Treatment for Plantar Fasciitis: ESWT

C.J. Watson's plantar fasciitis surgery at the Weil Foot and Ankle Institute was all over the news, blogs and Twitter last week. Many fans did not know that C.J. Watson struggled with plantar fasciitis, and others did know that it bothered him so much that he needed surgery! As noted in Dr. Weil, Jr.'s blog post on plantar fasciitis, patients have several treatment options. While patients can utilize conservative treatment to alleviate symptoms, if pain persists, patients can opt for either non-invasive and/or minimally invasive treatments for plantar fasciitis, both of which have been pioneered by Weil Foot & Ankle Institute physicians.

The non-invasive procedure that Weil Foot and Ankle Institute physicians employ is called Extracorporeal Shockwave Therapy more commonly know to us as ESWT. ESWT has been FDA Approved since 2000 and uses sound waves to stimulate healing in some physical disorders, such as plantar fasciitis and Achilles tendonitis. "Extracorporeal" means "outside of the body" and refers to the way the therapy is applied. Because there is no incision, ESWT offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity. 

There are two different types of ESWT that can be performed including:

Low Energy ESWT

Low energy ESWT is performed in three sessions over three weeks. Low energy ESWT sessions are performed in the clinic setting, take approximately 10 minutes and are generally done without anesthesia or sedation. Patients can return to normal work and life immediately after their treatment.

High Energy ESWT

High energy ESWT is performed in one session. Anesthesia/sedation is required for this procedure, which takes approximately 30 minutes. Someone will need to be present to drive you home afterwards.

The surgeons at Weil Foot & Ankle Institute can discuss the risks and benefits of each procedure with you so that.

If you would like to learn more about ESWT, and to find out if you are a candidate for treatment, visit here and call our office at 847-390-7666 to schedule your consultation now!

Shockwave Therapy Effective for Treating Heel Pain

FOOT AND ANKLE
ORTHOPEDICS TODAY July 1, 2010

Shock wave therapy effective for chronic heel pain in randomized, prospective trial
Visual Analog Scale pain scores at 12 months post-treatment dropped 7.5 points from baseline and those patients reported no major adverse events.

Investigators for a multicenter study found that extracorporeal shock wave therapy safely and effectively reduced recalcitrant chronic plantar heel pain, according to findings from their randomized placebo-controlled trial.

“The focused extracorporeal shock wave therapy (ESWT) as applied in this study shows statistically and clinically relevant results with a much better outcome in the active group,” compared to the control group, Ludger Gerdesmeyer, MD, of Kiel, Germany, said at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.

In the ESWT study group, “We have found no relevant side effects,” Gerdesmeyer said. The data he presented have been submitted to the U.S. Food and Drug Administration for possible clearance of the Duolith SD1 (Storz Medical) used in the study for this indication.

The 250-patient study was conducted at European and U.S. centers. Investigators enrolled patients from each center with chronic plantar heel pain of greater than 5 on the Visual Analog Scale (VAS) that did not respond to conservative care.
Focused ESWT

After a wash-out period, patients were randomized to either the active or control group. The active group received 0.25 mJ/mm2 ESWT, 4 Hz frequency, with the device focused on the site of heel pain without the aid of any radiography. Patients in the control group underwent a sham treatment where the ESWT device was deactivated but used identically.

Patients underwent three treatments each. Their results were assessed at 3 months and 12 months following their last treatment using the VAS pain scores as the main outcome measure. Results of the Roles and Maudsley patient self-assessment score and the SF-36 score served as secondary outcomes.

At 3 months, baseline composite VAS scores of 8.3 decreased to 2.7 points after ESWT in the active group and decreased to 5.3 points in the control group. In the ESWT group, VAS scores further decreased after 12 months to 0.8 points.
Less pain

“In the active group we have 69% of the patients [having] more than 60% pain reduction compared to baseline,” Gerdesmeyer said. By comparison, sham treatment was associated with more than 60% pain reduction in 34% of control patients, he said.

Differences between the baseline and follow-up secondary outcomes also favored the active group.

No major adverse events occurred related to ESWT treatment. Some patients treated with ESWT, however, reported device-related events including slight pain or discomfort during and after treatment and minor local swelling or redness.

“It was interesting to see that placebo patients getting just a sham treatment also reported pain during treatment,” Gerdesmeyer added. — by Susan M. Rapp

Reference:

* Gerdesmeyer L, Gollwitzer HW, Saxena A, et al. Focused shock wave therapy in chronic plantar heel pain: A randomized placebo controlled trial. #706. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.

Ludger Gerdesmeyer, MD, can be reached in the Department of Orthopedics and Traumatology, Klinikum Recht der Isar, Technical University Munich, Insmaniger Str. 22, Munich, Germany; 49-89-41402271; e-mail: gerdesmeyer@aol.com.

Perspective

Carol C. Frey, MD
Carol C. Frey

Published studies report that more than 2 million patients are treated for plantar fasciitis each year, accounting for approximately 11% to 15% of all foot-related encounters with physicians annually. Plantar fasciitis is a painful inflammatory process that when not treated can evolve into chronic degenerative changes in the fascia. Traditional treatment options, including conservative measures and medication, have shown success rates from 44% to 82%. Surgical intervention with open or endoscopic release of the plantar fascia has unpredictable results, substantial risks and recovery is usually very slow — 1 year. Researchers have been building a strong body of published clinical evidence for ESWT. ESWT has been shown to be safe and effective in several prospective randomized studies including studies by Gerdesmeyer. In cases of failed nonsurgical treatment, ESWT represents an excellent option to surgery and radial ESWT may be a better option than focused ESWT, as anesthesia is not required.

