Extracorporeal shockwave treatment, also known as ESWT, is a non-invasive, non-surgical option for treating chronic plantar fasciitis (sometimes referred to as “heel spurs”). “Extracorporeal” means “outside the body”. Shockwaves, also known as pressure or sound waves, are generated from a special ESWT device and focused onto the targeted tissue. The shockwaves are delivered outside the body to trigger your body’s own repair mechanisms. Shockwaves stimulate and activate healing to advance normal tissue healing. In years past, surgical intervention for chronic plantar fasciitis was required when these other treatments had failed. Today, ESWT is available as an alternative, non-invasive treatment option.
Prior to undergoing ESWT treatment, the patient must have been diagnosed with chronic plantar fasciitis for at least six months. Only after the patient’s symptoms fail to respond to three conservative treatments should ESWT be administered. Conservative treatments include rest, physical therapy, heel cushions, non-steroidal anti-inflammatory drugs (ibuprofen, acetaminophen, etc), cortisone injections, taping, orthotics, shoe modifications, night splinting and casting. In years past, surgical intervention for chronic plantar fasciitis was required when these other treatments had failed. Today, ESWT is available as an alternative, non-invasive treatment option.
There are currently two devices approved by the FDA for the treatment of chronic plantar fasciitis, the OssaTron® by HealthTronics, Inc., approved in October 2000, and the Epos Ultra® by Dornier, Inc., approved in January 2002. Both systems result in equally successful patient outcomes and are high-energy devices that utilize a single treatment protocol.
For over twenty years, extracorporeal shockwave lithotripsy (ESWL), a non-invasive procedure, has been successfully used in the treatment of kidney stones. As the force of a shockwave causes the disintegration of the kidney stone, so does the acoustic energy promote healing in the distressed tissue. The shockwave stimulates and reactivates healing through revascularization and other elements necessary to advance normal tissue healing.
The ESWT device consists of a power supply, a console for generating shockwaves, and a portion of the device that transmits the shockwaves. During the treatment, the shockwave delivery aspect of the device is aligned or positioned over the body so that energy is delivered to the specific body part, with minimal energy delivered to the surrounding tissue. The Epos Ultra® includes an ultrasound imaging system that allows the physician to precisely direct the shockwaves to the treatment area during the procedure.
Treatment and Prognosis
On the day of the procedure, you (the patient) will arrive at the treatment location approximately one half hour before the scheduled appointment. There you will meet your physician and the ESWT technician. After fulfilling the brief registration requirements, you will recline in a comfortable chair or bed with your injured foot resting on a large, fluid-filled cushion.
Typically, an ankle block utilizing local anesthetics is administered to numb the afflicted area. Other methods of anesthesia may be used upon your physician’s request. After localizing the inflamed fascia, the injured heel receives several thousand shockwaves during this 20 minute outpatient procedure.
Post operatively patients are discharged directly home from the treatment centers. Your physician will provide post-treatment instructions imperative to your recovery.
Your health history should be reviewed with your doctor to see if this treatment is appropriate for you. ESWT is not recommended for patients with certain conditions. Patients with pacemakers and patients taking medications that may prolong or interfere with blood clotting (coumadin) are not candidates for ESWT. Also, children or pregnant women are not considered appropriate candidates for ESWT. ESWT is not appropriate for individuals suffering from acute plantar fasciitis.
Compared to surgery, ESWT has fewer side effects and a much shorter recovery time. The most common patient complaint is some minor pain or discomfort during and after treatment. Other side effects might include minor skin bruising, reddening, or swelling of the treated area. However, these possible occurrences usually resolve within a few days. The risks associated with surgery and general anesthesia are eliminated.