discussions. We could have a subtitle explaining that this is a section for discussing, debated ESWT and not for patients to view but they can. The point is to separate this out from patient care. Debate is important we learn from everyone and everything. For example Scott has pointed out to us his use of repetitive high energy ESWT which as far as I know is new. We need difference to make ESWT sucessful.

Re: New Idea- Scottr

Connie Moody on 11/10/04 at 08:37 (163428)

I agree, as I recognize the need and benefit of 'debating' between the professionals who are working with or pondering the purchase of ESWT equipment/treatments...
And then there are those of us on the end of the spectrum of the equipment and treatments being utilized on us...who need to know in such a different interpretive arena.
However, I did not find the 'Ask the Dr.' that beneficial to post ESWT patients but if we utilized it more perhaps the
'likes of me' could be learning what we NEED to know and reaping the benefits of the 'behind the scenes debates'!
BTW, I am reaping positive responses to using heat post ESWT (as opposed to cold) - as well as the calf stretches! Thanks for the advice!
Connie M

Re: New Idea- Scottr

Dr. Z on 11/10/04 at 08:49 (163429)

I don't recall if I also pointed out the plantar fascia stretches. These are very effective for that morning pain. I believe that you are also going to start the personal foot trainer? Ok back to the pf stretch. In the AM or any time you are sitting for longs periods of time and then have to walk. Cross the painful foot over your over knee. With one hand pull your toes back toward you. With your palm of your other hand push the fascia toward the ball of the foot. Not hard just push. Do this ten times. Start at the arch and push toward the ball of your foot. If painful, it is too much tension with your toes pulled back. Make sense
Use flexible coban around the arch and around the ankle daily. The Pronation Control Device is also a great substitute for taping.
No bare feet. Heat Heat Heat Time Time Time .

Re: New Idea- Scottr

Connie Moody on 11/10/04 at 08:59 (163430)

Yes, I am also doing the PF stretches, thanks.
but have not been using the coban nor the Pronation Control Device...where do I find this?
Am eagerly awaiting the Foot Trainer products!
I had almost given up...with the worsening pain post ESWT until receiving your advice and now see there is truly hope for a more functional life!
Thanks so much...(Am doing the heat 3- 4 times a day when working and 6-8 times a day on the days I do not have to work) Precious hubby is helping me with my stretches..
Am wanting to lose about 20 pounds so do some floor exercises that do not affect my feet and of course eating better...seems that this site encourages bicycling, is that true? Have a small home and need to consider this when I puchase any exercise equipment.
Thanks for your help, Dr.Z
Connie M

Re: New Idea- Scottr

Dr. Z on 11/10/04 at 09:40 (163433)


Try using the Coban first.It is the flexible type.

Re: New Idea- Scottr

Dorothy on 11/10/04 at 10:50 (163436)

Dr. Z - What a great website and source of what appear to be very useful products. This is new to me so maybe I have just missed seeing it here in the past. Thanks much!

Re: New Idea- Scottr

Dorothy on 11/10/04 at 10:54 (163438)

Dr. Z -
As far as my interests are concerned, you are on a fabulous roll today! This is the best description of this plantar fascia stretch yet - and I have seen it described here several times. Somehow the use of the words 'With the PALM...PUSH the fascia toward the ball of the foot..' made it so much clearer and precise. I found this description very helpful for improving a stretch that I have been doing since first mentioned here. Thanks for this!

Re: New Idea- Scottr

Ed Davis, DPM on 11/10/04 at 11:00 (163442)

Dr. Z:
The product has been out for a few years. The design is logical. The difficulty patients ran into was movement of the device so they would need to tighten it, sometimes too much. Are you using it or recommending it? Have your patients had success with it? Any changes in design or suggestions to better keep it in place?

Re: New Idea- Scottr

Ed Davis, DPM on 11/10/04 at 11:15 (163444)

I think that that would work but only if we/ the moderator enforce a 'hands off' policy on the ESWT board, not allowing unidentified 'interlopers' to present their cases to people in pain, looking for answers.

Re: New Idea- Scottr

Dr. Z on 11/10/04 at 11:26 (163445)

We can try . Now all we need is Scottr to think it an ok idea to begin

Re: New Idea- Scottr

Dr. Z on 11/10/04 at 11:32 (163448)

Thanks. I demo this to all of my pf patients and I think this is what enables me to picture this in my mind. It does work. Takes about 4-6 weeks to see a change. I believe the reason it works is not due to the pf stretching but due to the deeper intrinic muscles underneath the plantar fascia tetting a work out. This is why the Palm and Push is important. Becareful it doesn't take much pressure for this to work. This shouldn't be a painful work out

Re: New Idea- Scottr

Dr. Z on 11/10/04 at 11:49 (163450)

I have used if for years. What I do is have the patient cover the device with nylon knee high stockings. This helps it from not moving. I use Nylon knees high to cover all my bandages, tapings etc. It will stop that moving. Please don't laugh or think it is queer. Men just put the knee high on and then their regular socks on.

Re: New Idea- Scottr

Ed Davis, DPM on 11/10/04 at 11:57 (163451)

People stopped laughing about wearing nylon stockings when Joe Nameth admitted that he wore them...
Thank you!

Re: New Idea- Scottr

john on 11/10/04 at 14:32 (163463)

Dr Davis,

Now I'm an interloper? Come on. Please stop the personal attacks and name calling. Let's have a rational discussion/debate about ESWT: high energy, low energy, etc... If we can keep it factual, it will help everyone.

Re: PF stretch - Dr Z

Julie on 11/10/04 at 14:46 (163465)

Hi Dr Z

Clarification, please. When you say 'with the palm push the fascia towards the ball of the foot' do you mean a kind of stroking movement, the palm moving along the sole of the foot from the heel to the ball?

