When your feet hurt, you hurt all over! Nowhere perhaps, is this old saying more true than in the case of plantar fasciitis syndrome, where each step, all 12,000 to 18,000 a day, often on hard, unyielding, concrete floors, is painful.
There is almost an epidemic of heel spur pain (plantar fasciitis) seen in podiatry offices each and every day in this country. The aging of the baby boomers, 10-hour (and more) work days on hard floors, the overweight population, aerobics and so on, have all contributed to this painful debilitating problem in America. Most of the patients with this painful condition are helped with conservative office therapy, including anti-inflammatory medications, cortisone injections, orthotics (shoe inserts), stretching or physical therapy. Podiatrists believe that over 90% of painful heel patients should improve with these traditional therapies. For more information on these treatments, please see my article on heel pain.
Since the year 2000, an exciting modality has been available at a few select offices in the United States. This method has been used and studied in Europe for many years, and was approved in this country by the FDA (in October 2000) as effective in the treatment of plantar fasciitis where other conservative therapies have failed. This exciting method is Extracorporeal (out of the body) Shock Wave Therapy or ESWT, also just simply called shock wave.
For many years, it has been known that high energy shock waves can have profound effects on the human body. During W.W.II, it was noted that submariners suffered internal injuries when the submarine was near an explosion, even though the sub itself was not damaged. Studying this effect led directly to the eventual development of medically effective shock wave therapy and to the "crushing" of kidney stones" using this high energy. This procedure is called lithotripsy. Physicians performing lithotripsy soon noted new bone growth along the ribs that were exposed to the shock wave directed towards the kidney. From this, they reasoned, the shock wave had an affect also on the soft tissue-bone interface, and from this discovery, shock wave for soft tissue and bone has evolved and is now called Orthotripsy.
In Europe Orthotripsy can be used for chronic heel pain from plantar fasciitis, tennis elbow, non-union of bones, avascular necrosis of bone, and Achilles tendonitis. In this country, it has been approved for chronic plantar fasciitis, either with or without heel spur, when conservative therapy has failed. It has also been approved for tennis elbow. In addition, it is used for Achilles tendinitis, although not yet approved in the United States. There are several brands of machines available for use. Dr. Gurvis uses the FDA approved Epos Ultra® by Dornier, Inc., and brought to the office by United Shock Wave Therapy Company. For more information on that unit, and treatment, you can visit them here United Shock Wave.
It is important that other less costly methods of treatment are attempted prior to the use of shock wave therapy, as they are usually effective. Should you still have pain after conservative therapy; Dr. Gurvis will offer you the option of ESWT prior to suggesting surgery.
You must have had plantar fasciitis for at least 6 months and have tried 3 conservative therapies prior to being considered for Shock Wave treatment.
The Procedure
In the office, your foot is anesthetized with local anesthesia in an ankle block fashion. You are asked to lie on your side on a comfortable table, and your foot is placed on a water filled cushion and lined up by the technician. The shock wave is then administered. You may feel slight discomfort during the procedure. It is important to remember, these are shock waves only, and no cutting or open operation is involved.
After the procedure, you will go home, and may safely return to work within one or 2 days. The effects of the shock wave may be immediate, as it can stabilize the pain receptors, but more often is delayed and may begin to be noticed between 4-6 after treatment. Recovery and improvement can be expected for between 6 months to a year after the ESWT treatment was performed.
Results:
Recent studies have demonstrated, that using the highest, yet still safe, power settings, 75% to 80% of the patients with heel spur - plantar fasciitis pain are significantly improved. Remember, these patients are already the ones who have failed conservative therapy, so they are, indeed, the more stubborn ones to treat. With the use of this modality, surgery for plantar fasciitis - heel spur syndrome, while not becoming a "thing of the past", should, at least, become even less common.
Benefits of ESWT
- Stimulates your body’s own healing.
- Compared to surgery, ESWT has fewer side effects .
- Shorter recovery time.
- Risks associated with surgery and general anesthesia are eliminated.
ESWT treatment is not for everyone
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 Some patients may be taken off their Coumadin for 3 or 4 days prior to the procedure and then restarted on that medicine afterwards: with the permission of their family physician. Also, children or pregnant women are not considered appropriate candidates for ESWT. ESWT is not appropriate for individuals suffering from acute (recent onset) plantar fasciitis.
Doctor Gurvis was one of the very first to perform this procedure in Indianapolis and has now done over 150 of these procedures. The success rate for ESWT approaches 80%.
Ask Doctor Gurvis if this procedure is appropriate for your case if you are suffering from plantar fasciitis, and have not obtained sufficient relief with conservative care. If you are coming from a distance, you can have your records forwarded to Dr. Gurvis for review to see if your case might respond to Shock Wave Therapy prior to coming in for an appointment. There is no fee for this review.
Doctor Gurvis has been performing this Shock Wave Therapy since 2000 and is experienced in both its use, and, more importantly, when to use it. His success rate is approximately 80%
Avon Podiatry
Avon
Station Medical Center
8244 E. US Highway 36, suite 120
Avon, Indiana
46123
317-272-0556
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