ESW treatment for PF

"Parker Race" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Has anyone tried this for persistent plantar fascitiis?

http://heelspurs.com/eswt/index.html

I usually run with my podiatrist on Friday but I can't today. I think he
was talking about that a few weeks to another in the group, but I don't
remember his take. I drop him a line a see what he says. As a fellow
runner and friend he won't lie to me - I know where he lives. 😉

-Doug

"Doug Freese" <[email hidden]> wrote in message
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Quoted message said:

"Parker Race" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Has anyone tried this for persistent plantar fascitiis?

http://heelspurs.com/eswt/index.html

I usually run with my podiatrist on Friday but I can't today. I think he
was talking about that a few weeks to another in the group, but I don't
remember his take. I drop him a line a see what he says. As a fellow
runner and friend he won't lie to me - I know where he lives. 😉

Quoted message said:

-Doug

Ok, I've gotten more curious as there's a person in Albany who has the
equipment. Of course I'll have to see if my insurance covers it also.
I probably would wait for warm weather when I can ride a bike as it appears
weight bearing exercise isn't an option for a period of weeks after the
treatment.

Parker

Parker Race said:

"Doug Freese" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

"Parker Race" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Has anyone tried this for persistent plantar fascitiis?

http://heelspurs.com/eswt/index.html

I usually run with my podiatrist on Friday but I can't today. I
think he was talking about that a few weeks to another in the group,
but I don't remember his take. I drop him a line a see what he says.
As a fellow runner and friend he won't lie to me - I know where he
lives. 😉

Quoted message said:

-Doug

Ok, I've gotten more curious as there's a person in Albany who has the
equipment. Of course I'll have to see if my insurance covers it also.
I probably would wait for warm weather when I can ride a bike as it
appears weight bearing exercise isn't an option for a period of weeks
after the treatment.

How bad is it at present and what treatments have you already tried? I must
admit that I'm suspicious of any treatment that also stops you running for
weeks. At the end of the day you won't know whether it was the ESW or the
rest that cured you. Either way, you've had to stop running which isn't
good!

My recent brush with PF resolved with a couple of regular ultrasound
treatments (that I strongly suspect did nothing but the physiotherapist was
nice) and a regime of stretches and exercises.

Tim

"Tim Downie" <[email hidden]> wrote in message
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Quoted message said:

Parker Race said:

"Doug Freese" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

"Parker Race" <[email hidden]> wrote in message
news:[email hidden]...
> Has anyone tried this for persistent plantar fascitiis?
>
> http://heelspurs.com/eswt/index.html

I usually run with my podiatrist on Friday but I can't today. I
think he was talking about that a few weeks to another in the group,
but I don't remember his take. I drop him a line a see what he says.
As a fellow runner and friend he won't lie to me - I know where he
lives. 😉

Quoted message said:

-Doug

Ok, I've gotten more curious as there's a person in Albany who has the
equipment. Of course I'll have to see if my insurance covers it also.
I probably would wait for warm weather when I can ride a bike as it
appears weight bearing exercise isn't an option for a period of weeks
after the treatment.

How bad is it at present and what treatments have you already tried? I

must

Quoted message said:

admit that I'm suspicious of any treatment that also stops you running for
weeks. At the end of the day you won't know whether it was the ESW or the
rest that cured you. Either way, you've had to stop running which isn't
good!

My recent brush with PF resolved with a couple of regular ultrasound
treatments (that I strongly suspect did nothing but the physiotherapist

was

Quoted message said:

nice) and a regime of stretches and exercises.

Tim

I think the theory is that reinjuring the area will promote healing.
Sounds like having to break an improperly healed bone.
I've had this for over a year now and have tried therapy, ultrasound,
stretching, massage, ice.

I haven't tried complete rest for other than the first 10 days after the
initial onset.
When it occured it was acute and traumatic and running wasn't even an
option.
It may be the only way to get me to stop running for an extended period, so
maybe it is worth it!

