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Article for those considering ESWT

Posted by Susan on 7/19/05 at 06:29 (178609)

http://www.physsportsmed.com/issues/2004/1104/glazer.htm

Excerpt from the above link

A New Modality
Recently, extracorporeal shock-wave therapy (ESWT) with ultrasound has been proposed for the treatment of plantar fasciitis. ESWT is used extensively in the treatment of urolithiasis.27 In the 1990s, it was introduced as a treatment for tendinopathies.28 ESWT may provide analgesia and stimulate a healing response in the plantar fascia when traditional therapies fail. The US Food and Drug Administration has approved two devices capable of delivering ESWT.29,30

The efficacy of ESWT for the treatment of plantar fasciitis remains controversial. Initial studies showed promising results, and a recent meta-analysis supported its use.31 However, most of these studies are flawed, and some were funded by ESWT manufacturers, making their conclusions difficult to generalize. Currently, no standardized treatment protocol is used, and devices and patient populations vary widely among the studies. In addition, the literature contains few prospective, randomized, placebo-controlled studies supporting the use of ESWT.29,32 Some involve no comparison group,33,34 or compare two groups receiving ESWT without a standard treatment arm.29 Two studies that did compare ESWT to alternative treatments found outcomes to be similar in both groups.35,36

Two recent important studies have cast doubt on the efficacy of ESWT.12,37 However, subtle differences exist between the ESWT studies, making them difficult to compare. Variations in the energy type and dose imparted, the site where it is concentrated, and the selection of the patient population exist in all the studies, whether they support or oppose ESWT. It is likely that an optimal dose for ESWT exists and that a protocol for directing the ultrasound waves could improve outcome. The therapy may be more effective for patients with symptoms of longer or shorter duration. Clinicians may find that ESWT is more suitable for use in athletes than in a sedentary population. More research is needed to delve into these questions and to further explore the potential of this therapy.

Re: Article for those considering ESWT

Dr. Zuckerman on 7/19/05 at 07:50 (178617)

Both the Dornier and the Ossatron both had specific energy protocols and patient inclusions and exclusions. Both were approved by the FDA as being safe and effective.
This article just confuses the reader by not pointing out that the ossatron and dornier are approved by the FDA and were very specfic with their treatment criteria. The rest of the studies were done with protocol that isn't even being used in the USA
So my vote is that it is very a poor section for ESWT patients who are investigating ESWT. At least the article could name the devices that are FDA approved and explain the in-depth criteria that each had to under go for FDA approved.

Re: Article for reviewing conservative pf treatments

Dr. Zuckerman on 7/19/05 at 07:51 (178618)

That in my opinion is the better title

Re: Article for those considering ESWT

Rachel on 7/19/05 at 07:56 (178619)

Going to see a foot specialist this week, he does have an eswt device. Which device would I want him to have and use? So many questions at this point on what i should be looking for or having done. Thanks

Re: Article for those considering ESWT

Dr. Zuckerman on 7/19/05 at 10:56 (178636)

Find out what first if he or she thinks you area good ESWT candidate.
Here are some of the findings that will make a good candidate
1. First step morning pain
2. Pain on examination where the pf inserts into the bottom of your heel bone
3. Six months of pain and at least three failed conservative treaments

I always perform a diagnostic ultrasound to confirm the plantar fascia pathology