Over the past 20-years Shockwave Therapy has become the alternative treatment to invasive surgery for patients suffering from plantar fasciitis (heel pain).
What’s more, one of the worrying side effects of surgical treatment are potentially serious complications, such as continued pain, wound problems, and infections. Few complications have been reported with the use of shock wave therapy.
The plantar fascia is a thick connective tissue structure extending over the underside of the foot and its function is to help support the foot arch.
The attachment at the heel is to the medial calcaneus (heel bone) and extending forward to the heads of the metatarsal bones.
The Plantar fascia supports about 14% of the total load in each foot and is heavily involved with complex biomechanical process that occur to allow normal gait to occur.
Plantar fasciitis is the abnormal inflammation of the plantar fascia tissue on the under-side of the foot.
The main causes of mechanical plantar fasciitis are related to poor control of the foot during weight bearing. Plantar fasciitis may also occur in the high arched foot and results from the inability to dissipate force. It is often referred to by the old-fashioned description of ‘policeman’s heel’, based on the activity of policemen walking too much on ‘the beat’.
Before we can begin to treat you with shockwave therapy for Plantar Fasciitis we will need to ask you about your history of heel pain (or read the notes of your physician), examine the area so that we can understand the clinical history behind your condition. This is so that we can ensure that the ailment being treated is actually a plantar fasciitis and heel pain and is therefore treatable with shockwave therapy.
We will isolate the area that needs to be treated, then using our focussed shockwave equipment we will start sending gentle impulses to the area. Discomfort will be kept to a minimum and gradually the impulses will become more intense, although little pain will be felt and if it is it will gradually dissipate over a few days.
Generally, shockwave for plantar fasciitis and heel pain will resolve after three to four sessions, depending on your condition and how long you may have suffered with it, while early diagnosis can reduce the number of sessions needed.
It is important that you work with your physical therapist to ensure that you have an exercise regime and massage to ensure full recovery.
After your subsequent treatments you should notice a definite improvement in symptoms leading to reduction in the original pain felt.
Shock wave therapy works by inducing micro-trauma to the tissue that is affected in the heel and the foot. This micro-trauma initiates a healing response by the body, resulting in blood vessel formation, increased delivery of nutrients and stimulating a repair process that thus relieves the symptoms of pain.
A 2012 study, compared shockwave therapy to surgery and demonstrated that the outcomes for return to sport and continuation of sport whilst undergoing treatment were in favour of shockwave therapy for plantar fasciitis. Athletes were able to have shockwave therapy and maintain playing their chosen sport. Whilst athletes choosing surgery had to stop playing sport. (Saxena – 20121).
Another study demonstrated the morphological changes associated with shockwave therapy for plantar fasciitis. Most studies also show that on its own, shockwave therapy can reduce significantly pain and suffering associated with plantar fasciitis. (Vahdatpour – 20122)
One of the most attractive aspects of shock wave treatment is that it is a non-invasive for problems that are sometimes challenging to treat. This is sometimes described, medically, as being treated extraorporeally, i.e. outside of the body. Furthermore, since it is non-invasive, there is no lengthy recover period, little or no time off from work, or risk of causing further damage and infections.
The same cannot be said with surgery, it is not uncommon for postoperative plantar fasciitis patients who have surgery to miss work for two to six weeks due to immobilization. Plus of course, if they are private patients the cost of surgery can run into several hundreds, if not thousands of pounds.
Since about 1990 Extracorporeal ShockWave Therapy (ESWT) has become an alternative for treating chronic plantar fasciitis in Europe. The USA were slow to catch up and it didn’t catch on there until about the year 2000. There has been some controversy between manufacturers of ESWT technologies, with each of them doggedly determined to create an exclusive market for themselves. One of the common targets for differentiation was the level of energy used in shockwave technology.
We have been working with different shockwave technologies for a number of years and have now progressed to the latest, focussed, shockwave engineering. This has demonstrated that the older, earlier machinery, we once used was much less effective and inferior than what we have now.
In an attempt to quantify the long-term success of ESWT, a study in the USA looked at patients who underwent ESWT at the Weil Foot and Ankle Institute from 2000 to 2002.
The study included 75 patients and 87.5% of these were either satisfied or very satisfied with their ESWT experience at an average of nine years after treatment. 24% of patients were able to discontinue all aspects of maintenance treatment including orthotics, medications, supportive devices or shoes and physical therapy type activities.
We are grateful to Podiatry Today (http://www.podiatrytoday.com/eswt-plantar-fasciitis-what-do-long-term-results-reveal) and to Dr Lowell Weill, Jr., DPM, MBA for the following anecdote.
As a good example of the early and long-term success of ESWT, consider a 48-year-old woman who presented to a clinic in October of 2000. At the time, she had suffered with unilateral heel pain for nearly three years. She was a primary school teacher who was finding it difficult to complete her normal day of work due to the pain she was suffering. Very typically, she had pain when getting out of bed in the morning. Her drive to work took approximately 45 minutes and getting out of the car was very painful. Additionally, every time she rose from her seat in the classroom, the pain stopped her and she felt the pain was affecting her classroom behaviour. Furthermore, because of her heel pain, she had been unable to exercise to her desires and had gained 40 pounds during that three-year span.
The patient previously had seen three different podiatrists for treatment. She received three different pairs of orthotics, shoe gear changes, a reduction in physical activities, five cortisone injections, a variety of over the counter and prescription anti-inflammatory medications, several rounds of physical therapy, immobilization with a walking boot and cast, and a night splint. Her VAS pain at the time of initial presentation was 8 out of 10 at its worst on a daily basis.
Two weeks after her initial consultation, she was treated with high-energy ESWT under sedation. At her first follow-up visit two weeks after her procedure, she noted a 50 percent reduction in pain. At her visit three months after the ESWT procedure, she felt that 90 percent of her symptoms were resolved and was anxious to return to all activities including the use of a treadmill.
When we called patients back for our long-term study, she was insistent about having a long conversation with me. She wanted to help the study in any way she could because she felt that ESWT had “given her life back.” She related that her current condition was terrific. She has had no heel pain for six months following the original ESWT procedure. She had returned to all aspects of life including exercise and stated that not only had she lost the 40 pounds that she had gained during the plantar fascia problem but lost an additional 10 pounds. She told me she was running regularly and had completed two marathons in the previous five years. Her story, more detailed than most, was very common during our long-term study evaluations.
Our standard programme for treating plantar fasciitis with shockwave is £450 for three sessions per foot. These sessions are taken, usually once a week, over a three week period. However, if we are treating both feet at the same time, we are able to do this for a reduced fee of £600. If additional sessions are required the fee is £150 for one foot or £200 for both.
ESWT has proven to be a cost-effective treatment for plantar fasciitis while showing long-term success that other treatments cannot boast. Not only should one consider ESWT a mainstay of treatment for chronic cases of plantar fasciitis, it should now be an option earlier in the treatment regimen over and above other treatments that have not been validated. To find out more or to arrange an appointment, contact us now.
We now use castor oil, rather than gel or petroleum jelly as the medium between the shockwave equipment and the patient for many of our shockwave procedures. We have found that the little pain that our patients feel is reduced when we use castor oil and we believe that the shockwaves reach the areas needing treatment more effectively. You can find out more about this, if you wish, by reading our news item Castor Oil versus Gel in Shockwave Therapy.