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Othopedic Dr. Opinion

Posted by elvis on 3/08/05 at 16:09 (170736)

I went to an orthopedic foot specialist in La Jolla this morning. I have been going to her since Dec '04 and have been suffreing from chronic PF for a little over a year. Here's what she had to say about ESWT:

1. She uses the Ossatron and didn't even know the name Dornier.
2. When I told her about the Dornier not requiring general anesthesia she said that it must not be high energy. I told her that the Dornier was a high energy machine but she certainly didn't believe me! LOL She said that I don't want to have low energy ESWT.
2. I asked her if she used general anesthesia and she said yes. I told her that I didn't wnat that if it was not necessary. She then said she could go with a local on the foot and not do 'mild' general anesthesia. I said good.
3. I asked her what kind of recovery I could expect. She said she would put me in a walking boot for a month. She basically said what I've read here that pain relief will more than likely be gradual and she couldn't predict how long. She recently did a patient that could hardly walk and she is almost pain free now.
4. I aksed her if she could prredict success and recovery time based on how long I have been screwing around with this. I specifically asked if I would have less chance of success and a longer period of recovery because I've had symptoms for over a year. She said there was no way to tell and the length of time having PF shouldn't be a factor relating to results.
5. I forgot to ask how much it would cost and if my Blue Cross PPO would cover it. So I went back and talked to the insurance person and she said she would get back to me.

I'd appreciate any comments.

Re: Othopedic Dr. Opinion

Dr. Zuckerman on 3/08/05 at 16:55 (170741)

Elvis,
The key is are you a good candidate. I would ask her why she think you are a good candidate from her physical examination. What did her testing and evaluation show.
As far as ossatron vs dornier. I use the dornier and I know about both machines I like the dornier for alot of reasons. If you want to go to http://www.eswtusa.com there are a list of reasons
More important were you happy with this doctor and did you feel she was the rigth doctor for you

Re: Othopedic Dr. Opinion

elvis on 3/08/05 at 17:52 (170743)

I was referred to this doctor by a guy I trust a lot. He was the San Diego Chargers orthopedic guy 10 years ago or so for whatever that's worth but he's a 'knee' guy. The gal I was referred to is a foot specialist orthopod and to tell you the truth she acted like I had cooties. She put on a latex glove (don't blame her for that but my regular guy never did that) and only gave what I would call a cursory look-see at my foot on the first visit. She's never even got close to my foot on the other visits even though I 'disrobed' my foot for her! And believe me I don't show my naked feet to just any female!! LOL She looked at my x-ray and MRI. She is a firm believer in stretching every hour during the day.

To answer your qustion, 'I don't know.' If I answer that then maybe I just realized that she is not the right doctor for me.

Re: Othopedic Dr. Opinion

Dr. Z on 3/08/05 at 18:27 (170745)

Elvis,
The following examination factors are very important when determining if ESWT will help you.
1. Alot of pain on physical palpation at the plantar fascia insertion
2. No local nerve entrapment including TTS.
3. Good range of motion at the ankle joint
4. Abnormal mri and or ultrasound
Must rule out other systemic, diseases such as Rheumatoid Arthritis, Lupus, Diabetic Neuropathy.
Must have pain when sitting for any length of time and then trying to walk

Re: Othopedic Dr. Opinion

elvis on 3/09/05 at 00:51 (170762)

Thanx Dr Z...... Here's my 'results'

1. Yes and no. I've never kicked the doctor but I do have pain on palpation. I hate to pull a 'Clinton' but what is 'alot'? Put another way it is VERY tender especially later on in the day.
2. I bleive the MRI said no but I've not had any doctor tell me that I had nerve netrapment or tarsal tunnel syndrome whihc I assume is TTS
3. I have a very good range of motion at the ankle joint and the chiropractor said I had a very muscluar lower leg/foot whihc he indicated was a good sign.
4. UltraSound report said I had mild inflammation (easy for them to say)at the insertion site with subtle bone marrow edema. The podiatrist who put the cast on me did an ultrasound and said the thickness of the pf was on the high normnal end. The outside was a little thicker than the medial side. From the beginning I have the most pain on the lateral side of my heel.