Parker

"Parker Race" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Has anyone tried this for persistent plantar fascitiis?

http://heelspurs.com/eswt/index.html

Funny you should ask, I just heard a seminar given on the basic
science behind ESWT this past monday (I am a MD/PhD student in an
orthopedics lab). The upshot was that no one really knows how this
treatment works, and what it is doing. It was pretty clear from the
data I saw (which is not yet published) that there is some
degenerative response in the cutaneous sensory nerves that are
subjected to ESWT, suggesting that the positive clincial outcome (ie
reduced pain) is due to "killing" the nerves, not necessarily causing
healing. It could very well be therefore just masking symptoms.
Obviously, the science behind this is not all worked out.

As a runner with mild PF, I would not get ESWT until there is more
evidence that it is actually helping the problem; if I were a 80 year
old looking to be able to walk comfortably to the bathroom in the
morning, I might consider it.

Another thing to consider: various clinical studies have various
results when looking to see whether ESWT does provide effective
symptom relief. My guess is that this is largely to do with
heterogenous subject populations and different treatment modalities.
Two quick examples from a quick pubmed search follow:

It works:

J Bone Joint Surg Am. 2004 Oct;86-A(10):2216-28.

Electrohydraulic high-energy shock-wave treatment for chronic plantar
fasciitis.

Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME.

Atlanta Medical Center and the Skeletal Educational Association, 3435
Habersham Road N.W., Atlanta, GA 30305, USA. [email hidden]

BACKGROUND: Plantar fasciitis is a common foot disorder that may be
resistant to nonoperative treatment. This study evaluated the use of
electrohydraulic high-energy shock waves in patients who failed to
respond to a minimum of six months of antecedent nonoperative
treatment. METHODS: A randomized, placebo-controlled, multiply
blinded, crossover study was conducted. Phase 1 consisted of twenty
patients who were nonrandomized to treatment with extracorporeal shock
waves to assess the phase-2 study protocol. In phase 2, 293 patients
were randomized and an additional seventy-one patients were
nonrandomized. Following ankle-block anesthesia, each patient received
100 graded shocks starting at 0.12 to 0.22 mJ/mm(2), followed by 1400
shocks at 0.22 mJ/mm(2) with use of a high-energy electrohydraulic
shock-wave device. Patients in the placebo group received minimal
subcutaneous anesthetic injections and nontransmitted shock waves by
the same protocol. Three months later, patients were given the
opportunity to continue without further treatment or have an
additional treatment. This allowed a patient in the active treatment
arm to receive a second treatment and a patient who received the
placebo to cross over to the active treatment arm. Patients were
followed at least one year after the final treatment. RESULTS:
Treatment was successful in seventeen of the twenty phase-1 patients
at three months. This improved to nineteen (95%) of twenty patients at
one year and was maintained at five years. In phase 2, three months
after treatment, sixty-seven (47%) of the 144 actively treated
patients had a completely successful result compared with forty-two
(30%) of the 141 placebo-treated patients (p = 0.008). At one year,
sixty-five of the sixty-seven actively treated, randomized patients
maintained a successful result. Thirty-six (71%) of the remaining
fifty-one nonrandomized patients had a successful result at three
months. For all 289 patients who had one or more actual treatments,
222 (76.8%) had a good or excellent result. No patient was made worse
by the procedure. CONCLUSIONS: The application of electrohydraulic
high-energy shock waves to the heel is a safe and effective
noninvasive method to treat chronic plantar fasciitis, lasting up to
and beyond one year.

It doesn't work:

JAMA. 2002 Sep 18;288(11):1364-72.

Ultrasound-guided extracorporeal shock wave therapy for plantar
fasciitis: a randomized controlled trial.

Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes
A.

