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ESWT info from UNC med school web site

Posted by Susan on 7/14/05 at 11:18 (178399)


Re: ESWT info from UNC med school web site

Elyse B on 7/14/05 at 11:37 (178401)

thanks Susan for the interesting website. I guess there are risks to everything just like surgery and you have to personally weigh the pros and cons against the risks/rewards. Thanks again for posting.

Re: ESWT info from UNC med school web site

Dr. Zuckerman on 7/14/05 at 11:52 (178403)

The difference is that the so called ESWT risks areen't even in the same league as Plantar fascia releases. With pf release the foot can cause permenet pain and disablity that can and does last a life time This is something you just haven't seen and if you did you wouldn't be even comparing ESWT and PF foot surgery at all.

Re: ESWT info from UNC med school web site

Ralph on 7/14/05 at 12:13 (178405)

Dr. Z,
Doctors certainly see far more surgery complications than those of us here on heelspurs, but we've certainly read enough posts from people to know that what they are saying true.

The unfortunate thing is that doctors continue to perform the surgery in spite of what you continue to say and regardless of whether ESWT is tried prior to surgery, they still will continue to perform the surgery especially if ESWT doesn't work for the patient.

As long as they know how to cut and as long as the surgery is legal it will still happen. How many will ESWT save from surgery still remains to be seen I think.

Re: ESWT info from UNC med school web site

Elyse B on 7/14/05 at 12:18 (178406)

Dr. Z may I ask what I wrote in the posting above that required you to write a nasty response? Was there one word in my posting about comparing surgery to ESWT? All I wrote is there are risks to everything and choices one has to make(in all of life by the way) and you jumped down my throat. By your response you obviously want to make the choices for the people on this board (ESWT v. surgery) and it was uncalled for. It also makes me believe that all you want to do is push ESWT. Additionally by calling the risks of ESWT as 'so called', you are diminishing something that has been published, that is not fair.

Re: ESWT info from UNC med school web site

HilaryG on 7/14/05 at 12:40 (178407)

Interesting post. Thanks, Susan. Guess there are risks to everything, after all.

Re: ESWT info from UNC med school web site

Ralph on 7/14/05 at 12:40 (178408)

To try and put out a possible fire if I can, I'd like to suggest that Dr. Zuckerman wasn't responding directly to you Elyse when he posted even though he used the word 'you' in the last sentence of his response.

Lets substitute the word 'you' for 'we' and rewrite that last sentence 'we wouldn't be comparing ESWT and surgery'.

I don't think Dr. Z was attacking you personally I read his post as a general statement meaning 'all of us here'.

Re: ESWT info from UNC med school web site

Elyse B on 7/14/05 at 12:47 (178410)

Ralph I will accept that he was not attacking me personally but no one was comparing ESWT to surgery. The article that was posted was about risks and all I said was that there are risks in everything. The good doctors here insist that there are absolutely no risks with ESWT and I don't get how they can make that blanket statement. It is obviously untrue and they just won't cop to that.

Re: ESWT info from UNC med school web site

Susan on 7/14/05 at 13:11 (178411)

You're welcome. Informed consent is very important.

Re: ESWT info from UNC med school web site

Dr. Zuckerman on 7/14/05 at 13:25 (178412)

This is a mis-understanding. There are normal responses to procedures and that there are ABNORMAL responsed to procedures. A normal response such has a pinch isn't a risk to foot surgery or ESWT. Pain from the cutting of the pf fascia is a risk due to the risk that it may not resolve or it may make the foot worse off.
I just can't believe that we are comparing risks of ESWT with the risks of plantar fascia surgery.

You are absolutely correct Dr. Z wants to push ESWT on this board when the indications are correct and the patient meets the criteria I will do this regardless of insurance coverage which is really the issue in my opinion with posters, doctors. It is my believe that if you have failed to improve with conservative treatment and are considering foot surgery then ESWT should be your next choice before foot surgery .
That has always been my position from the first day that I started ASK THE DOCTORS with Scott R

Re: ESWT info from UNC med school web site

Elyse B on 7/14/05 at 13:47 (178415)

Yes I believe it was a misunderstanding as well. I think you have misunderstood me from day 1 in my feelings about ESWT. As I have said over and over and over, caveat emptor, the patient should try and know EVERYTHING before they have ANY procedure including risks and should as I said weight the risk v. rewards. I also have never said that ESWT is not an incorrect or wrong treatment choice.