I have no ther abnormalities which have been ruled out by the first orthopod, the chiropractor and the podiatrist. Right now I have sever pain upon waking (30 seconds to a minute) and then once I get moving it feels pretty good until about noon. Then it gets really sore when I get up from the computer. Driving in the car seems to give me particularly acute intense pain after a half hour drive. Same for a plane ride. Excruitiating pain at my destination. Once i get up and start moving the pain is quite tolerable. No one really knows I have a problem except when I get up and take the first several steps.

I guess I'm a good candidate, huh?

Re: Othopedic Dr. Opinion

elvis on 3/09/05 at 01:03 (170763)

Error.......In my last post, #4 should read 'MRI report said I had mild inflammation at the insertion site with subtle bone marrow edema.' Not the ultrasound.

Sorry.

Re: Othopedic Dr. Opinion

elvis on 3/09/05 at 01:27 (170765)

Dr Z......thanx for your information. It's petty clear that my 8 marathons from December 2001 - December 2003 caused my chronic PF. No one ever did a blood work up for Rheumatoid, lupus, diabetes, etc. I don't think there was a reason for that. My recollection is that the ultrasound indicated that my lateral pf near the heel was 5.1mm. Does that sound correct? My recollection that the high end of normal was something like 4.9mm. It was ver close to the high normal thickness. The medial pf was in the normal range but at the high end. I do not recall the podiatrist commenting on the quality of the pf tissue.

Re: Othopedic Dr. Opinion

Julie on 3/09/05 at 02:23 (170767)

Elvis

I hope you don't mind my entering this discussion. I am wondering if you do anything to help yourself avoid that classic first step pain? I think you would find it helpful to spend a few minutes working on your feet before getting out of bed in the morning, and before getting up from sitting. Bending the feet backwards and forwards at the ankles, and rotating the ankles will gently stretch out the calf muscles and achilles tendons that have shortened during inactivity, and you may find that this will reduce, if not eliminate, the pain you have with those first several steps.

Have a look at the instructions for the foot yoga exercises and the plantar fascia stretch if you haven't already done so.
.

Re: Othopedic Dr. Opinion

Dr Ben Pearl on 3/09/05 at 02:48 (170769)

also consider shock absorption running shoes

Re: Othopedic Dr. Opinion

Dr. Zuckerman on 3/09/05 at 07:42 (170772)

Elvis,
It sure sounds like you are a good ESWT candidate.

Re: Othopedic Dr. Opinion

elvis on 3/09/05 at 11:38 (170790)

I used to use a night splint but that caused pain in the metatarsal area of my foot. Maybe it was too tight. I have tried the stretching exercises before geting up and they don't seem to help either. It's the first 3 steps that hurt. After that it loosens up. I'll take any suggestions I can get. Thanx for the input.

Re: Othopedic Dr. Opinion

Ralph on 3/09/05 at 11:57 (170791)

Elvis,
I use a night splint and have gotten some relief, but I use it consistently. When I first started using it I had to keep it pretty lose because like you I was experience pain and pulling.

Like any exercise and I considered this sort of an exercise I began sleeping with it lose and could not sleep through the entire night with it on but I just continued using it.

Honestly it took close to 4 months of consistant wearing before I can say that it began to help and I'm comfortable wearing it.

I told myself I'd use it the best I could and see if things would improve.
They have. If yours is too tight loosen it and go on from there. You can always tighten it later on just like you'd add more weight if you were working with weights. Remember I'm not a doctor here so take my advise as just another suffer. I'm certainly no expert or medical person.

How long did you stick with the night splint? You also must keep doing those exercises. Even if you don't see any improvement keep doing them.
I use Julie's Yoga exercises faithfully now.

I think people give up quickly because they want instant relief. From what I've read on this site that doesn't happen so I just keep at. That's my suggestion for you too. I also tape my feet every day. I don't wear orthotics. The pair I had made hurts my feet toooo much so I tape.

The way I look at this condition for myself is I'm going to try everything and anything in Scott's book consistantly for at least a year because I already know I don't want any surgery.

Re: Othopedic Dr. Opinion

elvis on 3/09/05 at 17:55 (170820)

Ralph.........I bought the night splint in March '04 - a year ago. I used it every night (except when I had my cast) until a month ago. It only gave me releief from the initial morning pain. You have a good idea though. I'll take the wedge out from underneath my toes whihc increases the dorsiflexion (i think that's the correct term) and see what happens. I've been a little lax on the stetching too so I'll resume every hour. Oops got to go stretch!

