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.
What causes plantar fasciitis?
There are a number of predisposing factors, including foot pronation, obesity, poor fitting shoes, minor trauma, occupational risks and change in exercise program. Although everyone is at risk, plantar fasciitis is most commonly found in athletes, runners, overweight individuals, or those who are required to stand on hard surfaces for prolonged periods of time. Although approximately 2,000,000 Americans suffer from plantar fasciitis ESWT is an appropriate treatment option in approximately 5% to 10% of those cases, as the remainder of the cases can be adequately addressed with more conservative therapies.
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.
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, an ankle block utilizing local anesthetics is administered to numb the afflicted area. 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.
Shockwave Therapy Frequently Asked Questions (FAQ):
What devices 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.
Am I a candidate for ESWT?
If you have been diagnosed with and treated for chronic plantar fasciitis for at least six months and have failed to respond to three conservative treatments, you may be a candidate for ESWT. Conservative treatments include rest, physical therapy, heel cushions, NSAIDs, cortisone injections, taping, orthotics, shoe modifications, night splinting and casting.
ESWT is not recommended if you have a pacemaker, if you are taking medications that may prolong or interfere with blood clotting (coumadin), or if you are pregnant. Your doctor can discuss other possible concerns with you. ESWT is not appropriate for individuals suffering from acute plantar fasciitis. Your health history should be reviewed with your doctor to see if this treatment is appropriate for you.
What should I expect on treatment day?
On the day of the treatment, expect to arrive at the treatment facility approximately 20-30 minutes prior to the scheduled appointment time. Our technician will meet you with some paperwork and your physician will be there to answer any last minute questions you may have. After the brief registration process, you will recline in a comfortable chair or bed with your injured foot resting on a large, fluid-filled cushion.
After the administration of the ankle block and the localization of the inflamed area with the ultrasound, shockwaves will be delivered to the injured heel. The outpatient procedure lasts approximately 20 minutes per injured foot.
Following the procedure, you will be discharged home from the treatment facility and will be provided with instructions and exercises that are important and necessary to your recovery.
What do I need to bring with me on treatment day?
Be comfortable! Most patients wear comfortable clothes and shoes, such as gym shoes. It is a good idea to bring identification (driver's license, ID card) and insurance information.
Your injured foot will be numbed during the procedure. Therefore, it is imperative that you bring someone to drive you home following the procedure. United Shockwave does not recommend that any patient drive themselves home after receiving ESWT.
What are the side effects of ESWT?
Compared to surgery, ESWT has fewer side effects and a much shorter recovery time. The most common adverse reactions include temporary pain associated with bruising and soreness, and swelling. These possible occurrences usually resolve within a few days. Again, most risks associated with surgery and general anesthesia have been eliminated.
Does ESWT hurt?
The most common patient complaint during therapy is mild pain or discomfort during and immediately following the procedure. Typically, an ankle block utilizing local anesthetics is administered to numb the afflicted area prior to receiving any shockwaves.
What can I expect after the treatment?
After the treatment, it is normal to experience mild pain and/or discomfort when the ankle block has subsided. You may even experience heel pain similar to what you were feeling before the procedure. This pain is manageable in most situations with over the counter medications. These symptoms do not mean that the treatment was not effective. It is important to note that this is normal and to be expected following the procedure. Based on many of the clinical trials, the true and lasting effects of ESWT should be evaluated no sooner than 12 weeks following treatment. The healing process continues for weeks and months following ESWT.
Stretching exercises should be continued following the treatment per your physician's orders. You may also want to abstain from stressful activity such as running, sports, or heavy housework for a few weeks. After approximately four weeks, you should be able to resume normal activities.
Will my insurance cover ESWT?
Despite its widespread effectiveness, some insurance companies do not offer coverage for ESWT at this time. For information regarding your specific coverage, please contact your physician.
How much will I owe?
The out-of-pocket expense for ESWT depends on each patient's insurance coverage. Please contact your physician for further explanation of your financial responsibilities.
» Back to Top