I will repeat once again, no one was comparing the risks of ESWT v. surgery and how it came to that, is beyond me. I think there is way to much defensiveness about ESWT. It would be nice if there would be equal time with orthopedic surgeons on this board who can report their findings about EPF surgery. I think we would find that there have been a great number of success stories in the same way you post about ESWT. Equal time, unfortunately, orthopedic surgeons do not post on this board.

I am not quite sure why any of the doctors would respond in any negative way about the article from the UNC. We read the articles that you post about the positive studies on ESWT and this article was positive but it also suggested that their might be risks. Should we only be allowed to read positive studies about treatments and drugs? I think not.

Re: ESWT info from UNC med school web site

Susan on 7/14/05 at 13:58 (178416)

You're welcome.

Re: ESWT info from UNC med school web site

Dr. Zuckerman on 7/14/05 at 15:08 (178422)

I will try to explain this another way. The items such as bruising, edema, black and blue, nausea aren't risks of ESWT . Why? First let me point out that the above I have never seen with ESWT, but lets say that they are present. When you have a tooth filling there is going to be swelling, maybe nausea, pain. Are these risks ?. In my mind no they are normal events that can take place for a very short period of time after the tooth filling and aren't permenant or lasting. You just can't compare ESWT effects with Plantar fascia effects. Ok. I will leave the comparsion between ESWT and plantar fascia release out of this discussion.
By the way the risks or side effect from that North Carolina web site was the Sonocur ESWT treatment for Chronic Lateral Epicondylitis ( Tennis Elbow).
If I was using ESWT low energy treatment without Anesthesia I will explain the entire progess differently. Mrs Jones, the treatment can be painful. We will adjust the energy levels to your comfort level. I will probaby give the patient a regional block if they had pain or some type of medication or approach the procedure very very gradual with energy levels.

Re: ESWT info from UNC med school web site

Dr. Zuckerman on 7/14/05 at 15:15 (178423)

There is a mis-understanding about the risks of this procedure and the reality of the procedure.
There maybe people that think that bruising or swelling is dangerous and avoid neeed treatment . This is the point I am making. Swelling and bruising is a normal reaction ( still have seen it so far) to ESWT for CLE and goes away.
This isn't a risk this is a normal reaction that sometimes happens but may never happen and has no negative effect on the quality of life or pain level post-treatment after a few days.
It could be that due someone lack of medical understanding of procedures and the responds to these article as Inform Consent that this could be dangerous reactions and that you are in trouble. That is the problem I have with this entire thread

Now lets get to some reality. If a pateint asked me would my foot become Black and Blue from ESWT My answer would be no but it can from the local anesthesia. ( again I never see this black Blue , reason being I know how to block the human foot with lidocaine)

Re: ESWT info from UNC med school web site

Elyse B on 7/14/05 at 15:57 (178424)

thanks for the follow up.

Re: ESWT info from UNC med school web site

elvis on 7/14/05 at 17:46 (178425)

My 2 cents worth on the risks of ESWT as reported by UNC. On a 1 to 100 scale of risk with 100 being most risky and 0 being no risk I would assign a risk value for ESWT at 0.0001. I agree with Dr Z and probably view the risk profile for a ll practical purposes being ZERO. They report the risks based on patient interviews just like they do for drug side effects. UNC forgot diarrhea and constipation because for all drugs that is reported on the package insert (at least all that I have ever looked at). Because of this Dr. Z is corrrect in that just because something is on the 'risk' list it doesn't mean that it is caused by the prodecudre or in the case of drugs a side effect. Look at any package insert for a drug and if someone took those literally then not too many people would be taking any drug. The nausea, tremors, etc. are most likley caused by the anxiety of the procedure and not as a direct result of the procedure. Could it be 'caused' by the ESWT? Sure it could but being on the list doesn't prove that. Everbody's gonna assess the risk differently. I assess a 0 risk. When assessing ESWT risk I think everyone should also compare it to surgery because surgery is usually the only other procedure available for someone who has tried all other conservative treatments.

