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What makes the Foot and Ankle Center of Washington different from
other centers performing extracorporal shockwave therapy?
Dr. Hale has no financial interest in any of the extra corporal
shockwave therapy companies. Many physicians are stockholders in the
extra corporal shockwave company they are using. Currently, the
extracorporal shock wave company is paying quarterly dividends to
physicians owning a financial interest in the company. Make sure your
doctor is making medical decisions based on medical data and your own
interest and not on the thought of a quarterly dividend. Dr. Hale was
one of the first physicians in the State of Washington certified to
perform extracorporal shockwave therapy using both types of the extra
corporal shockwave machines for treatment of plantar fasciitis. Dr. Hale
has lectured regionally on the treatment of plantar fasciitis.
Note: Currently high energy shockwave therapy is not being offered in
the State of Washington. Insurance was not reimbursing for the procedure
so companies are no longer bringing in the equipment. Some clinics are
doing low energy shockwave therapy; however, at this point we have not
found a low energy machine that is effective enough to use.
What is ESWT?
Extracorporeal shockwave treatment, also known as ESWT, is a
non-invasive, non-surgical treatment option for the intense, persistent
heel pain associated with chronic plantar fasciitis. “Extracorporeal”
means “outside the body”. Shockwaves, also known as pressure or sound
waves, are generated from a special ESWT device and focused onto the
targeted tissue. The shockwaves are delivered outside the body to
trigger an individual’s own repair mechanisms. The concept behind
shockwave therapy in orthopedic disorders is that the shockwave
stimulates and reactivates healing to encourage revascularization and
other elements necessary to advance normal tissue healing. Additionally,
shockwaves help to over-stimulate pain transmission nerves, which can
lead to a reduction in sensitivity and pain.
What is plantar fasciitis?
The plantar fascia is a band of connective tissue on the plantar surface
of the heel that plays a large role in maintaining the normal
architecture of one’s foot. Plantar fasciitis is a common clinical
condition caused by overuse or injury of the plantar fascia and is
defined as traction degeneration of the plantar fascial band at its
origin on the medial tubercle of the calcaneus. Inflammation, fibrosis,
and decreased vascularization of the fascia occur, causing symptoms of
heel pain. Other symptoms that may occur include burning in the sole of
the foot, recurring foot pain that is especially aching in the morning
or after sitting, or heel pain after beginning a new exercise routine.
Who should receive ESWT for plantar fasciitis?
Prior to undergoing ESWT treatment, the patient must have been diagnosed
with chronic plantar fasciitis for at least six months. Only after the
patient’s symptoms fail to respond to three conservative treatments
should ESWT be administered. Conservative treatments include rest,
physical therapy, heel cushions, non-steroidal anti-inflammatory drugs
(ibuprofen, acetaminophen, etc), cortisone injections, taping, orthotics,
shoe modifications, night splinting and casting. In years past, surgical
intervention for chronic plantar fasciitis was required when these other
treatments had failed. Today, ESWT is available as an alternative,
non-invasive treatment option.
Who should not receive ESWT treatment for plantar fasciitis?
Your health history should be reviewed with your doctor to see if this
treatment is appropriate for you. ESWT is not recommended for patients
with certain conditions. Patients with pacemakers and patients taking
medications that may prolong or interfere with blood clotting (coumadin)
are not candidates for ESWT. Also, children or pregnant women are not
considered appropriate candidates for ESWT. ESWT is not appropriate for
individuals suffering from acute plantar fasciitis.
What are the side effects of ESWT?
Compared to surgery, ESWT has fewer side effects and a much shorter
recovery time. The most common patient complaint is some minor pain or
discomfort during and after treatment. Other side effects might include
minor skin bruising, reddening, or swelling of the treated area.
However, these possible occurrences usually resolve within a few days.
The risks associated with surgery and general anesthesia are eliminated.
What machines are used?
There are currently two devices approved by the FDA for the treatment of
chronic plantar fasciitis, the OssaTron® by HealthTronics, Inc.,
approved in October 2000, and the Epos Ultra® by Dornier, Inc., approved
in January 2002. Both systems result in equally successful patient
outcomes and are high-energy devices that utilize a single treatment
protocol.
How Does ESWT Work?
For over twenty years, extracorporeal shockwave lithotripsy (ESWL), a
non-invasive procedure, has been successfully used in the treatment of
kidney stones. As the force of a shockwave causes the disintegration of
the kidney stone, so does the acoustic energy promote healing in the
distressed tissue. The shockwave stimulates and reactivates healing
through revascularization and other elements necessary to advance normal
tissue healing.
The ESWT device consists of a power supply, a console for generating
shockwaves, and a portion of the device that transmits the shockwaves.
During the treatment, the shockwave delivery aspect of the device is
aligned or positioned over the body so that energy is delivered to the
specific body part, with minimal energy delivered to the surrounding
tissue. The Epos Ultra® includes an ultrasound imaging system that
allows the physician to precisely direct the shockwaves to the treatment
area during the procedure.
What happens on treatment day?
On the day of the procedure, you (the patient) will arrive at the
treatment location approximately one half hour before the scheduled
appointment. There you will meet your physician and the ESWT technician.
After fulfilling the brief registration requirements, you will recline
in a comfortable chair or bed with your injured foot resting on a large,
fluid-filled cushion.
Typically, the area is numbed with local anesthetic. Other methods of anesthesia may be used upon your physician’s request. After localizing the inflamed fascia, the injured heel receives several thousand shockwaves during this 20 minute outpatient procedure. Post operatively patients are discharged directly home from the treatment centers. Your physician will provide post-treatment instructions imperative to your recovery.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.
