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Sonorex Helped me recover

Posted by bird on 1/17/05 at 14:45 (167411)

I have had successful outcomes with Sonorex and want to report back to those of you who are considering it. I had my procedure performed in San Diego at oasis sports medical group. It was performed in March 2003. At the time, my health insurance (Blue Cross) did not cover the procedure so I had to pay out-of-pocket. Cost was $600 per treatment, and I had three treatments for 1 foot. The treatments were virtually painless. It felt only as if someone was applying pressure to the bottom of my foot. Procedures did not last more than couple of minutes. And there was no subsequent or consequential pain from the procedure. Procedure was entirely noninvasive and did not require any local or topical numbing anesthetic. They performed three treatments over the period of six weeks.

at the time, I did not believe that the procedure had accomplished anything. Six months after the procedure, I was scheduled to have a plantar fascia release because I did not feel I had gotten better. In fact I had had improved so slowly that i did not really notice. As I began to approach my surgery date I realized I had actually not had discomfort doing ordinary activities that had hurt me previously. It is overwhelming and obvious to notice the onset of pain but difficult to notice the absence of pain especially as it changed so slowly.

At about six months I began to realize that I can tolerate some small amounts of physical activity again (one hour of swing dancing). So I decided to cancel my surgery and wait to see what was going to happen and to see if I could comfortably live within the limits of my pain.

It has now been a year and half. I'm sure the consequence of the procedures have more than finalized. I'm not fully recovered but I can do almost everything I used to with the exception of high-impact exercise or daily/repetitive exercise. For example, I can no longer take a step class five days a week. But I can take them every other day. However, if I'm on my feet three hours a day on a regular basis, I cannot take a step class in addition to it. But I can be on my feet for several hours at a time so long as I don't do it every day.

So, for me, I have decided to accept my limits and work within them. I do not have debilitating pain, just mild reminders as I push the limits but compared to where I have been with my injury (at one point in a wheelchair), is limits are acceptable and I have regained my life.

Just a follow up from someone who one REALLY suffered from PF. I think a lack of follow ups from those of us that recover my create inacurate information/statistics on what works and what doesn't.

Re: Sonorex Helped me recover

Ed Davis, DPM on 1/19/05 at 20:52 (167569)

Glad to hear about you success with Sonorex. The broad perspective; Canadian, European and US has clearlty demonstrated that it is the amount of energy applied to the plantar fascia that counts, as opposed to the application of all the energy at once via high energy machines which have become a big dollar item in the US. The US has a good health care system but one that is very driven by the profit motive so utilizing high energy with its anesthesia requirments, possible need for a facility and high equipment costs has, for the time being, taken the 'limelight' from the FDA. I think that this is a transient situation as a 'critical mass' of those cured by ESWT, particularly low energy ESWT becomes available.

Re: Sonorex Helped me recover

Dr. Wishnie on 1/20/05 at 08:21 (167586)

Low energy ESWT does work but requires several treatments. In the USA it is not FDA approved for plantar fasciitis or heel spurs as of yet. Most of our ESWTs are done in the office setting, thus eliminating anesthesia and surgery center costs. Occasionally we have to do it in a surgery center because the insurance co. will only pay for the procedure in that type of facility. I agree that in these cases it is a waste of time and money. In addition, I have treated many failed low energy ESWT patients. Again, this does not mean it does not work and if one can go to Canada and spend some time there it might be worthwhile. However, if the treatment does not work, money is wasted, especially since there are many docs using ESWT right in their office.

Re: Sonorex Helped me recover

Ed Davis, DPM on 1/23/05 at 21:01 (167776)

Dr. Wishnie:
How many patients who have had unsuccessful high energy ESWT followed successful low energy ESWT do you have personal knowledge of? It is not a common US scenario. The significance is that clinical success is a function of the total energy applied so the order of application may not have mattered, only the fact that repetition occurred.

Re: Sonorex Helped me recover

Dr.Wishnie on 1/24/05 at 09:28 (167803)

Hi Ed:

I know of five patients with the above scenario. Like you said, it is not a common scenario, but in about four years I have treated over 300 patients with ESWT and since I do see more heel pain than most, I get to see all types of heel pain problems.

Re: Sonorex Helped me recover

Dr. Z on 1/24/05 at 20:56 (167861)

I would be curious to know if you or Sunny know of any cases that had failed high energy protocol and then had a repetitive low energy protocol that achieved a sucessful pain free outcome. From a logical stand point your statement about total energy being the key functional factor should be true. I just don't know if we have proven this or has anyone even tried.