Re: ESWT info from UNC med school web site

Dr. Zuckerman on 7/14/05 at 18:22 (178429)

I agree with what you are saying and like the way you present this information.
I will comment that the nausea and tremors on this list is due to the pain from the low energy ESWT treatment.
It is also my opinion that with experience low energy ESWT treatment pain can be reduced and or eliminated The experience in the FDA study for the sonocur isn't that many cases.
I bet you hear alot less pain problems from Dr. Ed patients or patients that are treated with low energy in Canada.
I can do a single high energy treatment with almost no pain from the injection thru the entire treatment but I have done a few thousand ESWT procedure

Re: ESWT info from UNC med school web site

scott r on 7/15/05 at 09:45 (178448)

Elyse, are you going to start 'warning' every new patient who posts here away from ESWT just because you're mad at the doctors? So what exactly are these 'risks' you keep talking about when it comes to ESWT? Please, if there is anyone reading these messages that has been harmed, or knows of anyone that has been harmed by ESWT, let them post now.

Re: ESWT info from UNC med school web site

Dr. Z on 7/15/05 at 21:26 (178495)

I will point out some problems I have seen from ESWT. Nerve neuritis and damage from improper nerve block. From what I have heard and spoken with patients these happen at Ambulatory Surgical Centers. Patients were put to sleep and then injected with an anesthetic. This is something that should never be done in my opinion. The actual procedure with the Dornier can't harm the foot due to outline ultrasound which shows the doctor EXACTLY where the shockwaves are going.
According the ISMST a guildance system is very important to the successful out come of ESWT treatment.
The perforance of ESWT with the use of any type of general anesthesia in combination with IV sedation and local anesthetic nerve blocks. can cause the potential nerve damage due to the lack of the patient ability to feel if a nerve has been hit with a needle.
If a doctor is going to use an ASC it should be straight IV WITHOUT any
local nerve block.

Re: ESWT info from UNC med school web site

elvis on 7/16/05 at 00:17 (178497)

Dr Z...........as I have evaluated the ESWT I first was very conncerned about the general anesthesia given in many Ossatron procedures. I told the LaJolla orthopedic surgeon that no way would I undergo a general. She said 'OK, we'll just us a local'. When I told her abut the ultrasound with the Dornier she said that she also had an ultrasound to guide the ESWT treatment in the Ossatron machine like the Dornier (at least I think like the Dornier). My current doctor, a podiatrist with a sports medicine group, said he uses an off-label use the so called 'low energy' Sonocur which involves starting out with low energy and as the numbing effect starts to kick in he increases the energy dose and ends up with a high energy treatment all without any anesthetic at all. He doesn't like the anestheitic because he feels that it is important to get the bioeedback from the patient during the procedure. With a general or local that is not possible. But the podiatrist said that it is extremely important to deliver a 'high' energy dose. What do you think about his approach?

Re: ESWT info from UNC med school web site

Susan on 7/16/05 at 08:24 (178505)

Are you saying here that PF rupture is not serious? Or neuropathy? The UNC article and others mention those possibilities. But you just 'notice' that the UNC article mentions bruising and then say that it's normal. I'm not for or against ESWT, but seeing you skip over adverse reactions they they are not there makes me wonder.

Re: ESWT info from UNC med school web site

Susan on 7/16/05 at 08:26 (178507)

'like' they are not there

Re: ESWT info from UNC med school web site

Dr. Z on 7/16/05 at 08:47 (178508)

There has never been a documented rupture or neuropathy caused with ESWT in the World in the treatment of plantar fasciitis. They have been over 70,000 ESWT treatment just in Germany in 1996/
I didn't skip over this part. They stated potential and there are alot more potential risks involved such as death if you want to start to list every possible risk.
So skip over no I didn't skip over.