Department of Clinical Epidemiology, Cabrini Hospital and Cabrini
Medical Centre, Malvern, Victoria, Australia 3144.
[email hidden]

CONTEXT: Extracorporeal shock wave therapy (ESWT) is increasingly used
for plantar fasciitis, but limited evidence supports its use.
OBJECTIVE: To determine whether ultrasound-guided ESWT reduces pain
and improves function in patients with plantar fasciitis. DESIGN:
Double-blind, randomized, placebo-controlled trial conducted between
April 1999 and June 2001. SETTING: Participants were recruited from
the community-based referring physicians (primary care physicians,
rheumatologists, orthopedic surgeons, and sports physicians) of a
radiology group in Melbourne, Australia. PARTICIPANTS: We screened 178
patients and enrolled 166; 160 completed the 15-week protocol. Entry
criteria included age at least 18 years with plantar fasciitis,
defined as heel pain maximal over the plantar aspect of the foot of at
least 6 weeks' duration, and an ultrasound-confirmed lesion, defined
as thickening of the origin of the plantar fascia of at least 4 mm,
hypoechogenicity, and alterations in the normal fibrillary pattern.
INTERVENTIONS: Patients were randomly assigned to receive either
ultrasound-guided ESWT given weekly for 3 weeks to a total dose of at
least 1000 mJ/mm(2) (n = 81), or identical placebo to a total dose of
6.0 mJ/mm(2) (n = 85). MAIN OUTCOME MEASURES: Overall, morning, and
activity pain, measured on a visual analog scale; Maryland Foot Score;
walking ability; Short-Form-36 Health Survey (SF-36) score; and
Problem Elicitation Technique score, measured at 6 and 12 weeks after
treatment completion. RESULTS: At 6 and 12 weeks, there were
significant improvements in overall pain in both the active group and
placebo group (mean [SD] improvement, 18.1 [30.6] and 19.8 [33.7] at 6
weeks [P =.74 for between-group difference], and 26.3 [34.8] and 25.7
[34.9] at 12 weeks [P =.99], respectively). Similar improvements in
both groups were also observed for morning and activity pain, walking
ability, Maryland Foot Score, Problem Elicitation Technique, and
SF-36. There were no statistically significant differences in the
degree of improvement between treatment groups for any measured
outcomes. CONCLUSION: We found no evidence to support a beneficial
effect on pain, function, and quality of life of ultrasound-guided
ESWT over placebo in patients with ultrasound-proven plantar fasciitis
6 and 12 weeks following treatment.

back to lurking,
Ilona

"ilona" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

"Parker Race" <[email hidden]> wrote in message

news:<[email hidden]>...

Quoted message said:

Quoted message said:

Has anyone tried this for persistent plantar fascitiis?

http://heelspurs.com/eswt/index.html

Funny you should ask, I just heard a seminar given on the basic
science behind ESWT this past monday (I am a MD/PhD student in an
orthopedics lab). The upshot was that no one really knows how this
treatment works, and what it is doing. It was pretty clear from the
data I saw (which is not yet published) that there is some
degenerative response in the cutaneous sensory nerves that are
subjected to ESWT, suggesting that the positive clincial outcome (ie
reduced pain) is due to "killing" the nerves, not necessarily causing
healing. It could very well be therefore just masking symptoms.
Obviously, the science behind this is not all worked out.

As a runner with mild PF, I would not get ESWT until there is more
evidence that it is actually helping the problem; if I were a 80 year
old looking to be able to walk comfortably to the bathroom in the
morning, I might consider it.

<snip>

Thanks so much.
I read somewhere that doctors in Thailand who lacked the equipment to offer
this treatment utilized a more common tool known as a hammer as an
alternative!

Looks like cross training and tape are in my immediate future.

Parker

"Tim Downie" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

My recent brush with PF resolved with a couple of regular ultrasound
treatments (that I strongly suspect did nothing but the
physiotherapist was nice) and a regime of stretches and exercises.

And maybe you had a very minor case of PF which responed well.

-DF