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ESWT question for Docs

Posted by S. B. on 5/12/05 at 15:13 (174839)

My husband had Osstron on Feb. 3. So far, no real improvement. (had some then back to burning). We are considering a second treatment. Is it too soon in your opinion? The doctor wants to build on what we've done, and they are working to get it at a greatly reduced cost. (he's waiving his fee for starters.) My husband is on concrete all day, and we really think the job is what is prohibiting him from healing, and don't know if a second treatment would benefit much since he'll still be at the job. He took 8 weeks off with the first surgery, but if he has a second, he'll have basically no time off at all.

Re: ESWT question for Docs

Dr. Z on 5/12/05 at 20:17 (174853)

So long as the correct diagnosis is made a second ESWT treatment can give you dramatic pain reduction regardless of the results of the first treatment. Does you husband limp or have pain when he first gets up in the morning or after sitting for any length of time?

Re: ESWT question for Docs

S. B. on 5/12/05 at 23:02 (174865)

Yes. He didn't always. It really didn't start that way. But for the past while he is in pain when he gets up from sitting. It seems to bother him more getting up from sitting than in the mornings.

Re: ESWT question for Docs

Dr Ben Pearl on 5/15/05 at 03:09 (175057)

the burning may suggest neuritis as well as p.f.
ESWT does not do as well with this.
I'm not sure you are building on anything with 2nd treatment.

Re: ESWT question for Docs

Julie on 5/15/05 at 05:46 (175062)

Standing on concrete all day is not only prohibiting him from healing, it is one of the most common causes of plantar fasciitis and was probably the cause of his. If your husband continues with this job it is going to be difficult for him to heal. The tissues are continually being reinjured, and in that case there may not be much point in a second ESWT - in my opinion, and I am not a doctor.

Has he explored ways of changing his duties? It seems to me that this should be the first line of approach. If change is really impossible (but that is rarely the case: once it's made a health priority, there will probably be some solution to the problem) you should look at ways of improving the situation. Things to consider might be:

What about his shoes? Are they the right size? Do they give him plenty of support? Are the soles thick enough to provide some help? Do they have cushioning inside?

Has he tried taping? Tape provides support and reduces the strain on the fascia. It can relieve pain, and if it does, it is contributing to healing.

Does he have orthotics? If no, this could be investigated. If yes, have they been of any help at all? If not, an adjustment, or a new pair might make a difference.

What about his working surface? Is he walking around all day, or mainly standing in one spot? If the latter, a thick carpet length would cushion the impact. If the former, he could try gluing some carpet, or thick foam to the soles of his shoes. Anything to minimise the effect of the impact of the unforgiving working surface on his feet.

I hope some of these suggestions are useful.

Re: ESWT question for Docs

S. B. on 5/15/05 at 16:47 (175093)

He's always had 'burning pain' on the bottom of his heel. Nerve damage was ruled out by 3 doctors.

Re: ESWT question for Docs

S. B. on 5/15/05 at 16:54 (175094)

Thank you for the suggestion of the carpet on the soles. Haven't thought of that one and we'll give it a shot.

He stands, walks and sits all day. Sits as much as possible, but not that much. There is nothing he can do to change his duties. He has the only job at the place that actually allows someone to sit as much as he does.

We've discussed a new job. It's not that simple though when he provides the insurance and he's been there almost 20 years. But it may be what needs to happen.

Taping kills him. Hurts about worse than anything. He's tried it several times from different doctors and also by himself.

I can't tell you how many shoes he's tried. Finally the Brooks Beast are the best so far. But yes, they are the right size...several doctors have checked them. He's been in orthotics for over 10 years. He's now able to wear soft ones since his doctors (a few of them) recommended them. He wore hard ones up until about 3 months ago. In the past he couldn't tolerate them for longer than a few months. And they've all been custom made. So we're hoping that's an improvement of some sort.

As you can see, he's tried it all. lol. That's why we really feel like it's the concrete. Thanks so much for all your suggestions.

Re: ESWT question for Docs

S. B. on 5/15/05 at 16:56 (175095)

Having said that, please tell me the symptoms of neuritis. We asked several of his doctors about nerve issues, but they all said he didn't have the symptoms.

Re: ESWT question for Docs

Dr. Z on 5/15/05 at 17:25 (175099)

If there is descrete pain at the pf insertion and the ultrasound and or mri shows plantar fasciitis. I would do another ESWT treatment

Re: ESWT question for Docs

S. B. on 5/15/05 at 17:52 (175102)

He has had neither. He had a bone scan and x-rays last year when he was diagnosed. Neither showed a whole lot. He has it in both feet, and all doctors have said that's what he has. But he hasn't had either of these tests. His surgeon did say that when he's had to do two treatments, it's been on patients that have it in both feet. They've all agreed there is nothing else it could be. Process of elimination I suppose. We're still looking into it since it did help for a while. Although the concrete is a major concern of ours.

Re: ESWT question for Docs

john king on 5/17/05 at 16:24 (175205)

Check for diabetes. Burnin pain can be symptom of peripheral neuropathy.
Now you are talking big trouble.

Re: ESWT question for Docs

Ron on 5/18/05 at 18:07 (175277)

> We've discussed a new job. It's not that simple though
> when he provides the insurance and he's been there
> almost 20 years. But it may be what needs to happen.

This is what sucks about our present medical/insurance system. You work your whole life, you've done everything right, and then when a serious disease strikes you might have to give up your insurance, and his disease will probably be considered from thenceforth an uncovered prior disease.

> As you can see, he's tried it all.

Have you? Have you tried ART, massage, stretching and other things?

My answer for me came when I started using an Active-Isolated Stretch routine. I used static stretching for years to no avail. I was becoming an invalid. Your answer is out there, just don't give up.

Good luck.