Re: ESWT info from UNC med school web site

Dr. Z on 7/16/05 at 08:59 (178509)

There is no ultrasound guildance system with the ossatron. What the ossatron has are called Cross Bows that help the aligment of the shockhead during the treatment. Three is no direct visualization.
This high energy approach could work but here is what my concerns would be. You have to realize that I have never used the sonocur but I have used this technique with another machine in my early days.
How can you tell if the patient has moved during the treatment and you are away from the treatment zone? Just a mm or two movement can make a difference with treattment results. Once the patient is numbed by the ESWT effects you have no more feed back.
When I use ESWT I use three parameteres to moniter treatment
1. The painful area is marked and confirmed on ultrasound
2 Ultrasound is makes sure the patient hasn't moved during the treatment
3. Knowing where the problem is from clinical experience.
#3 is probaby what your podiatrist is doing. He knows what the problem is and where he wants to go with the treatment . The patient can move without you knowing it during the treatment.
In Canada the Sonocur plus is used and it has ultrasound directly attached to the machine.
So your doctor could be doing something that works and is new but I have no experience with the sonocur and its 'driving' ability so to speak

Re: ESWT info from UNC med school web site

Susan on 7/16/05 at 12:53 (178519)


Re: ESWT info from UNC med school web site

Dr. Z on 7/16/05 at 14:04 (178523)

I am not sure where my answer to the ACAFS link went. I have never read of any literature or study that mentioned a plantar fascia rupture except that there was one pf rupture during the ossatron FDA trial post three months after the end of the 12 week endpoint. The conclusion was that there was no relationship between the ossatron treatment and the pf rupture.

This link talks about reported. I have a feeling that this is what they are talking about.
There is also mis-information about children. If the growth plates are closed and there is chronic pf ESWT can be used with good results. The key is the growth plates and not the age.

Re: ESWT info from UNC med school web site

David on 7/16/05 at 16:06 (178526)

Dr. Z.

Actually, two patients out of the 130 treated by the Ossatron in Healthtronics FDA study experienced plantar fascial tears. Upon approval, the FDA required a post-approval study to investigate plantar fascial tears for patients treated with the Ossatron. The tears occured sometime during the FDA study.

Re: ESWT info from UNC med school web site

Dr. Z on 7/16/05 at 16:38 (178530)

and what was the conclusion of this investigation ? From what I remember it was common for all PMA's to have a follow up for any complications.
Do you know if there are any additional warnings or labeling for pf rupture for the ossatron?

Re: ESWT info from UNC med school web site

Dr. Z on 7/16/05 at 16:52 (178531)

I did go back and look there were two pf in the PMA report. I wonder if these were pre-pf tears. An ultrasound or MRI was never performed pre eswt with the ossatron. It is my opinion and the ISMST that ultrasound should be used to rule out any pathology and for ESWT guildance

Re: Thanx for Your Opinion

elvis on 7/16/05 at 18:40 (178539)

Dr. Z.......thanx for your opinion regarding the Sonocur off-label procedure. Hope I don't have to figure this out from personal experience!! LOL

Re: ESWT info from UNC med school web site

elvis on 7/16/05 at 18:46 (178540)

My 2 cents worth. Any pf sufferer can get a pf rupture especially those who have received cortisone shots. As I mentioned before just because something is reported is not proof that there is a cause and effect relationship. The nature of ESWT would make such a reltionship unlikely. Should there be further study? Sure.

Re: ESWT info from UNC med school web site

Dr. Z on 7/16/05 at 18:56 (178541)

I believe that the investigation showed no definite relationship between the treatment and the plantar rupture. That is what I remember but it been years since I read the Ossatron study. Maybe David can tell us what the investigative report showed.

