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What
is ESWT? |
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 Shock
Wave Therapy utilizes an Electro Magnetic Shock
Wave emitter to generate shock waves (also known
as pressure or sound waves) delivered outside the
body to trigger appropriate repair mechanisms.
ESWT
has been used since the early 1990s as an
alternative to traditional heel surgery in cases
of chronic painful plantar fasciitis. |
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How
does ESWT reduce heel pain?
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How
does ESWT reduce heel pain? |
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Recent
research has demonstrated that with chronic plantar
fasciitis, the body's normal inflammatory response has
diminished to a point where blood flow is decreased to the
injured area of the fascia. Without adequate blood flow to
any injured tissue, one's normal repair mechanisms are
compromised. ESWT has been demonstrated to initiate
angiogenesis, or formation of new blood vessels. This
treatment therefore acts to jump-start a normal
inflammatory response which can lead to healing in cases
where other conservative treatments
have not proven effective. The
shock waves can also act to over-stimulate pain
transmission nerves, which can lead to a reduction
in sensitivity and discomfort.
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How
successful is this type of treatment?
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How
successful is this type of treatment? |
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Depending
upon which study is evaluated, success rates are
consistently greater than 50% three months following ESWT.
Although symptoms may not be completely eliminated, they
do tend
to diminish to a point where pain is significantly
less disabling and surgical intervention is no longer
indicated. |
How
is the procedure performed?
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How
is the procedure performed? |
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 During
the procedure, the heel is placed on a water-filled
cushion which is part of the Shock Wave Therapy system.
The injured area of the plantar fascia is easily
visualized via the ultrasound imaging system which is part
of the Dornier Epos Ultra ShockWave Generator. A total of
3,800 shock waves are generated, which reach an energy
delivery of 1,300 mJ per square millimeter. The entire
procedure lasts approximately twenty minutes. While the
treatment is performed, one may be aware of a tapping
sensation within the heel region. With local anesthetic,
however, this is usually easily tolerated.
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Is
anesthesia required?
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Is
anesthesia required? |
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The
procedure is performed under local anesthetic on an out
patient basis, often in the doctor's office. The patient
is able to walk after the procedure is
completed. |
What
can I expect following the procedure?
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What
can I expect following the procedure? |
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As
previously stated, this procedure leads to increased blood
flow about the injured heel region. Along with increased
blood flow, there may be a transient increase in
inflammation and discomfort under the heel which generally
lasts no longer than two weeks. Analgesia requirements typically consist of acetaminophen.
Non-steroidal anti-inflammatory medications are avoided as
the goal of this procedure is to allow for a normal
inflammatory cycle to proceed.
Approximately
one month following the procedure, stretching exercises
are initiated and other physical activities are increased
to tolerance. |
What
if ESWT does not reduce my heel pain?
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What
if ESWT does not reduce my heel pain? |
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As with
the other conservative treatments which were utilized
prior to performing ESWT, failure of all treatments is a
possibility. If ESWT is unsuccessful in reducing pain, and
should this pain be disabling, surgical plantar fascial
release can be considered. |
Are
there patients who should not undergo ESWT?
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Are
there patients who should not undergo ESWT? |
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At this
time, ESWT is not recommended for patients who are taking
medications that may prolong or interfere with normal
blood clotting, such as Coumadin. Patients with pacemakers
and pregnant patients are also not considered appropriate
candidates for this procedure. |
Will
my insurance carrier pay for ESWT?
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Will
my insurance carrier pay for ESWT? |
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Although approved by the FDA
for treatment of plantar fasciitis, ESWT is not yet covered by all insurance carriers. Should your insurance
not cover this procedure, a fee schedule which is quite
reasonable does exist. Keep in mind that using the Dornier
Epos Ultra Shock Wave Generator is less expensive than
other high powered shock wave generators (such as OssaTron)
because the procedure is performed under local anesthetic.
The OssaTron Shock Wave Generator requires general
anesthetic or IV sedation which increases costs and
potential risks associated with this form of anesthesia. All factors
considered, ESWT with the Dornier Shock Wave Generator is
an attractive option when comparing costs, disability and
possible risks associated with surgical plantar fascial
release. |
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