ESWT (Shockwave) Therapy
PLANTAR FASCIITIS HELP WITH EXTRACORPOREAL SHOCKWAVE THERAPY IN AUSTIN
COMMON SYMPTOMS OF PLANTAR FASCIITIS:
WHAT IS PLANTAR FASCIITIS?
Plantar fascia is a strong ligament that spans from your heel to the base of your toes. Imagine the bones that make up your arch as a hunting bow. Your plantar fascia is the bow string. When too much pressure is exerted downward on the bow(bones), the bow string takes stress and gets inflamed. This is especially true at the insertion, of the plantar fascia, on the heel. Inflammation leads to adhesions or scar tissue, in the plantar fascia or it can even become a calcified heel spur. This is where the Piezowave 2 (The brand of extracorporeal shockwave therapy we use) comes into play.
- Ready to leap out of bed without the pain of plantar fasciitis?
- Ready to dance again with ESWT(extracorporeal shockwave therapy)?
- EWST is safe and shows better long term results compared to cortisone or surgery.
COMMON SYMPTOMS OF PLANTAR FASCIITIS:
- stabbing foot pain, near the heel
- pain in the arch of your foot
- aching feet, in the morning, upon applying weight
- might feel better when feet are warmed up
WHAT IS PLANTAR FASCIITIS?
Plantar fascia is a strong ligament that spans from your heel to the base of your toes. Imagine the bones that make up your arch as a hunting bow. Your plantar fascia is the bow string. When too much pressure is exerted downward on the bow(bones), the bow string takes stress and gets inflamed. This is especially true at the insertion, of the plantar fascia, on the heel. Inflammation leads to adhesions or scar tissue, in the plantar fascia or it can even become a calcified heel spur. This is where the Piezowave 2 (The brand of extracorporeal shockwave therapy we use) comes into play.
WHO GETS PLANTAR FASCIITIS?
Around 10% of people will have plantar fasciitis, in their lifetime and the chances go up as you age. If you're on your feet all day, perhaps teaching, delivering packages or being a nurse, etc, you're more likely to develop it. If you're also overweight, that makes the problem escalate.
HOW CAN SHOCKWAVES HELP?
Treatment with EWST, for plantar fasciitis, gained FDA approval, in 2000. With the Piezowave 2, high energy sound, or acoustic waves, are introduced into the soft tissues, of your feet, at about 5 to 15mm deep. Your normal tissue moves with the sound waves, like water, that has been displaced, by a stone. Scar tissue, within the plants facsia, is brittle and does not bend, like healthy tissue. The calcification will break on a microscopic level. Blood that was blocked, from flowing, can re-enter the damage tissue (revascularization) and lead to tissue regeneration [2]. With a conservative estimate of 1 to 2 visits, per week, your plantar fasciitis will begin the healing process, that may take up to 6 to 8 weeks. Some symptoms will be gone sooner and some may take longer.
We also look for taut muscular knots, called trigger points, that refer pain in the plantar fascia. A 2014 study showed treating the trigger points, in the calf muscles, in combination with the plantar fascia, was more effective than just the plantar fascia [23].
RISK FACTORS FOR PLANTAR FASCIITIS
WHAT MAKES THE PIEZOWAVE 2 DIFFERENT FROM OTHER ESWT?
Around 10% of people will have plantar fasciitis, in their lifetime and the chances go up as you age. If you're on your feet all day, perhaps teaching, delivering packages or being a nurse, etc, you're more likely to develop it. If you're also overweight, that makes the problem escalate.
HOW CAN SHOCKWAVES HELP?