The most important thing I can offer is that your ESWT treating doctor MUST rule out any pf rupture of partial tear before ESWT treatment that is why you may or may not can a rupture after treatment

Re: DR Z.........Arthiritis vs Pain From Inactivity

elvis on 7/17/05 at 14:58 (178545)

Drz......or Dr Ed......My last visit to the podiatrist here in San Diego the doctor re-adjusted my orhtotics which seemed to have helped greatly. The pain on the top of my foot has gotten worse than the pain in my heel. A month or so ago the podaitrist injected cortisone(derivative - don't know which one) into my 4th and 5th metatarsal joints. He wants to get rid of the meatarsal pain before thinking of doing the ESWT for my heel. He said it may be arthritis. I don't buy the arthritis daignosis one bit without some further diagnostic confirmation. I'm 51 years old and have been a runner all of my life albeit at a modest level until my ealry 40s when I kicked it up a notch to 5 miles/day. At age 42 I started doing half marathons and then at age 47 marathons. I have never ever had a pain in my metatarsal area until I got that stupid cast off last summer (2004). Through the years my orthodpedic doctor has taken X-rays that showed my hips, knees and feet. I always ask him how the joints look and if there are any problems looming. He has always said , 'No problem - don't stop exercising.' The only halfway serious probelms I've had are a pulled hamstring (ouch!) and patellar tendonitis (ouch again). Both have resolved without any problems. I take chondroitin/glucosamine supplements.

The meatarsal pain is like pf in that it hurts realy bad upon rising in the morning and then subsides. It almost seems like something that running through may help. Is arthritis a good guess? What diagnostics would be good to pinpoint the etiology of this pain and what in particular could rule out arthritis? I just walked 2.3 miles in 35 minutes. I had little or no heel pain but I did have the meatatarsal pain that was worse upon wlaking and then subsided somewhat during the walk.

Re: DR Z.........Arthiritis vs Pain From Inactivity

Dr. Z on 7/17/05 at 15:41 (178547)

This could be a few things. Capsulitis, Tendonitis, bursitis and or neuroma. The cast story has me lending toward the neuroma because of the cast situation.and lateral compression of the foot with a cast.
Is there shooting pain, numbness, tingling, cramping, stabbing, throbbing type of pain?
Does massaging the area make it feel better. I would add a metatarsal padding directly behind the necks of the metatarsals to lift the bones away from the nerves, supports the joints.
This could give you a idea of whether my suggestions are correct. IF I could examine you and review an x-ray I could tell you in five minutes. Sometimes a doctor will say arthritis when he's not sure which of the above problems you are having. The treatment should be the same. Off loading of the joints ( metatarsal padding) injections, taping, add the met padding to the orthosis if the met padding helps on the feet.
I have found alot of neuroma problems can cause heel pain

Re: DR Z.........Arthiritis vs Pain From Inactivity

elvis on 7/17/05 at 16:18 (178549)

Thanx Dr. Z......There is no shooting pain, cramping, stabbing or throbbing type of pain. A few weks ago I had a numbness and tingling along the lateral part of my foot right above the floor line (if you stand on your foot) from the mid-ankle area forward to just in front of that bone that sticks out in front of the ankle (sorry I don't know the bone names). It has since subsided. Right now my foot feels pretty good. It is tender upon probing with my finger right in the middle of my foot (3rd metatarsal?) back to the base of my leg and then over laterally to under the ankle bone. It's most tender in the middle top of my foot at the 3rd metatarsal. The doctor had said that he suspected arthritis because of the middle foot pain. He said it's right at the fulcrum and that pain is not usaully caused by the orthotic being off. He didn't conclusively say it was arthritis but he said that's what he was leaning towards. Thanx for the info.

Re: ESWT info from UNC med school web site

Dr. Z on 7/18/05 at 20:09 (178584)

Do you understand what informed consent is? and how you obtain it ?

Re: ESWT info from UNC med school web site

Susan on 7/18/05 at 21:08 (178586)

Seein' as how I've had lots and lots of book learnin', I think I do. As for how to obtain it, I would say when it comes to receiving medical services, it would require both a knowledgeable AND honest, ethical doctor.

Why did my mentioning it put such a burr in your saddle?