Thanks for your response in advance.

Re: New Idea- Scottr

Ed Davis, DPM on 11/10/04 at 22:03 (163497)


My apologies for the insult. I think if we are to have 'internal' debates about ESWT they need to be separated from the general ESWT board. Again, the purpose of the board is for people in pain to come here to get information. Certainly there are controversies but we should not let those controversies confuse people looking for help. Put yourself in the place of a person with intractable plantar fasciitis coming here for the first time. What would you learn and what impression would you get?

John; if we were sitting at a table having a 'rational' discussion about ESWT, don't you think that people would ask you who you are? We assume that the people who come here anonymously are patients looking for help, not industry representatives, anonymous providers, etc. We are not looking necessarily for specifics about who you work for but want some general knowlege of your background. When someone becomes an advice giver as opposed to an asker, then people have the right to know who is giving them the advice.

Re: PF stretch - Dr Z

Dr. Z on 11/10/04 at 22:18 (163499)

Start at the arch area and move forward. Don't go near the heel please

Re: PF stretch - Dr Z

Dorothy on 11/11/04 at 00:23 (163506)

NOTE TO JULIE: I think someone needs to put the description of this stretch (shall we call it The PF Stretch?) into a form that will enable people to click on it the way they can Yoga and in a way that incorporates all of Dr. Z's recent clarifying instructions. I think those recent clarifications really make it perfectly clear now. (Your question to him yielded one more valuable clarification.) I hope that 'someone' will be you. Would you - perhaps in collaboration with Dr. Z. - do those honors?? This, along with Yoga, with Foot Trainers info., is valuable, healing information.

Re: PF stretch - Dr Z

Julie on 11/11/04 at 01:37 (163508)

I'd be glad to do that, Dorothy, if Dr Z will do just one more post with as complete instructions as possible, which I can then refine a bit (no discourtesy to your writing skills, Dr Z - I am a professional 'exercise writer'!)

For the instructions to be clickable, Scott would have to provide a link, but it might be best for me to append it to the yoga post, which everyone knows now, and then it would be there for everyone who made that click. What do you think?

And Dr Z, will you oblige? You can email me if that's easier - julie fried @ clara. co. uk (leave out the spaces).

Re: PF stretch - Dr Z

Dorothy on 11/11/04 at 02:18 (163510)

Excellent in all respects!

Re: New Idea- Scottr

Scott R - moderator on 11/11/04 at 11:22 (163550)

If John does have a bias for financial reasons, then he might be able to give a general idea as to the source of the bias without sacrificing anonymity. Even just an admission of bias may be enough.

If he is a financially-biased provider of information who influences vistors' purchasing decisions, then even if he does not gain from it, there is still a valid argument against too much anonymity

Re: New Idea- Scottr

Scott R - moderator on 11/11/04 at 12:50 (163566)

I don't want to create more message boards than necessary. The categories are supposed to be as broad, seperate, few as possible. Long ago when i broke the message board up into categories, there were many visitors who did not like it at all. Some got angry. Some left.

Many of the patients who visit the ESWT board want to know which technology and methodology is best. I don't think the technology and the treatment are seperate things.

Re: New Idea- Scottr

kathy t on 11/11/04 at 17:41 (163605)

Dear Dr. Z
Thanks for the pf stretch,so simple yet effective. Also you mentioned heat heat heat. What type of heat?(moist or dry)??????
Had Doriner swt done in both feet 3 wks a part. I am at 5wks and 8wks. The first 3wks were pretty painful(shooting and burning pains in feet and low ankle. This has greatly subsided. Still know if I do too much, such as lawn work(raking etc.). However after sitting or upon waking in A.M. my outside anke just below the bone hurts alot.Is this still healing?
Thanks for your advice.
P.S. please stop argueing. Peace out guys...........thanks

Re: PF stretch - Dr Z

Dr. Z on 11/11/04 at 19:53 (163627)

Here goes.
The plantar Fascia stretch
Purpose: To reduce first step morning pain
Duration: Do for at least six weeks to see improvement and reduction in pain
Description: Sit on the edge of the bed. Cross the pain heel over the opposite leg.
Pull the toes back to tighten the plantar fascia. Take the opposite hand and place th palm in the middle of your foot. With a pushing motion massage the fascia toward the ball of your foot. Do go past the ball of your foot. Push ten times.
IF there is pain reduce the pressure of the pushing ( don't go so deep) and reduce the tension that you are placing with the toes.

Ok fix it up

Re: PF stretch - Dr Z

Dorothy on 11/11/04 at 20:00 (163630)

Peer Review Begins Now:

Should it be 'Do NOT go past the ball of your foot..' rather than 'do go past the ball of your foot...'???

Re: PF stretch - Dr Z

Dorothy on 11/11/04 at 20:01 (163631)

Oh, wait .....I'm not a doctor, so I'm not a peer, so my comment can't be 'peer review'.....

Let's call it Bear Review. :-)

Re: PF stretch - Dr Z

Dr. Z on 11/11/04 at 20:17 (163633)

Good point. Never go past the ball of the foot

Re: PF stretch - Dr Z

Julie on 11/12/04 at 02:03 (163667)

Thanks, Dr Z. I've printed your post out and will have a look at it today. Then I will post it with any revisions for you to check. Then I will email it to Scott and ask him to include it at the end of the yoga foot exercises post. Then it will have a permanent home on the board so that people can be directed to it and you won't have to explain it again.

Perhaps the old-timers who often point people towards the yoga post - Kathy, Suzanne, Carole, Pauline - could make a mental note that Dr Z's PF stretch is going to be there too.