About Shockwave Therapy

	Finally, there’s effective treatment for your chronic heel pain or other chronic orthopedic conditions...without open surgery or lengthy therapy sessions. Extracorporeal Shockwave Therapy (ESWT) is restoring patients with chronic heel pain syndrome (Plantar Fasciiti) to a normal, active lifetstyle with a single treatment. A non-invasive proceedure similar to lithotripsy used in the treatment of kidney stones, ESWT uses therapeutic pressure waves to relieve the pain and inflammation in the tendon on the bottom of the foot. With the FDA”S approval of ESWT in 2001, hundreds of thousands of Americans can now experience this effective technology that has been used internationally for a decade to treat a variety of chronic musculoskeletal conditions.
	Plantar Faciitis		What is ESWT? Shock Wave Therapy utilizes an Electro Magnetic Shock Wave emitter to generate shock waves (also known as pressure or sound waves) delivered outside the body to trigger appropriate repair mechanisms. ESWT has been used since the early 1990s as an alternative to traditional heel surgery in cases of chronic painful plantar fasciitis.

			How does ESWT reduce heel pain? Recent research has demonstrated that with chronic plantar fasciitis, the body's normal inflammatory response has diminished to a point where blood flow is decreased to the injured area of the fascia. Without adequate blood flow to any injured tissue, one's normal repair mechanisms are compromised. ESWT has been demonstrated to initiate angiogenesis, or formation of new blood vessels. This treatment therefore acts to jump-start a normal inflammatory response which can lead to healing in cases where other conservative treatments have not proven effective. The shock waves can also act to over-stimulate pain transmission nerves, which can lead to a reduction in sensitivity and discomfort.

			How successful is this type of treatment? Depending upon which study is evaluated, success rates are consistently greater than 50% three months following ESWT. Although symptoms may not be completely eliminated, they do tend to diminish to a point where pain is significantly less disabling and surgical intervention is no longer indicated.


	Heel Spur		How is the procedure performed? During the procedure, the heel is placed on a water-filled cushion which is part of the Shock Wave Therapy system. The injured area of the plantar fascia is easily visualized via the ultrasound imaging system which is part of the Dornier Epos Ultra ShockWave Generator. A total of 3,800 shock waves are generated, which reach an energy delivery of 1,300 mJ per square millimeter. The entire procedure lasts approximately twenty minutes. While the treatment is performed, one may be aware of a tapping sensation within the heel region. With local anesthetic, however, this is usually easily tolerated.

			Is anesthesia required? The procedure is performed under local anesthetic on an out patient basis, often in the doctor's office. The patient is able to walk after the procedure is completed.

			What can I expect following the procedure? As previously stated, this procedure leads to increased blood flow about the injured heel region. Along with increased blood flow, there may be a transient increase in inflammation and discomfort under the heel which generally lasts no longer than two weeks. Analgesia requirements typically consist of acetaminophen. Non-steroidal anti-inflammatory medications are avoided as the goal of this procedure is to allow for a normal inflammatory cycle to proceed. Approximately one month following the procedure, stretching exercises are initiated and other physical activities are increased to tolerance.

			What if ESWT does not reduce my heel pain? As with the other conservative treatments which were utilized prior to performing ESWT, failure of all treatments is a possibility. If ESWT is unsuccessful in reducing pain, and should this pain be disabling, surgical plantar fascial release can be considered.

			Are there patients who should not undergo ESWT? At this time, ESWT is not recommended for patients who are taking medications that may prolong or interfere with normal blood clotting, such as Coumadin. Patients with pacemakers and pregnant patients are also not considered appropriate candidates for this procedure.

			Will my insurance carrier pay for ESWT? Although approved by the FDA for treatment of plantar fasciitis, ESWT is not yet covered by all insurance carriers. Should your insurance not cover this procedure, a fee schedule which is quite reasonable does exist. Keep in mind that using the Dornier Epos Ultra Shock Wave Generator is less expensive than other high powered shock wave generators (such as OssaTron) because the procedure is performed under local anesthetic. The OssaTron Shock Wave Generator requires general anesthetic or IV sedation which increases costs and potential risks associated with this form of anesthesia. All factors considered, ESWT with the Dornier Shock Wave Generator is an attractive option when comparing costs, disability and possible risks associated with surgical plantar fascial release.

			Testimonials "ESWT is a new technology and it works! It is my understanding that Dr. Paul Slowik is the first in North San Diego County to proceed with this type of treatment. I was very curious as to how it all worked together and not sure at the same time because of the simplicity of the procedure. But it's really that good. Dr. Slowik was very thorough in answering all the questions I could think of in regards to this type of treatment. His staff was great, helpful and comforting to me, especially the day of the procedure. Kendra set the appointment times and explained the post procedure exercises. Becky was with me the entire prep-time and we didn't proceed until I was ready. The Shockwave treatment went smoothly, took very little time and not at all inconvenient. It actually was interesting to see the monitor. I have to admit the ESWT has helped me the most with my plantar fasciitis problems. The date of my treatment was than a month ago. The only time I took off of work was for the appointment times the day of my procedure. My life style hasn't changed other than, for now, I have to be careful with quick walking. I continue with my post shockwave stretches but each day seems to be better than the previous. They say it takes approximately three months to really know how the procedure took. My life style has not been compromised. I am looking forward to having this procedure done on my other foot real soon. The fact is I would have had them both done at the same time if I knew it was going to be so easy. You actually leave the room walking (unlike the Plantar Fasciitis surgery I had in 2003 where your heel is non-weight bearing for 30 days so you need crutches or a walker, bandages, ice, and time off of work). With the ESWT you are walking immediately! I am also one of those patients who has a problem with getting shots. Yes, some shots are involved but don't let your mind fool you into thinking the worst. Believe me, I can't think of anyone who wouldn't want to try this method over surgery. You will be fine. Dr. Slowik and his staff will give you the best care possible." Eleanor "Ellie" S. "I've been dealing with this foot problem for six years. When Dr. Slowik told me about the short recovery with Shockwave Therapy, let alone the fact that you don‚t need to go under general anesthesia, I was definitely excited. The procedure itself was quick and the recovery has been great. I would definitely recommend this procedure!" Cynthia M.


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