Re: ESWT info from UNC med school web site

Dr. Z on 7/18/05 at 21:48 (178590)

You didn't place any burr in my saddle. But you have now !!!I just wanted to know what your understanding of informed consent was. Just a very simple and honest question.
Maybe Elvis can enlighten us with my question. You don't have to become defensive with all of this ethical and honesty that you have tossed out without any thought. There are ethical and honest doctors that have failed to achieve informed consent but my question was do you really know what informed consent is . I will make it even more simple.
When you place a needle into some one arm do you have to tell them that their arm may become black and blue for a short period of time

Re: ScottR

Dr. Z on 7/18/05 at 21:54 (178593)

Hey ScottR
This is a typical thread with lack of understanding except for Elvis who happens to be a lawyer. I asked a simple question and then Susan becomes very defensive BUT never answered my question except to become what you call not nice.
It is important in this decussion to make a point as to what exactly is informed consent because Susan has sort of link the North Carolina Web Site to LACK of informed Consent if you don't mention any of the lists of potential problems which have never be associated directly with ESWT. So I asked her to explain what she feels is lack of informed consent.
This is the problem with heelspurs.com. I guess it would be best to just delete this entire link or have someone such as Elvis to expound as to what is informed consent.

Re: ESWT info from UNC med school web site

Ed Davis, DPM on 7/19/05 at 01:07 (178596)

My answer to the dileman you have discussed is PUBLIC EDUCATION. Many people spend more effort in choosing a car and house than with health desicions. We would like to see as many patients as possbile come to sites like these to self-educate. An attorney is obligated by law to be the advocate for the client. A doctor is not obligated to be the patients' advocate. I would like to see that changed.

Re: ESWT info from UNC med school web site

Sally on 7/19/05 at 01:48 (178600)

Be nice.

By the way, I have a lease on my car. Can Elyse help me with my lease? :)

Re: ESWT info from UNC med school web site

Sally on 7/19/05 at 02:01 (178603)

Teere are no orthopedic surgeons who have been regulars on this board. Feel welcome to ask an orthopedic surgeon to come to the board.

Re: ESWT info from UNC med school web site

Elyse B on 7/19/05 at 05:07 (178605)

why not your brother the alleged podiatrist? That would be great, when will he be posting Sally?

Re: ESWT info from UNC med school web site ScottR

Susan on 7/19/05 at 06:38 (178611)

Is this combativeness appropriate?

Re: To Dr. Ed. ESWT info from UNC med school web site

Ralph on 7/19/05 at 09:27 (178623)

Dr. Ed,
I don't understand your post or why you even posted to me under this thread.

Re: ESWT info from UNC med school web site ScottR

scott r on 7/19/05 at 10:19 (178627)

Susan, Dr. Z asked if you understood informed consent. I can see how his short wording can be interpreted as antagonistic, but he might have been asking because he doesn't understand all of it it himself and was really wondering if a patient really understood it.

Re: ESWT info from UNC med school web site ScottR

Ed Davis, DPM on 7/19/05 at 10:34 (178631)

I did not realize that Elvis was an attorney. It would be great if he explained informed consent on this board.

Re: ESWT info from UNC med school web site ScottR

Dr. Zuckerman on 7/19/05 at 10:49 (178634)

I understand it as a doctor I just wanted a patient/poster point of view. It is my opinion that you don't have to list as RISKS of ESWT Diabetic Neuropathy and or plantar fascia rupture since the risk is so small and as far as I know has never been documented with the dornier epos ultras which is a completely different machine then the ossatron.

Re: general anesthesia and nerve block

Jennifer on 7/19/05 at 22:27 (178689)

Dr. Z, If while under general anesthesia for ESWT, a patient received a nerve block that damaged a nerve, how long could this possibly take to heal? Is this something that has been a documented problem when doctors give nerve blocks for ESWT after the patient is under? This is how ESWT was done for me, and I did sustain nerve damage, but we don't know how.

Re: general anesthesia and nerve block

Dr. Z on 7/19/05 at 22:43 (178691)

It could take weeks, months and sometimes never to heal. I am not sure if it has been documented . It is something that in my opinion can happen due to the patients lack of ability to feel the needle touching the nerve. There are alot of other factors such as the size of the needle , the amount of anethesia used and the total dosage used. It is impossible for Dr. Z to determine exactly what happened with your foot without knowing the exact technique used.