Treatment with EWST, for plantar fasciitis, gained FDA approval, in 2000. With the Piezowave 2, high energy sound, or acoustic waves, are introduced into the soft tissues, of your feet, at about 5 to 15mm deep. Your normal tissue moves with the sound waves, like water, that has been displaced, by a stone. Scar tissue, within the plants facsia, is brittle and does not bend, like healthy tissue. The calcification will break on a microscopic level. Blood that was blocked, from flowing, can re-enter the damage tissue (revascularization) and lead to tissue regeneration [2]. With a conservative estimate of 1 to 2 visits, per week, your plantar fasciitis will begin the healing process, that may take up to 6 to 8 weeks. Some symptoms will be gone sooner and some may take longer.
We also look for taut muscular knots, called trigger points, that refer pain in the plantar fascia. A 2014 study showed treating the trigger points, in the calf muscles, in combination with the plantar fascia, was more effective than just the plantar fascia [23].
RISK FACTORS FOR PLANTAR FASCIITIS
- weak muscles of the foot that don’t share the load
- tight calf muscles leading to decreases flexibility
- flat feet or excessively high arches
- poorly fitted or old shoes
- excessive standing
- wearing heels all day and then going running
- being overweight
WHAT MAKES THE PIEZOWAVE 2 DIFFERENT FROM OTHER ESWT?
Piezoelectrically derived shockwaves, are the most specific, controllable and effective shockwaves, on the market, to help you with plantar fasciitis. As you will see below, the research on ESWT, for plantar fasciitis, shows very good results. However, if the research was done with piezoelectrically sourced shockwaves, the results would be even more profound.
HOME CARE DURING ESWT:
WHAT IF I’VE BEEN MISDIAGNOSED?Other ailments can mimic plantar fasciitis. This is why we evaluate the structure of your foot, to see if there are any bony misalignments, trigger points, that radiate into your painful areas, possible tears, in your soft tissue or impingement syndromes.
While the Piezowave2 is working on your foot, you will actually feel it working. This is not a machine that just sprays the area, with sound waves. The waves are very specific, and if areas of discomfort are found, there is benefit. It may be from another part of the plantar fascia, a tendon (often the peroneus longus, posterior tibial or flexor hallucis longus tendon) or even in a joint, but healing will be taking place. If a differential diagnosis is needed, this may involve looking to the lower leg, taking an x-ray or referring for an MRI evaluation. I can refer you, if necessary.
PLANTAR FASCIITIS AND ESWT RESEARCH:
Studies show, with extracorporeal shockwave therapy, for plantar fasciitis, a 34% to 88% success rate[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. The success rate climbs higher when that holistic approach is taken, using chiropractic care & rehab, as well.
In 2002, the Journal of Bone and Joint Surgery, published a study showing a significant alleviation of pain and enhancement of the ability to move and perform [15].
Again in 2002, in a significant population, Wang et al found 75.3% without any symptoms, 18.8% significantly improved and 5.9% somewhat improved. This was after a one year follow up[17]. In scientific method, researchers attempt to eliminate variables by narrowing treatment down to one therapy. You, however, will have the benefit of the clinical setting where a multifaceted approach will be to your advantage.
A 2010 study showed corticosteroid injections to have better short-term results than ESWT, however, when the results were analyzed over a long duration, shockwave therapy showed better results [19]. Then when you look at the long term damage of steroids, like osteoporosis, tendon rupture, fascia rupture, suppression of cellular metabolism, retardation of collagen synthesis and others, there is no comparison [22]. ESWT is the clear winner.
When using ESWT to treat plantar fasciitis, some practitioners use a local anesthesia. Studies show that ESWT is not as effective when the treatment includes the use of anesthesia. [20,21]. We do not use anesthesia in our office. The treatment is uncomfortable, but not painful or unbearable. You will, absolutely, be able to handle the treatment. Make sure to tell us if you would like us to turn the intensity down. The treatment will be just as effective.