– Carol C. Frey, MD
Foot & Ankle Section Editor
Orthopedics Today

Study Shows ESWT an Effective Non-Surgical Alternative

The doctors of the Weil Foot & Ankle Institute have studied, published on and utilized Extracorporeal Shock Wave Therapy (ESWT) for years to treat patients with heel pain and other painful conditions of the foot and ankle. The studies commented on below are another confirmation that ESWT can be an effective non-surgical alternative to treating pain. From Orthopedics Today:

Published studies report that more than 2 million patients are treated for plantar fasciitis each year, accounting for approximately 11% to 15% of all foot-related encounters with physicians annually. Plantar fasciitis is a painful inflammatory process that when not treated can evolve into chronic degenerative changes in the fascia. Traditional treatment options, including conservative measures and medication, have shown success rates from 44% to 82%. Surgical intervention with open or endoscopic release of the plantar fascia has unpredictable results, substantial risks and recovery is usually very slow — 1 year. Researchers have been building a strong body of published clinical evidence for ESWT. ESWT has been shown to be safe and effective in several prospective randomized studies including studies by Gerdesmeyer. In cases of failed nonsurgical treatment, ESWT represents an excellent option to surgery and radial ESWT may be a better option than focused ESWT, as anesthesia is not required.

– Carol C. Frey, MD
Foot & Ankle Section Editor
Orthopedics Today

Treating Heel Pain with ESWT: Our Happy Patients

Hey Doc! I am writing to let you know of my ESWT and office visits from start to finish. When I got there on my first visit I liked the fact that you were straight forward and didn’t try to sell me ESWT and let me know it was not a covered (insurance) item. I had just gotten a shot from my referring doctor so my foot was feeling good. You introduced me to Jennifer and said when and if I decide to do something please call her and she will take care of it from start to finish. She did.

I called several months later and came in and got my first treatment followed by the 3 other two a few weeks apart and we talked every time and I did feel like you were really listening and wanted to let you know I appreciated that. Still and all my foot was not feeling as good as I would have liked. Once again you took the time to listen and we talked about a moving forward game plan. From here is where I really to emphasize my treatment by your staff; in particular Jennifer (She was great!!). The plan was to send in for insurance approval for orthotics. Jen had me get molded so that if they approved them then you get them done and I could come back when complete and be good to go. She said if they say no, we will go to Plan “B” which was using my fourth “freebie” ESWT, and then see how that took and go from there to Plan “C”, which was surgery.

I was called the next day by someone and told that insurance wouldn’t cover the ortoics and if I wanted I would have to pay $550 now. I said to hold them and I will think more on them and get back with them. Then I asked to speak to Jen and schedule the fourth ESWT treatment. I really thought this would be a hassle or was thinking something would be less than before being on you. It was not and you handled it just like normal and one of the things I want to report in this letter is the fourth time was the charm and my foot has felt 100% better since.

Everything seemed great until…I got a bill wanting me to pay approx. $125 for my part of the bill for work that was never done and what the insurance didn’t cover on the orthotics that they did pay for. I called and talked to someone who I’m sure was more than happy to hand this over to Jen to take care of. (I was not happy) The first thing Jen said was will take off everything on this bill that’s not right and make everything right.

She had me come in for another fitting which did not have the office co-pay since I was there before for that. (A cheap guy like me appreciates that). Made the next appointment for the fitting and said if I had any issues on the bill we will finalize them after the fitting. Today after the fitting she walked me out to the waiting area, spoke to Lindsay personally and had her correct the bill to what made sense and then had Lindsay (who was also very nice) go over the bill with me in detail. Then Jen stopped back in and made sure I was a “happy camper”. This was the right thing to do, the professional thing to do, and the nice thing to do. They took a wrong and made it right. Please accept my compliments on your work, Lindsay’s work, and especially Jennifer’s work. She is the best! Please feel free to share this and use me for any reference.

Thanks,
Bob
Franklin Park, IL

International Society for Medical Shockwave Treatment

Dr. Lowell Weil, Jr.

Lowell Weil, Jr., DPM, MBA was elected President of the International Society for Medical Shockwave Treatment (ISMST) at their annual meeting in Sorrento, Italy, this past week. He is the first podiatric physician to be elected to an executive position of this organization. His term of office will run through June of 2010 when he will host the 13th Annual ISMST2010 Meeting in Chicago, IL. This multidisciplinary meeting will not only involve ESWT for musculoskeletal disorders, but also the application of this modality in the treatment of wounds, arterial disorders, cellulite, and other cosmetic conditions. Dr. Lowell Weil, Jr.

Dr. Weil, Jr has pioneered the use of extracorporeal shockwave treatment ( ESWT) for plantar fasciitis in the United States and has been involved in three FDA studies and written several papers, as well as co-authored a book on the subject of musculoskeletal ESWT. Dr. Weil, Jr. is the Fellowship Director of the Weil Foot & Ankle Institute, Des Plaines, IL and is a team podiatrist for the Chicago White Sox.