Chronic Plantar Fasciitis

Extracorporeal Shock Wave Therapy

Gold Standard treatment for  chronic plantar fasciitis and Achilles tendonitis.

If your heel hurts in the morning when you first get out of bed, and later after getting up from sitting, either in the bottom of the heel or the back of the heel, you probably have plantar fasciitis.

 


  • > 90% effective in our practice

  • No down time

  • Treats RECALCITRANT HEEL PAIN

  • Saves you from unnecessary Surgery!

  • 18 minute procedure DONE IN THE OFFICE

  • No surgical risks

  • Same day back to work


 


Click Here to E-mail Dr. Christina Teimouri

Get general info on ESWT and schedule appts by calling 878-313-FEET (3338)

 

  • ABFAS Certified foot surgeon

  • Podiatry Offices- Allegheny County, Butler County, and also in Beaver County

  • We have treatments not offered anywhere else in Pittsburgh

  • Hours by appointment

A Closer Look At The Research

Article from Podiatry Today (click above to read full article)

Many different studies in peer-reviewed journals were published on the success or failure of ESWT. Nearly every study that involved a retrospective analysis of ESWT on plantar fasciitis found success in the 80 to 88 percent range in substantially reducing heel pain.2,3 These statistics were nearly identical to those of retrospective studies on surgical procedures for plantar fasciitis.

  My colleagues and I published a study comparing surgical success with that of ESWT and found the success rates of both treatments to be equivalent.4 The study consisted of 40 feet treated with ESWT. We used electrohydraulic shockwave with a mean of 20.6 kV in combination with a mean of 2,506 pulses. Read more…at the link above


FAQ Frequently Asked Questions – Extracorporeal Shock Wave Therapy

What, exactly, is Extracorporeal Shockwave Therapy (ESWT, Shockwave Therapy)?

  • ESWT is by now a well established GOLD STANDARD treatment for heel pain, both infracalcaneal ( plantar fasciitis) and posterior calcaneal (achilles tendonitis) in nature. It is a non-invasive treatment for many other chronic musculotendinous injuries.  shock wave therapy delivers many small bursts of very high intensity ultrasound energy to the damaged tendons crossing the elbow joint—it is these tendons which cause symptoms in almost all patients. It’s interesting that this ultrasound energy is exactly the same type used by ultrasound machines to image babies and abdominal organ, just many times stronger.  Clinically, this causes these tendons to heal properly and symptoms to go away. We typically recommend that our Plantar fasciitis Mt Lebanon patients opt for ESWT after exhausting common, completely non-invasive options such as NSAIDS (ibuprofen) and rest.

How, exactly, does ESWT work?

 

Picture of ESWT Machine,Pittsburgh, PA Dornier Epos Ultra

 

What can I expect during my Shockwave Therapy Treatment?  What’s it like?

  • Before any procedure of any kind is started, a thorough history is taken and a thorough exam is performed.  Once you’ve been cleared for Shockwave therapy, you’ll be prepared for treatment—the treatment area is cleaned and local numbing medication such as novocaine or lidocaine may be used.  Shockwave is generally very well tolerated, and local numbing isn’t even needed in most cases. The elbow is placed on a specialized “water bubble” which is part of the ESWT generator. This is important, because ultrasound energy travels best through water.  Many small pulses of ultrasound energy are delivered to the tendons and ligaments of the elbow and the treatment is concluded. The patient will hear a clicking sound as the shockwaves are generated, and usually feels no discomfort. The treatment usually takes under 20 minutes.

WHAT ARE THE DIFFERENCES BETWEEN THE DORNIER EQUIPMENT USED BY Beaver Valley Foot Clinic for SHOCK WAVE THERAPY AND OTHER ESWT EQUIPMENT?

Beaver Valley Foot Clinic has selected the Dornier EPOS Ultra as our equipment of choice because it offers the highest, yet most variable, energy output. It also incorporates ultrasound to view the damaged tissue and target the shock waves directly at, and only to, the damaged tissue.

The Dornier is capable of performing both low energy and high energy treatments. Excellence Shock Wave Therapy does not perform low energy shock wave therapy for plantar fasciitis. Only high energy is FDA tested and approved for plantar fasciitis. High energy ESWT causes cavitation or microtrauma to the tissue. This forces the body to lay down new fibroblast tissue and actually repair the tendon while also affecting pain receptors.

Low energy shock wave therapy affects only the pain receptors. Low energy shock wave therapy cannot be performed with a local anesthetic because a local injection has been shown to nullify the results of low energy treatments on pain receptors. This means the patient must be able to tolerate the pain of the treatment. Once tolerance has been reached, the energy level cannot be increased. Multiple treatments are required to affect the pain receptors with low energy shock wave therapy.

Lately there have been some manufacturers of devices that are unfocused pressure waves machines trying to position their machines as ESWT. Pressure wave devices are used for relaxing muscles and trigger point pain. They are not ESWT, and do not produce the same results or function in the body. Insist on high energy ESWT with the Dornier Epos Ultra.

WHY DOESN’T MY ORTHOPEDIC SURGEON OR PODIATRIST DO THIS PROCEDURE?

Orthopedic surgeons do surgery!  We are committed to AVOIDING surgery at all costs! Many Orthopedic practices are surgically oriented and prefer not to offer the option of non-surgical treatments. You may find many physicians are not even familiar with this treatment. Additionally a practice must invest a half a million dollars in the equipment to provide this service. A physician must have fully committed to this treatment to be able to offer it to his/ her patients.

Does it work?  How successful is it?