Re: Othopedic Dr. Opinion

elvis on 3/09/05 at 18:02 (170821)

Since this started I've only warn my running shoes. When my podiatrist took the cast off he told me I could never run or walk the dog. That's totally unacceptable so on my way home I bought a new pair of running shoes - Asics Cumulus. They pretty much wore out and 2 weks ago I bought a pair of Asics Gel-Landreth shoes. I also got new orthotics when all of this happened last year. I wear Ecco sandles sometimes at home. They feel really good on my feet. They have built in arch support. I also have ECCO dress shoes whihc are also great shoes.

Re: Othopedic Dr. Opinion

Fed Up Also on 3/09/05 at 18:23 (170824)

Why doesn't this reply from Dr. Zuckerman surprise me, goof figure.........Good candidate.........

Re: Othopedic Dr. Opinion

elvis on 3/09/05 at 18:55 (170828)

Hey, dude, he listened to me describe what's been going on with my foot. I appreciate his opinion and the fact that I now know exactly what questions to ask when I do go forward and get ESWT. Apparently there are no contraindications for me having ESWT. That's worth a lot to me at this point.

Re: Othopedic Dr. Opinion

Dr. Z on 3/09/05 at 19:11 (170833)

Elvis,

The general range of normal is 2-4 mm. Comparison of the non-painful opposite side is very helpful. Some will say 3.5 mm. is normal. The quality of the fascia is important also. The term hyoechoic is a term that describes poor fiber quality.

Re: To Fed Up Also

Moderator on 3/10/05 at 09:36 (170868)

Fed Up Also, if you have a problem with Dr. Zuckerman, you are only going to be asked once to take it elsewhere such as telephone or email. This has been going on long enough. Keep it up, and you will be blocked.

Re: To Moderator

Fed Up Also on 3/10/05 at 15:10 (170892)

I don't have a problem with Dr. Zuckerman personally, what I have a problem is that not one single doctor on this board or their individual web site is willing to give a straight forward answer about ESWT.

Web sites differ from FDA (PMA) results, from doctor to doctor, etc.

I seen posts like, 'There a great article in a particular magazine', 'or go to this site (and pay $20) for an article'. But never once has anyone, whom I am supposed to consider a professional given a straight forward answer as to how, why and where their particular results came from, why the Aussey report is wrong, why the AMA is incorrect, how different manufactures of ESWT have swade stats, etc.

I just want an answers. I've contacted the FDA via snail mail with the same questions, put copies of each individual Dr. web claims hoping they, the FDA can answer, confirm or deny these claims.

I had ESWT 8 months ago, the doctor gave the same claims, 100% success rate well guess what, it didn't happen, and talking to others who had the same procedure from the same doctor didn't acheive any result, some now a year past treatment.

So, how did the doctors come up with stats, because the actual stats (from talking with ACTUAL patients) don't add up......................

Re: To Moderator

Dr. Z on 3/10/05 at 20:18 (170914)

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1: Foot Ankle Int. 2004 May;25(5):290-7. Related Articles, Links


Extracorporeal shock wave therapy for the treatment of plantar fasciitis.

Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C.

Foot and Ankle Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. (email removed)

One hundred fifty patients were enrolled in a multicenter, randomized, placebo-controlled, prospective, double-blind study to assess the clinical safety and effectiveness of extracorporeal shock wave therapy (ESWT) using the Dornier Epos Ultra for the treatment of plantar fasciitis. The Active Group was treated with electromagnetically generated shocks using ultrasound guidance during a single therapy session. The Control Group received a sham treatment under similar clinical conditions. The groups were demographically similar with respect to age, height, and weight. The average duration of symptoms was nearly 2 years in both groups. All patients were evaluated by the visual analog scale for pain, American Orthopaedic Foot and Ankle Society scores, Roles and Maudsley Score, SF-12 health status questionnaire, and physical examination. The Active Group reported 56% success at 3 months and 94% success at 12 months posttreatment. The Control Group reported 47% success at 3 months posttreatment. Twelve-month data were not collected for the Control Group as they were unblinded at 3 months and offered treatment. ESWT represents a safe treatment option for chronic proximal plantar fasciitis.