CHECK OUT SOME OF THE MANY RESEARCH ARTICLES ON ESWT & PLANTAR FASCIITIS:
HOME CARE DURING ESWT:
- avoid all anti-inflammatory medication including over-the-counter NSAIDS
- do not use ice, as it will interfere with the healing process
- protect your plantar fascia from further irritation
- massage/stretch calves and plantar fascia (especially before you get out of bed)
- begin strengthening exercises, as prescribed
- if trigger points are present, use a lacrosse ball, daily, to apply pressure on them
- use of orthotics can be beneficial
WHAT IF I’VE BEEN MISDIAGNOSED?Other ailments can mimic plantar fasciitis. This is why we evaluate the structure of your foot, to see if there are any bony misalignments, trigger points, that radiate into your painful areas, possible tears, in your soft tissue or impingement syndromes.
While the Piezowave2 is working on your foot, you will actually feel it working. This is not a machine that just sprays the area, with sound waves. The waves are very specific, and if areas of discomfort are found, there is benefit. It may be from another part of the plantar fascia, a tendon (often the peroneus longus, posterior tibial or flexor hallucis longus tendon) or even in a joint, but healing will be taking place. If a differential diagnosis is needed, this may involve looking to the lower leg, taking an x-ray or referring for an MRI evaluation. I can refer you, if necessary.
PLANTAR FASCIITIS AND ESWT RESEARCH:
Studies show, with extracorporeal shockwave therapy, for plantar fasciitis, a 34% to 88% success rate[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. The success rate climbs higher when that holistic approach is taken, using chiropractic care & rehab, as well.
In 2002, the Journal of Bone and Joint Surgery, published a study showing a significant alleviation of pain and enhancement of the ability to move and perform [15].
Again in 2002, in a significant population, Wang et al found 75.3% without any symptoms, 18.8% significantly improved and 5.9% somewhat improved. This was after a one year follow up[17]. In scientific method, researchers attempt to eliminate variables by narrowing treatment down to one therapy. You, however, will have the benefit of the clinical setting where a multifaceted approach will be to your advantage.
A 2010 study showed corticosteroid injections to have better short-term results than ESWT, however, when the results were analyzed over a long duration, shockwave therapy showed better results [19]. Then when you look at the long term damage of steroids, like osteoporosis, tendon rupture, fascia rupture, suppression of cellular metabolism, retardation of collagen synthesis and others, there is no comparison [22]. ESWT is the clear winner.
When using ESWT to treat plantar fasciitis, some practitioners use a local anesthesia. Studies show that ESWT is not as effective when the treatment includes the use of anesthesia. [20,21]. We do not use anesthesia in our office. The treatment is uncomfortable, but not painful or unbearable. You will, absolutely, be able to handle the treatment. Make sure to tell us if you would like us to turn the intensity down. The treatment will be just as effective.
CHECK OUT SOME OF THE MANY RESEARCH ARTICLES ON ESWT & PLANTAR FASCIITIS:
- Buch M, Knorr U, Fleming L, Theodore G, Amendola A, Bachmann C, Zingas C, Siebert WE: Extracorporeal shockwave therapy in symptomatic heel spurs. An overview. Orthopade. 2002, 31 (7): 637-44. 10.1007/s00132-002-0323-z.PubMedView ArticleGoogle Schola
- Chen HS, Chen LM, Huang TW: Treatment of painful heel syndrome with shock waves. Clin Orthop. 2001, 387: 41-6.PubMedView ArticleGoogle Scholar
- Chuckpaiwong B, Berkson EM, Theodore GH: Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors. J Foot Ankle Surg. 2009, 48 (2): 148-55. 10.1053/j.jfas.2008.11.001.PubMedView ArticleGoogle Scholar
- Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L, Weil L, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H: Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008, 36 (11): 2100-9. 10.1177/0363546508324176.PubMedView ArticleGoogle Scholar
- Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L: Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007, 46 (5): 348-57. 10.1053/j.jfas.2007.05.011.PubMedView ArticleGoogle Scholar
- Hammer DS, Adam F, Kreutz A, Kohn D, Seil R: Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int. 2003, 24 (11): 823-8.PubMedGoogle Scholar
- Hyer CF, Vancourt R, Block A: Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. J Foot Ankle Surg. 2005, 44 (2): 137-43. 10.1053/j.jfas.2005.01.005.PubMedView ArticleGoogle Scholar
- Ibrahim MI, Donatelli RA, Schmitz C, Hellman MA, Buxbaum F: Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int. 2010, 31 (5): 391-7. 10.3113/FAI.2010.0391.PubMedView ArticleGoogle Scholar
- Kudo P, Dainty K, Clarfield M, Coughlin L, Lavoie P, Lebrun C: Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study. J Orthop Res. 2006, 24 (2): 115-23. 10.1002/jor.20008.PubMedView ArticleGoogle Scholar
- Metzner G, Dohnalek C, Aigner E: High-energy Extracorporeal Shock-Wave Therapy (ESWT) for the treatment of chronic plantar fasciitis. Foot Ankle Int. 2010, 31 (9): 790-6. 10.3113/FAI.2010.0790.PubMedView ArticleGoogle Scholar
- Norris DM, Eickmeier KM, Werber BR: Effectiveness of extracorporeal shockwave treatment in 353 patients with chronic plantar fasciitis. J Am Podi Med Asso. 2005, 95 (6): 517-24.View ArticleGoogle Scholar
- Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME: Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg – Am. 2004, 86 (10): 2216-28.PubMedGoogle Scholar
- Rajkumar P, Schmitgen GF: Shock waves do more than just crush stones: extracorporeal shock wave therapy in plantar fasciitis. Int J Clin Pract. 2002, 56 (10): 735-7.PubMedGoogle Scholar
- Rompe JD, Decking J, Schoellner C, Nafe B: Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med. 2003, 31 (2): 268-75.PubMedGoogle Scholar
- Rompe JD, Schoellner C, Nafe B: Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg- Am. 2002, 84 (3): 335-41. 10.1302/0301-620X.84B3.12460.PubMedView ArticleGoogle Scholar
- Wang CJ, Chen HS, Chen WS, Chen LM: Treatment of painful heels using extracorporeal shock wave. J Formosan Med Asso. 2000, 99 (7): 580-3.Google Scholar
- Wang CJ, Chen HS, Huang TW: Shockwave therapy for patients with plantar fasciitis: a one-year follow-up study. Foot Ankle Int. 2002, 23 (3): 204-7.PubMedGoogle Scholar
- Wang CJ, Wang FS, Yang KD, Weng LH, Ko JY: Long-term results of extracorporeal shockwave treatment for plantar fasciitis. Am J Sports Med. 2006, 34 (4): 592-6. 10.1177/0363546505281811.PubMedView ArticleGoogle Scholar
- Yucel I, Ozturan KE, Demiraran Y, Degirmenci E, Kaynak G: Comparison of high-dose extracorporeal shockwave therapy and intralesional corticosteroid injection in the treatment of plantar fasciitis. J Am Podi Med Asso. 2010, 100 (2): 105-10.View ArticleGoogle Scholar
- Labek G, Auersperg V, Ziernhold M, Poulios N, Bohler N: Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis. Zeitschrift fur Orthopadie und Ihre Grenzgebiete. 2005, 143 (2): 240-6. 10.1055/s-2004-832379.PubMedView ArticleGoogle Scholar
- Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L: Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Ortho Res. 2005, 23 (4): 931-41.View ArticleGoogle Scholar
- Yusuf Ziya Tatli and Sameer KapasiThe real risks of steroid injection for plantar fasciitis, with a review of conservative therapies, Curr Rev Musculoskelet Med. 2009 Mar; 2(1): 3–9. Published online 2008 Sep 19. doi: 10.1007/s12178-008-9036-1
- A. Moghtaderi, S. Khosrawi, F. Dehghan, Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: a randomised, placebo-controlled trial, Adv. Biomed. Res. 3 (2014) 99.