  • Shockwave therapy works!  In our practice, ESWT has over 90% success rates for the hardest to treat cases of chronic plantar fasciitis. It has saved thousands of patients from open surgery.  Research papers have outcomes of ESWT’s success rates as high as 80%. Success is defined as “excellent” or “good”, which means that the patient has normal function with some minor pain, or normal function without any pain at all.

Does ESWT hurt?  Is it painful?

  • No.  Patients feel either minor discomfort or nothing at all.  Our patients with Achilles tendonitis in Pittsburgh are generally astounded at how comfortable the treatment really is.

Who is the ideal candidate for ESWT?

  • Alternative Practices and Procedures Chronic plantar fasciitis is a common cause of heel pain. It is the most common diagnosis for pain in the inferior aspect of the heel. Current conservative treatments for plantar fasciitis include: · Rest * Physical therapy * Heel cushions · Nonsteroidal anti-inflammatory drugs (NSAIDs) · Corticosteroid injections · Taping · Orthotics · Shoe modifications · Nightsplinting · Casting Current non-conservative treatments for plantar fasciitis include: · Shockwave therapy by another commercially available shockwave generator · SurgeryAny patient who has tried the most basic treatment measures (such as NSAIDs and rest) without relief is an excellent candidate for Shockwave therapy.  Any patient considering an invasive surgical procedure should certainly consider all non-invasive procedures such as ESWT first—we strongly recommend Shockwave to many of our tennis elbow Moon patients.

Is there anyone who shouldn’t get Shockwave Therapy?

  • No.  While there will always be individual patients who don’t qualify for a specific procedure, ESWT has been used successfully on all major patient populations.  See the question below.

I’ve had cortisone (steroid) shots and they didn’t work.  Is ESWT still OK for me?

  • ESWT is generally a good option for tennis elbow patients who didn’t achieve full relief with injections.  In fact, Shockwave therapy has eliminated the need for further injections in some patients. The only notable exception are those who have had many injections at the same site, or who have been on oral steroids for long periods.  Each patient is different and there are no absolute rules, so make sure you discuss this issue with our physicians.

Are patients generally satisfied with Shockwave Therapy?

  • Very much!  Many of our patients suffering from Plantar fasciitis in Pittsburgh have been thrilled to recommend it to others.

Is ESWT a kind of surgery?  Is it invasive?

  • This lithotripsy type machine attempts to break up chronic inflammation in the foot or kidney stones with a minimal amount of  collateral damage by using an externally applied, focused, high-intensity acoustic pulse. The patient is regionally anesthetized with novocaine or its equivalent prior to the procedure to help them remain still and limit discomfort.

  • ESWT does not break the skin at any time and is not considered surgery.  Shockwave is a non-invasive treatment—this is one of the primary reasons physicians prefer to offer it as an option.

Is ESWT a good option for people who have already had failed surgery for plantar fasciitis?

  • Yes.  A failed surgery can complicate any subsequent treatments: this is true for any surgery, anywhere in the body.  However many patients with a history of failed surgery get exceptional results with Shockwave therapy.

What is the shock wave therapy cost?  If you are Federally insured, since the ESWT is FDA approved, it is a covered service. Other insurers cover it on a case by case basis, but normally it is an out of pocket expense. However, ESWT Pittsburgh is often 1/2 to 1/4 the price of ESWT Philladelphia, or ESWT NYC pricing!

What are shock wave therapy side effects? The side effects of ESWT are usually minimal to none. and if you have numbness or bruising it usually goes away on its own without treatment in several days to a month or so.

Do you recommend shock wave therapy for plantar fasciitis? ESWT for plantar fasciitis is a GOLD Standard treatment for chronic plantar fasciitis. It is definitely worth trying before open surgery and much more effective with less side effects!

What have been the shock wave therapy reviews? Generally 70-95% of patients are very satisfied to completely healed. Most would do it again, and in our practice come back years later(usually for the other foot!)

What are shock wave orthotripsy side effects? Orthotripsy side effects are mild and transient. Bruising at the site (more often from anesthetic injections), numbness that usually fades over time, are the most common side effects of ESWT.

What shockwave therapy machine is used in Pittsburgh at Beaver Valley Foot Clinic? We use the Dornier Epos T M Ultra ESWT machine. It was FDA approved for the treatment of chronic insertional plantar fasciitis on January 15, 2002.

When can I expect maximum results? Although your results may vary, typically patients experience major relief by weeks 6-12, often sooner.  Heel pain and arch pain symptoms gradually reduce in the weeks and months after ESWT and usually disappear completely often forever.

How soon can I go back to normal, everyday activities like driving, walking, and doing household work?

  • Immediately.

How soon can I go back to vigorous, higher impact activities like sports and weight lifting?

  • We recommend that our patients with tennis elbow in Coraopolis wait for 5 days before vigorous activity in order to be absolutely certain of an optimal outcome.

What’s the absolute best outcome I can expect from Shockwave? You can expect the complete relief of chronic plantar fasciitis symptoms and being able to resume normal activities with no restrictions after two weeks.

What’s the absolute worst outcome I can expect from Shockwave? No procedure succeeds 100% of the time.  For example, a patient with several failed surgeries who has extensive joint, tendon, and ligament damage may experience no relief at all.  This being said, ESWT cannot generally make heel pain (or any other condition) much worse.

Does insurance cover ESWT?  How much does it cost? Although rarely covered by insurance, our staff will check with  your personal insurance plan regarding your eligibility and covered benefits for the shock wave procedure.  Many of our tendonitis Seven Fields patients have had their insurance plan cover this procedure, especially those with Federal insurance coverage.