Re: Sonorex Helped me recover

Ed Davis, DPM on 1/25/05 at 13:18 (167909)

I have a large hammer and a small hammer. The first time, I take a piece of wood and it takes me 3 swings of the small hammer to get the nail into the wood. Some of the nail may be left protruding so one blow of the large hammer sinks it in.

The next time, I start with the large hammer. I deliver one hard blow and get the nail to go in more than 50% but still not all the way. I return with my small hammer and it takes 3 swings to the small hammer to get the nail flush.

The point I am making is that the cumulative deliver of energy is what really counts as opposed to high or low energy done first...

Re: Sonorex Helped me recover

Ed Davis, DPM on 1/25/05 at 13:40 (167913)

Yes, I have had such cases. Additionally, as an illustration, I have had some patients who needed more treatments than the accepted protocol. I am looking forward to a day that we justify treatment not just on subjective releif but functional measurements such as measurable decreases in the thickness of the fascia.

Re: Sonorex Helped me recover

Dr. Zuckerman on 1/25/05 at 16:42 (167919)

Sounds reasonable to Dr. Z . I just don't know if this applies to ESWT. We do know that different levels of energy applied to human tissue ie plantar fascia have different tissue effects. On page 21 in the book ESWT and Ultrasound Imaging of the Musculoskeletal System at 0.8mj/mm2 of energy ( low energy) we obtain hyperstimulation - analgesia effects. At energy levels above 0.28mj/mm2 we state to obtain activation of metabolism and starting at 0.36mjmm2 we start to obtain microlesion disintergration
If we accept Dr. Rompe definition of low, medium and high energy, we need to use energy levels above 0.28mj/mm2 to obtain DIRECT BIOGOLICAL changes in the plantar fascia tissue. Now this is the hypothesis that low energy via neuro-receptor interference and release of P substance has an inflamatory effect that increases blood supply to the plantar fascia tissue.
What I am saying is that do we really know if the EFD total is the same is we space if out as we do three three staged repetitive low energy
If is my opinion that is alot of cases if there is a true plantar fasciosis that reparative process only will completely take place with a direct biological interaction and not with an indirect hyperstimuation of pain reception resulting with increase blood flow.

Ok bottom line. No one really knows if accumulative vs stages ESWT is the same.

Re: Sonorex Helped me recover

Doris D. on 1/26/05 at 15:18 (167998)

Dr. Z.,

I am 'signed up' for ESWT. One time treatment. I understand I need to be somewhat sedated. Does this sound right for one treatment? And would you recommend same? My insurance will only pay for the procedure until March, and I don't want to go through something just because 'the money is there' from the insurance if it is not beneficial or if there is another way to do it without being sedated. Should I hold out for multiple treatments? I am very scared to be sedated...
Thank you,

Re: Sonorex Helped me recover

Dr. Z on 1/26/05 at 15:23 (168000)


We use the dornier epos ultra without sedation. We use a regional nerve block which is very effective for this high energy treatment. This is done either in the office or in our mobile treatment center. If you want to learn our ESWT one treatment protocol with the dornier you can e-mail me at (email removed) or go to our web site http://www.eswtusa.com
What is the name of your insurance company? Do you know the name of the machine that your doctor is suggesting

Re: Sonorex Helped me recover

john on 1/27/05 at 11:10 (168033)

Dr Davis,

Your hammer analogy doesn't apply for ESWT. There is a difference in the results between one high dose treatment and several low dose treatments!

There is a research paper, co-authored by Dr. Rompe, and published in the November 2003 issue of the JAMA entitled 'Extracorporeal Shock Wave Therapy for the Treatment of Chronic Calcifying Tendonitis of the Rotator Cuff' That study compared the results of placebo, low energy, and high energy. The same cumulative delivered energy was the same for both low energy and high energy. The study concluded 'Both high-energy and low-energy ESWT appeared to provide a beneficial effect on shoulder function, as well as on self-rated pain and diminished size of calcifications, compared with placebo. Furthermore, high-energy ESWT appeared to be superior to low-energy ESWT'.

This means that even though the treatments had the same cumulative energy, high-energy ESWT was superior to low-energy ESWT. There is no research to show that total energy is all that matters!!!!!

I hope this research article helps to correct this common misconception.