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ESWT vs arthoscopic plantar fasciotomy

Posted by elvis on 2/01/05 at 23:12 (168297)

I just sent an email to eswtusa.com for information on ESWT. Here's the short version. I'm 50 and in 2001 started running marathons with Leukemia & Lymphoma Society's Team In Training program. I've been a runner all of my adult life but never at that distance. After my 8th marathon in December 2003 the pf in my left foot turned chronic. I did have prior flare ups but the pain went away when I took a couple of days off running and some NSAIDs. I stopped running one year ago this week. I've tried rest, new orthotics, ice, NSAIDs, night splint, Medrol Dosepak (didn't work but worth a try), cortisone injections (April, Sept, Oct), cast (6 weeks June/July), chripractic (deep message, ultrasound, electrical stim) and accupuncture. I recently started with and orhtopedic surgeon in San Diego who wanted to start anew. I stretched every hour each day for a month along with 500mg of naprosyn. With the NSAID scares she told me to stop. It seemed to be getting better at first but still hurts as bad as ever. Lately it seems to feel pretty darned good in the morning and then by 1 or 2pm it starts hurting again especially after getting up from a sitting position. I work out of my house so my activity level is low. The rest of my foot is now starting to hurt.

The surgeon recommends high energy ESWT as the next level of treatment with the possibility of surgery later on. I have corresponded with a podiatrist in Lake Forest CA (Orange County) who suggests an arthoscopic plantar fasciotomy done by him of course. He cuts the medial 2/3 of the plantar fascia.

What are anyone's thoughts on ESWT vs arthoscopic plantar fasciotomy? What is success rate for each procedure? And of course.......yes I want to resume running marathons.

Re: ESWT vs arthoscopic plantar fasciotomy

Dr.Wishnie on 2/02/05 at 09:23 (168311)

Hi Elvis:

I am one of the docs with the ESWT group. I do both procedures and first I must say that EPF is not a bad procedure. In matter of fact, in the hands of the right surgeon it is a good procedure. However, it is still surgery and like with any surgery complications can exist. There are no complications with ESWT. The success rate is about equal (again in the hands of an experienced surgeon). Surgery should always be the last resort. If it was my foot, I would do ESWT first. Dr. Wishnie

Re: ESWT vs arthoscopic plantar fasciotomy

elvis on 2/02/05 at 13:26 (168326)

Thank you Dr. Wishnie. I appreciate very much your comment on what you would do if it was your foot. Sorry for using incorrect terminology -- endoscopic plantar fasciotomy (EPF). My surgeon has told me that if it does come to surgery then she would prefer an open PF instead of the EPF. She said that she was note yet sure if the endoscopic tracks can cause damage that would be avoidable with the open cut. She does recommend the ESWT first if our conservative treatments fails. One thing I forgot to tell you is that I want to lose 30-40 lbs before trying ESWT. I read that is more successful in normal weight people.

What kind of success rate do you see in your practice ( a general % would be good information and I know that it is no guarantee) with ESWT? What is generally reported in the literature? From reading this website I will go with the high energy ESWT. I think my surgeon uses on Ossatron. Do you feel there is an advantage/disadvantage with either the Ossitron or the dornier machines? I assume I should ask how many procedures my doctor has done and what her success rate is. Would it be practical to fly to the east coast and have the procedure done there? Would I be able to fly back the next day?

Re: ESWT vs arthoscopic plantar fasciotomy

Dr. Z on 2/02/05 at 20:57 (168353)


I am sure that Dr. Wishnie will respond also. The dornier epos ultra is a high energy ESWT device that has built in ultrasound for pin point targeted ESWT guildance. The dornier is done under a regional local anesthetic unlike the ossatron which must be done in an ASC under IV and or general anesthesia.
We have many patients that fly in one day and leave the very same day. Both myself and Dr. Wishnie have vast experience with ESWT and have done hundreds of procedure over the last five years.
Here is the results of the one year follow after the FDA 12 week study for both the ossatron and the dornier.
Ossatron reported a sucess rate of 81% while the dornier was 94% . There were poor result with the ossatron and none with the dornier.
It is my opinion that the dornier is a more precise orthopedic device then the ossatron. Having used the dornier since it first was FDA approved I feel that the results are much better.

If you would like additional information about Excellence Shockwave Therapy Group feel freel to contact either Dr. Z at (email removed)

Re: ESWT vs arthoscopic plantar fasciotomy

elvis on 2/02/05 at 23:29 (168362)

Thanks. I'll be in touch if my weight loss is unsuccessful. I'll give that 3 months. I will contact you guys then.

Re: ESWT vs arthoscopic plantar fasciotomy

vince on 2/03/05 at 07:22 (168375)

and when you do decide look at http://www.unitedshockwave.com for a podiatrist that uses their EPOS equipment.

Re: ESWT vs arthoscopic plantar fasciotomy

Melissa on 2/03/05 at 15:16 (168419)

I had ESWT in 2002 and ended up having plantar fascia surgery in 2003. I am glad that I at least 'tried' ESWT since it was pretty non-invasive. The injections to numb the sight were a bit uncomfortable but the ESWT didn't work for me at all. I did have surgery in 2003 and am pain free in both feet and heels! I continue to wear a wrap on my left foot and wear sensible tennis shoes daily including to and from work. I also continue to wear orthotics and will probably never be able to wear any type of dress shoe for any length of time. I'm very glad that I had the surgery as it proved successful for me after battling heel pain for over six years.

Re: ESWT vs arthoscopic plantar fasciotomy

elvis on 2/03/05 at 16:55 (168432)

Thanx vince. I looked at the cite a couple of days ago. I had a bad experience with a podiatrist and am reluctant to go back to one. The guy (DPM) put me in a cast for 6 weeks and then told me to never run or walk my dog. After the initial pain subsided (in all of the other parts of my foot) the heel pain came back in les than 48 hours. He said to get an eliptical machine for aerobics or start biking. The only way I would go back to a podiatrist is to go to Drs. Wishnia or Zuckerman who have the most experience (at least from I can tell so far). I'm going to lose weight first.

Re: ESWT vs arthoscopic plantar fasciotomy

elvis on 2/03/05 at 16:56 (168433)

mellissa.......Did you have endoscopic surgery or open surgery?

Re: ESWT vs arthoscopic plantar fasciotomy

Dr.Wishnie on 2/03/05 at 19:09 (168437)

Hi Elvis:

The other key advantave of the Dornier-Epos over the Ossatron is that it is ultrasound guided. This means that you can see the plantar fascia while you are treating it. Unlike the Ossatron, there is no guess work and that is one of the reasons for its high accuracy. I have about a 94 percent success rate. Yes, you would be able to fly back the next day or even that day. You can also reach me personall via e-mail at (email removed).