Extracorporal Shock Wave Therapy (ESWT)
- General Commentary
ESWT is an emerging new therapy for the treatment of chronic heel pain. Although the treatment has undergone clinical trials and although there have been no significant complications from the overuse of this new therapy, time will tell how effective this treatment is in a larger study of patients.
When Endoscopic Plantar Fasciotomy (EPF) was first introduced in the early 1990's, everyone thought that it would be the final "cure" for heel pain. Unfortunately, the procedure has been apparently overutilized and many people suffered severe and debilitating complications from the procedure. Understand that many people where also helped by the procedure, but the over-enthusiasm in performing this surgical procedure resulted in surgery being performed too quickly, without conservative care, and in unsuitable candidates with resultant complications.
Likewise, there is likely to be a large increase in the use of ESWT to treat heel pain. Time will tell whether this utilization will result in significant complications in patients who, retrospectively, where poor candidates.
Generally, ESWT is only indicated in patients with chronic heel pain who have not responded to other treatments.
The heel pain should have been present for over six months before ESWT treatment.
The heel pain must be directly under or to the inside portion of the heel. ESWT is not indicated for arch pain - even if the arch pain is caused by plantar fasciitis.
Prior conservative treatment should have consisted of a variety of: physical therapy, stretching, night splints, orthotics, anti-inflammatory medication, cortisone injections, or even previous surgery (EPF or conventional heel surgery). CONSERVATIVE THERAPY IS ESSENTIAL BEFORE ANY SURGERY FOR HEEL PAIN IS CONSIDERED.
ESWT is indicated in heel pain caused by plantar fasciitis only. It is not indicated in heel pain resulting from other pathologies. A complete medical evaluation including laboratory blood work may be indicated to confirm a diagnosis.
ESWT should be used with care in patients with cardiac pacemakers.
ESWT should be used with care in patients on immunosuppressive agents or cortisone therapy or patients on medications that prolong bleeding time (e.g., coumadin, or even low-dose aspirin).
ESWT can cause damage to major nerves or blood vessels if the ESWT treatment unit is placed directly over those structures.
We are interested in hearing from patients who have undergone ESWT treatment and who have had major complications. Please use our contact page to advise us of such complications, so that we may post the same on this page. THANK YOU.