What Is It?
Extracorporeal Shock Wave Therapy (ESWT) is a procedure used to treat chronic heel pain (plantar fasciitis/heel spur syndrome). "Extracorporeal" means "outside of the body," and refers to this non-invasive surgical procedure in which strong sound waves are directed at the area of heel pain. The device used is similar to that currently used in non-surgical treatment of kidney stones.
What Is Plantar Fasciitis?
This painful condition results from inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. It is sometimes associated with a heel spur, in which case it is called "heel spur syndrome." The condition can usually be successfully treated with conservative measures such as use of anti-inflammatory medications and ice packs, stretching exercises, well fitted supportive shoes, orthotic devices, or physical therapy. If the condition does not clear up after six months with any combination of these treatments, ESWT may be considered.
What Happens During ESWT?
Your doctor will ask you to quit taking anti-inflammatory medication approximately three days prior to the procedure. The treatment takes about 30 minutes and is performed under local anesthesia and/or "twilight" anesthesia. Strong sound waves penetrate the heel area and stimulate a healing response by the body. It is an outpatient procedure and does not require an overnight stay in the hospital.
Who Should Not Be Treated with ESWT?
ESWT is not appropriate for patients who have a bleeding disorder or who are taking medications that may prolong bleeding or interfere with blood clotting. It should not be used during pregnancy or for children. In addition, its safety and effectiveness have not been established for those with nerve damage, osteoporosis, rheumatoid arthritis, tarsal tunnel syndrome, diabetic neuropathy, severe peripheral vascular disease, metabolic disorders, and infections.
What Happens After Treatment?
There may be some mild pain or numbness and tingling after the treatment. Patients should be able to return to work or school the following day with modified or light duties. Activities to be avoided for the 4 to 6 weeks after the procedure include heavy lifting of objects, running, aerobic classes, or sporting activities.
Are There Complications?
As with any surgical procedure, complications may arise. There have been reports of bruising of the skin, swelling, pain, numbness or tingling, and rupture of the plantar fascia. Misdirected treatment may result in blood vessel or nerve damage.
Talk with Your Podiatric Foot and Ankle Surgeon
ESWT is a new treatment modality used since 2003-04, and may not yet be available in all areas of the country. A podiatric foot and ankle surgeon can advise whether you may be a candidate for ESWT and where treatment can be obtained. For the name of a podiatric surgeon in your area, contact the American College of Foot and Ankle Surgeons toll-free hotline, 888-THE-FEET or on the web at www.footphysicians.com