Re: Thanks for posting the article

Ralph on 3/10/05 at 21:59 (170919)

Dr.Z,
I was about to post to ask you if you could put the article that you are refering to on this site. I tried to find it in that journel but apparently you have to purchase a subscription to read it.

While searching for that article I found this article, but here that Dr. Zingas is talking about a low energy machine. Here is the link that I found while searching for the one you just posted which I couldn't find.

http://www.pslgroup.com/dg/24449a.htm Interestingly enough he talks about low energy being good too.

This is a bit confusing to a newbie like me. Low energy, high energy,
etc. etc. It's interesting though I don't fully understand it all.

I personally would like to hear from doctors on the other side of this coin. Those that don't use any machine. I think their view would be interesting too.

Re: Thanks for posting the article

Dr. Z on 3/10/05 at 22:30 (170924)

I have the article on my office server. I will try to place it on this site. As you can see it talks about the one year success rate being over 90%.

Re: To Moderator

Richard, C.Ped on 3/11/05 at 08:32 (170935)

I don't usually post on this board because I don't have anything to do with ESWT, but Fed up's reply as well as the other posts have me thinking. It almlost sounds like ESWT is like orthosis or any other type of treatment. Sometimes it works, sometimes it does not. Some of the large off the shelf generic orthosis companies have some over the top elaborate claims about their product, but as a c.ped, I think it is crap. That is my opinion though.

I stand behind the orthosis we make here. I know they work. I also know, they do not work on everyone, but I am truly going to try my best to do so.

Re: To Moderator

Dr. Zuckerman on 3/11/05 at 08:55 (170936)

Richard,
I agree, but the claims that we report are from journals, studies and personal experience.
There is just today an article printed in the Journal of Foot and Ankle reporting very effective results with the Dornier Epos. To cut a foot for chronic plantar fasciosis is just not standard in my opinion when ESWT is available.

Re: To Moderator

Moderator on 3/11/05 at 09:18 (170938)

I have no problem with you or anyone else requesting information regarding ESWT studies. The problem is when personal attacks are used just because someone does not agree with an opinion. Ask questions all you want. Do not add sarcastic comments to other posts that do not concern you or your questions.

Re: To Moderator

Cori P on 3/11/05 at 09:58 (170942)

Dear Fed Up,

I have read the many posts to your message and do have a comment based on ESWT in general. I believe you stated having the ESWT procedure done 8 months ago but never received 100% success. Did you receive any benefit from having the ESWT procedure done? I have been providing treatments for almost 5 years now and I have never given a success rate of 100% nor have I ever given a guarantee that the ESWT procedure will be effective. The best advice I can give my patients are the facts and what to expect following treatment. It seems to me that you may have been given some false information and you were counting on that information to be true. Nevertheless, I don't believe that all doctors and therapists out there providing ESWT treatment and information are the enemy. ESWT has helped many people and perhaps further research on the topic will help to clear up any unanswered questions. Best of luck to you.

Cori P

Re: To Moderator Scott R

Dr. Z on 3/11/05 at 16:33 (170967)

There is no need to use my name in this post. I have nothing to do with other posts, web site or doctor to doctor. What am I the personal guardian for ESWT facts?. I have given Fed up also STRAIGHT answers
I would appreciate this post being removed it has nothing to do with me and just an another insult that has nothing to do with Dr. Z

Re: Enough with Redundant Questions

Moderator on 3/12/05 at 07:48 (171006)

I agree with Dr. Z. Answers have been given to the questions asked. If the same question is asked over and over, that question will be edited out. I strongly suggest that if there are any more questions about what machine is better, please contact via email. This and other posts are becoming very redundant.

Re: To Moderator

Ed Davis, DPM on 3/15/05 at 12:21 (171235)

To Mr. Fed UP:
There is no issues over which the doctors on this board have not given you straight answers on. WE HAVE NOT SEEN YOUR FOOT.
Ed

Re: To Moderator

Ralph on 3/15/05 at 15:28 (171248)

Haven't seen Fed Up post in a while. Did I miss one of his posts or are you just now responding to one of his older posts Dr. Ed?

Hey tell us more about the DolorClast.