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Burton J. Katzen, DPM
Non-Surgical Treatment For Heel Pain Extracorporeal Shockwave Therapy (ESWT)
Metro Foot Care Centers
. http://www.marylandfootdoctor.com

Non-Surgical Treatment For Heel Pain Extracorporeal Shockwave Therapy (ESWT)

Definition of Plantar
Fasciitis/Heel Pain Syndrome
In our previous articles we have reviewed the definition, etiology, and several treatment options, both non-surgical and surgical, for the painful foot condition known as plantar fasciitis/heel spur syndrome. Plantar fasciitis is a painful condition of the heel, arch, and less commonly the toes that results from inflammation or tearing of the connective tissue (ligament or elastic band) that stretches from the heel across the arch of the foot into the base of the toes. It may or may not be associated with a heel spur (bony or calcified deposit), in which case it is called heel spur syndrome.
The majority of patients with this condition can be treated successfully with conservative therapy, which may include a combination of
Physical Therapy
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroid injections
In spite of the excellent success rate of conservative therapy, many patients continue to suffer from chronic heel pain. Until now, the only alternative for these patients was surgical intervention. As with any surgery, there are risks and complications with heel spur surgery such as infection, swelling, nerve damage, medial arch flattening, no resolution or worsening of symptoms, etc. Complications have been reported in 15-20% of traditional heel spur surgery cases in some studies. Also, with most heel spur surgery, there is an extended recovery period, often necessitating several weeks of bandaging or casting and long periods of time off work and exercise.
What is Extracorporeal Shock Wave Therapy (ESWT)?
Recently, a non-surgical alternative modality called Extracorporeal Shock Wave Therapy (ESWT) gained the Food and Drug Administrations approval for treatment of recalcitrant plantar fasciitis. This technology has been around for over 20 years for treatment of kidney stones. It is a non-surgical, non-invasive alternative for chronic heel pain sufferers who have failed to improve after an extended period of conservative therapy.
How Does It Work?
Shockwaves, also known as pressure or sound waves, are generated from a special FDA approved ESWT device directed at the targeted painful tissue. The concept in orthopedic disorders is that the shockwave stimulates and reactivates healing to encourage revascularization and other elements necessary to advance normal tissue healing. Additionally, the shockwaves help to over-stimulate pain transmission nerves, which can lead to a reduction in sensitivity and pain.
Post Treatment Care
Since there is no incision, the patient may leave the office in their own shoe and supportive foot gear (orthotics/shoe inserts) and return to their tolerated pre-treatment level of function immediately following the procedure. Application of ice and the use of anti-inflammatory medication may prove helpful for the first several days. One may expect an increased level of discomfort three to seven days post treatment as the local inflammatory response ensues. Strenuous weight bearing athletic activities should be avoided for at least the initial two to three weeks.
Expected Results And Conclusions
While no treatment modality can be considered a panacea for heel pain sufferers, several studies have shown long-term patient satisfaction results following ESWT treatment to be in the neighborhood of 82-85%. One five-year follow-up showed a 90% satisfaction rate. This compares favorably with 83% of patients that had undergone surgical release of the fascia [Weil et. Al., The Journal of Foot and Ankle Surgery (Vol 41, No. 2], but without the risks or disability associated with an open heel spur/plantar fasciitis surgery.
In conclusion, ESWT is a valuable alternative to surgery for chronic heel pain sufferers who have not responded to conservative therapy, especially athletes and patients with ambulatory jobs who cannot afford the down time associated with traditional heel surgery.

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