Shock Wave Therapy
Extracorporeal Shock Wave Therapy (ESWT) involves a machine which generates a current outside the body, using a spark in water or an electromagnetic coil. This current is then transmitted, via a special pad, into the tissue of the affected body part. Urologists have used this technology for kidney stones to successfully avoid surgery by applying current to break the stones into smaller pieces that can pass out of the ureters. into the bladder, and out of the body. Orthopaedic surgeons investigated this technology to treat chronic soft tissue and bone conditions, such as patellar tendonitis (jumper’s knee), epicondylitis (tennis elbow), and plantar fasciitis. The current disrupts the tiny nerves that signal pain, and then stimulates healing by increasing the density of blood vessels in the area after treatment. ESWT is viewed as a second line treatment for plantar fasciitis, used in patients who have had failure with shoe inserts and stretching alone. The FDA has approved ESWT for use in patients with plantar fasciitis symptoms for six months or more. Use of this technology may or may not be covered by insurance.
Plantar Fasciitis Non-Operative Treatment
Treatment of plantar fasciitis aims to calm down the pain under the pad of the heel. Gel heel pads, orthopaedic shoe inserts, physical therapy, splinting or taping, and steroid injections are often used for this painful condition. Unfortunately, a fair number of patients struggle with this issue on a chronic basis. They may change shoes or inserts and often seek care several times for this condition. Sometimes, patients pursue surgery in an effort to definitively treat their condition. However, there are complications that can occur when the plantar fascia is released, and the recovery is often fairly lengthy. As such, many practitioners aim to pursue non-operative treatment in the majority of plantar fasciitis cases.
Plantar fasciitis is a painful musculoskeletal condition involving severe pain under the pad of the heel. Patients often complain the most about pain when they first get up in the morning and try to get out of bed. A podiatrist or orthopaedic surgeon will often order foot xrays, and these may show a small bone spur underneath the calcaneus or heel bone. This spur shows where the anatomic structure involved in this painful condition, the plantar fascia, starts. The plantar fascia is a thin layer of connective tissue that runs under and supports the arch of the foot. When it gets irritated under the calcaneus, patients can have significant discomfort with standing, walking, or exercising.
The Storz Medical Duolith ® SD1 Extracorporeal Shock Wave Therapy is one of several devices made by the Storz company for use by podiatrists or orthopaedic surgeons trained in ESWT. Patients are given five in-office treatments, which may be painful at the time. Results have been shown to be consistently better than placebo, with very few side effects, and much less risk than surgery. Meta-analyses, or studies comparing multiple studies, have shown around 60% reduction of heel pain as the expected outcome with Storz ESWT treatment.