Extracorporeal Shockwave Treatment

Extracorporeal Shock Wave
Treatment for chronic Proximal Plantar Fasciitis

eswtusalogoA revolutionary new treatment for plantar fasciitis has arrived. Many people suffer from the classic symptoms of plantar fasciitis. These symptoms typically are heel pain the first few steps in the morning and/or after rest. This pain usually subsides some after walking for five to ten minutes. As the condition progresses, patients may experience heel pain late in the day as well. Extracorporeal Shock Wave is now FDA approved to treat plantar fasciitis.

“Extracorporeal” means “outside the body.” Shock waves are created by very strong acoustic (sound) energy. The ESW treatment is preformed with a device called the OssaTron. The OssaTron is a shock wave generator very similar to the shock wave devices used to treat kidney stones without surgery (Lithotripsy). The shock waves are created by a spark plug that is enclosed in a soft plastic dome filled with water. During ESW treatment, this dome is placed close against the heel so that the shock waves pass through the dome into the heel. ESW is a non-invasive way of treating heel pain. There are no incisions, stitches or dressings associated with ESW treatment.

The day of the ESW treatment:

Dr. Lebovic will probably ask you to come to the surgery center a few hours before your ESW treatment is scheduled. You should wear shorts or loose fitting clothing that can easily be rolled up to the knee of your affected leg. Otherwise, you may be asked to change from your own clothes into a hospital gown. The staff may take your temperature, pulse and blood pressure and ask you some questions about your general health. They also will make sure you have signed a consent form for the ESW treatment.

The ESW treatment may cause some discomfort, so an anesthetic is commonly given before the procedure. Usually, this is a local anesthetic or a regional anesthetic called a heel block. During the ESW treatment, you will be asked to rest comfortably on your back while Dr. Lebovic holds your foot up to the OssaTron shock head.

An ESW treatment for chronic proximal plantar faciitis usually takes about 30 minutes. The ESW treatment is performed as an outpatient procedure. No overnight hospital is necessary.

After the ESW treatment:

Immediately after treatment, you will stay at the hospital or surgery center until the anesthetic wears off enough that it is safe for you to walk. Dr. Lebovic will probably ask you to restrict “stressful activity” involving the treated foot for four weeks after treatment. “Stressful activity” may include running or jogging, doing heavy housework or yard work, and participating in sports.

Some patients need a mild pain medication following ESW treatment. Although some patients feel immediate relief from pain after the ESW treatment, it is more common for it to take up to six weeks for pain relief to begin.

Dr Lebovic will ask you to return to the office for a follow up visit after ESW treatment.

How can I get more information about ESW treatment for heel pain?

Talk to Dr. Lebovic. In order to use the OssaTron to treat chronic proximal plantar faciitis, Dr. Lebovic had to complete a specialized training program. The training program not only allowed Dr. Lebovic to learn how to perform the ESW treatment, but it also included information about shock wave energy in general, and information from the OssaTron clinical study. Therefore, Dr. Lebovic is the best person to talk with if you have any questions or concerns about ESW treatment for chronic proximal plantar faciitis with the OssaTron.

Other treatments available for treating chronic proximal plantar faciitis:

Many other people get better after trying one or several conservative treatments, which include:

  • Rest from excessive or abusive activity and the application of heat or cold
  • Physical conditioning exercises
  • Use of a custom foot orthotics.
  • Physical therapy, including ultrasound therapy
  • Over-the-counter pain relievers, such as aspirin or Tylenol (acetaminophen)
  • Prescription pain relievers
  • Non-steroidal anti-inflammatory medications (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen)
  • Steroid injections (cortisone)

In difficult cases of chronic proximal plantar fasciitis, open or arthoscopic surgery may be performed.

Who should consider having ESW treatment for proximal plantar fasciitis?

ESW treatment with the OssaTron is for patients who have had heel pain for at least six months and who have tried other methods for treating their heel pain. In the OssaTron clinical study, the treated patients had failed to respond to at least three attempts at conservative treatment: two prior courses of non-invasive treatment, including physical therapy and the use of an orthotic device; and one prior course of pharmacological treatment.

ESW treatment with the OssaTron is for patients who can tolerate anesthesia prior to the ESW procedure. ESW treatment with the OssaTron is painful.

ESW treatment with the OssaTron is for patients who can tolerate hearing protection to reduce the risk of hearing impairment due to the sound of the OssaTron.

Contraindications:

  • Anyone taking medications that may prolong or interfere with blood clotting should not have EWS treatment.
  • Anyone with a history of bleeding problems should not have ESW treatment
  • Children should not have ESW treatment.
  • Pregnant women should not have ESW treatment.

Because the OssaTron has not been tested on people who have the following conditions, its effect, safety, and effectiveness on someone who has one of the following conditions is unknown:

  • Tarsal tunnel syndrome or other nerve entrapment disorders (damage or pressure on the nerves to the foot)
  • Diabetic neuropathy (nerve or pressure on the nerves to the foot)
  • Fracture of the foot or ankle
  • Significant peripheral vascular disease (problems with the circulation in the blood vessels in the legs)
  • Severe arthritis
  • Rheumatoid arthritis
  • Osteoporosis
  • Metabolic disorders
  • Malignancies
  • Paget’s disease
  • Osteomyelitis
  • Systemic infection

Dr. Lebovic can provide you with additional information about these and other conditions and how they might affect the decision to perform ESW treatment.

Side Effect and Complications:

  • The ESW treatment may cause skin reddening or bruising of the treated foot. This usually clears within a few days.
  • The ESW treatment may cause numbness or tingling in the treated foot.
  • The ESW procedure may cause the plantar fascia to tear.
  • The ESW treatment may not help heel pain in your case. You may have episodes of pain similar to the pain you had before treatment. The pain may continue for a few days to several weeks after treatment.
  • Shock waves directed at large blood vessels or major nerves may cause damage to these structures. Misdirected ESW may result in nerve or blood vessel injury.

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