Re: general anesthesia and nerve block

Elyse B on 7/20/05 at 07:09 (178694)

Jennifer was that a risk which was advised to you by the doctor before ESWT about nerve damage?

Re: general anesthesia and nerve block

Ralph on 7/20/05 at 15:10 (178724)

Dr. Z,
If a general anesthesia is used why is a nerve block also needed? Isn't the patient fully out? I thought if your out your out. Are they just using Iv sedation and calling it general anesthesia? Is a breathing tube needed?

Re: general anesthesia and nerve block

Jennifer on 7/20/05 at 20:41 (178744)

No, it wasn't. In fact we discussed ESWT at length, and the only caution my doctor had was it may not work -but I'd be not worse off.

Re: general anesthesia and nerve block

Ed Davis, DPM on 7/20/05 at 22:08 (178750)

Nerve blocks are done for all kinds of procedures on the foot, not just ESWT. I can remember one patient in 22 years of practice who had some temporary nerve damage from a nerve block to remove some warts from the bottom of her foot a back in 1987.

Re: general anesthesia and nerve block

Elyse B on 7/21/05 at 07:28 (178760)

thanks Jennifer for letting us know, just another question for posters to ask their doctors.

Re: ESWT info from UNC med school web site

Sally on 7/23/05 at 21:45 (178957)

This site has several boards. This specific board focuses on ESWT and the evidence of ESWT benefit is overwhelming. Why are you looking for orhtopedic surgeons who have something negative to say about ESWT? Perhaps they are hard to find. The have the same right to post here as anyone else as do other posters.

Re: ESWT info from UNC med school web site

Sally on 7/23/05 at 21:52 (178959)

There are about 15,000 podiatrists out there with only 4 to 5 posting here. My brother is not going to post just for your benefit. He certainly doe not need to come here when you have insulted him by referring to him as \'elleged.\' Why should he come here just to fight with you?

Re: ESWT info from UNC med school web site

Dr. Z on 7/23/05 at 22:03 (178962)

I know alot of orthopedic surgeons who use ESWT and support ESWT. All of the FDA research was done by orthopedic surgeons. Here are just a few.
1. Dr. Zingas
2. Dr. Odgen
3. Dr. Levitt
4 Dr. Myerson- President of the Orthopedic Foot and Ankle Society
5 Dr. Furia.

Re: Dr Z........Another Doctor Who Uses ESWT

elvis on 7/23/05 at 23:18 (178968)


It says laser but he meant ESWT!! LOL

Re: Dr Z........Another Doctor Who Uses ESWT

elvis on 7/23/05 at 23:19 (178969)

OK Try this!!


He said 'laser' but meant ESWT! LOL

Re: Dr Z........Another Doctor Who Uses ESWT

Dr. Z on 7/23/05 at 23:38 (178970)

I trained him last week. I think I will introduce him to ELyse

Re: DR Z.........Arthiritis vs Pain From Inactivity

Ed Davis, DPM on 7/24/05 at 09:32 (178980)

The area around the base of the third toes is in proximity to Morton's neuromas. Also be aware of orthotics, designed to limit STJ overpronation that tend to shift too much weight to the outside of your foot. The orhtotic should limit overpronation at the subtalar joint (reafoot) but limit oversupination (rolling out) at the midtarsal joint (forefoot).

Re: general anesthesia and nerve block

Dr. Z on 7/24/05 at 10:29 (178982)


If you are going to use IV sedation and or general you can go without any type of local anesthesia . This will depend on the skill and experience of the Anesthesiologist

Re: ESWT info from UNC med school web site

john on 7/24/05 at 21:51 (179009)

Unfortunately, all of the ESWT FDA research was not done by orthopedic surgeons. True that Dornier and Healthtronics used orthopedic surgeons at leading research hospitals. However, Medispec use podiatrists and their study was done at podiatrist's offices.

Draw you own conclusions.