Extracorporeal Shockwave Therapy

ESWT is a non-surgical, outpatient treatment for persistent heel pain associated with chronic plantar fasciitis. “Extracorporeal” means “outside the body.” Shockwaves, also known as pressure or sound waves, are generated by a special ESWT device, and focused onto the inflamed plantar fascia.

Extracorporeal Shockwave Therapy or ESWT is a method of treatment for multiple tendonopathies.

Presently this technology is only approved in the US by the Food and Drug Administration (FDA) for treatment of plantar fasciitis and tennis elbow. In the future possible approvals may be given to treat patella tendinitis, shoulder tendinitis, achilles tendinitis, pseudoarthrosis, stress fractures and shoulder calcification.

There are several theories as to how ESWT may or may not help promote better healing. The most accepted one is that the microtrauma of the repeated shock wave to the affected area creates neo-vascularization (new blood flow) into the area. It is this new blood flow that promotes tissue healing. Another theory is that in chronic pain, the brain has “forgotten” about the pain and is doing nothing to heal the area. By having shockwave therapy a new inflammatory process is created and the brain can react to it by sending the necessary body nutrients to the area to promote healing.

For treatment of heel pain the FDA study criteria are quite specific. A person has to have experienced heel pain for at least six months and had at least three other types of treatments (cortisone injections, oral anti-inflammatory medication, orthotics, physical therapy, etc.) without relief.

Contraindications for this procedure include: neurological and vascular disease of the foot, history of rupture of the plantar fascial ligament, open bone growth plates, pregnancy, implanted metal in the area (bone screws and pins) and people on medication that interferes with blood clotting such as coumadin and prophylactic aspirin.

Source: (http://www.heelpaintreatmentcenters.com/about_eswt.php)

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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.

Success rate for the procedure is approximately 70%. 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.

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