FAQ's

1. What are the causes of heel pain?
2. What is Plantar Fasciitis?
3. What can I do?
4. I still have heel pain what’s next
5. I don’t want surgery!
6. What is ESWT for Plantar Fasciitis?
7. Is it FDA approved?
8. Am I a Candidate for ESWT?
9. What can I expect with ESWT?
10. When can I return to normal activities?
11. After the ESWT?
12. What if it doesn’t work?
13. What costs are associated with ESWT?
14. What is the Future of ESWT?

What are the causes of heel pain?
Heel pain can be Plantar Fasciitis, Bursitis, Tendonitis, Arthritis, a Stress Fracture or even a Cyst. A qualified physician will provide you with a proper diagnosis.

What is Plantar Fasciitis?
Plantar Fasciitis is inflammation of the plantar fascia. The plantar fascia is a tight band of fibrous tissue which begins at the heel, travels across the arch, and fans forward toward the toes. The plantar fascia acts like a bowstring to maintain the arch of the foot. Heel pain generally occurs when the inflexible fascia is repeatedly stressed causing inflammation where the fascia attaches to the heel bone (calcaneus). This inflammation often results in a calcification (bone formation) of the fascia at the attachment to the heel bone which may create a bone spur. Bone spurs are not the problem but a symptom of the problem.

What can I do?
The longer the problem persists the harder it is to get rid of. There are things you can do that may alleviate the problem. First, wear shoes with good arch supports. Reduce the activities that cause stress to your heel. Ice the sore area for 30 to 60 minutes several times a day. Take an over the counter anti-inflammatory. Finally exercise, stretch the fascia 3 times per day. If this doesn’t work and the pain lasts for more than two weeks, its time to see a podiatrist or other qualified physician. A proper diagnosis is critical to a successful outcome. Heel pain can be Plantar Fasciitis, Bursitis, Tendonitis, Arthritis, a Stress Fracture or even a Cyst. A diagnosis is critical.

I still have heel pain what’s next?
Once you have a diagnosis your podiatrist will lay out a treatment plan. It will include some of the things you are already doing such as exercise, icing and medication. Your podiatrist may suggest custom orthoses (arch supports), taping or even cortisone injections. Great news! At this point you should be better. Actually 85% of the patients respond favorably to this protocol. Sadly 15% do not!

I don’t want surgery!
If you happen to be one of the 15% that do not respond to conservative treatment we still have another option before surgery. Extracorporeal Shockwave Therapy (ESWT) don’t let the big name scare you. It is simply acoustic or sound waves applied to the heel tissue. It’s exactly the same principle as lithotripsy (used to break up kidney stones). In treating the Plantar Fasciitis the sound waves make microscopic tears in the fascia and the scar tissue that has formed around the fascia. The objective is to create healthy tissue where the scar tissue and thickened fascia once were. There are few side effects and the FDA studies show an 80% success rate.

The procedure takes about 25 minutes. For those strong at heart it can be done without anesthesia. The FDA studies were done with “No anesthesia allowed”. Actually “It Hurts”. You can choose an ankle block which is “mildly uncomfortable” or you can choose a “twilighy anesthesis” (MAC), that is quite a pleasant experience. Most patients return to normal activities the next day. Many patients feel relief the next day but the entire process of creating a new blood supply for the affected area is 6 weeks to 3 months. It is important to continue your stretching exercises during this critical period.

What is ESWT for Plantar Fasciitis?
ESWT is a safe and proven, non-invasive therapy that relieves pain by directing sound waves into the pain location. Perhaps the technology is best known for its use in treating kidney stones. The procedure is done with the Orthospec devise which is a high energy devise that directs acoustic or sound waves into the heel tissue. Studies have shown high energy devices to have a better success rate than their low energy counter parts.

ESWT has been shown to be very beneficial in the treatment patients who have suffered from chronic pain caused by Proximal Plantar Fasciitis. In treating the plantar fascia the sound waves make microscopic tears in the fascia and the scar tissue that has formed around the fascia. This will trigger your individual repair mechanisms to reactivate healing and encourage revascularization and other elements necessary to advance normal tissue healing. In addition the over stimulation of pain transmission nerves by the shockwaves may lead to a reduction in sensitivity and pain.

Is it FDA approved?
Yes the FDA has approved ESWT for the treatment of chronic heel pain syndrome (Plantar Fasciitis).

Am I a Candidate for ESWT?
If you have received at least 6 months of conservative treatment for Plantar Fasciitis under a physicians care and your heel pain has not been resolved then ESWT is considered a therapeutic option for you. Conservative treatments are considered; anti-inflammatory mediations, steroid injections, ice packs, stretching exercises, orthotic devices (shoe inserts), and physical therapy.

ESWT therapy is not for everyone.

There will be no guess work, your physician will review your health history with you to determine if this treatment is appropriate for you. Patients that are not considered candidates for ESWT include those with pacemakers or patients taking medications that may prolong or interfere with blood clotting (coumadin). In addition children, pregnant women and those with acute Plantar Fasciitis are not considered appropriate candidates for ESWT.

If ESWT is right for you don’t delay. The sooner you receive treatment the sooner you can start enjoying your hobbies and active lifestyle again!

What can I expect with ESWT?
Your physician will instruct you to stop taking anti-inflammatory medications (for example ibuprofen) for five or more days prior to the procedure. Avoiding medications is important since they are known to prolong bleeding under the surface of the skin and will stop the inflammatory process.

The procedure is performed on an outpatient basis, so it does not require a stay in the hospital. The procedure takes about 25 minutes. For those strong at heart it can be done without anesthesia. The FDA studies were done with “No anesthesia allowed”. Actually “It Hurts”. You can choose an ankle block which is “mildly uncomfortable” or you can choose a “twilighty anesthesia” (MAC), that is quite a pleasant experience. We do advise that you have someone drive you home after the procedure.

When can I return to normal activities?
Most patients return to normal activities the next day. Many patients feel relief the next day but the entire process of creating a new blood supply for the affected area is 6 weeks to 3 months. It is important to continue your stretching exercises during this critical period.

ESWT delivers the same positive outcomes as surgery with a minimal risk of infection and a much faster recovery rate.

After the ESWT?
You may experience some pain or discomfort in the treated heel after the anesthesia effects have subsided. You may also continue to experience the same type of heel pain you had prior to treatment for 1 to 2 weeks. Pain is manageable by over the counter pain medication (i.e. Tylenol) in most cases.

You should not participate in any stressful activity involving the affected heel for 4 weeks. “Stressful activity” may include running or jogging, doing heavy housework or yard work, or participating in sports. Following this 4-week period, you should be able to resume normal activity.

To avoid re-injury, you should avoid completely flat shoes such as sandals, loafer, moccasins, or house slippers. Continued use of orthotics is encouraged.

Simple Stretching exercises should be performed several times daily and before any sports activity, or before walking long distances. Massage of the affected foot prior to rising after rest may also be beneficial. Stretching for 30 seconds several times a day is recommended.

Maximum healing effect of the procedure cannot be evaluated prior to 12 weeks post treatment. The healing effect is also dependent upon individual patient response, and improvement may continue beyond the 12-week evaluation period.

• Rest and elevate the foot for the remainder of the day and night.
• Resume gentle stretching exercises the day following the procedure.
• Avoid taking any anti-inflammatory medication, such as ibuprofen or aspirin, for up to four weeks after ESWT.
• Avoid heavy lifting until the surgeon approves resuming this activity.
• You may walk on the foot.
• Avoid running or excessive activity.
• Avoid going barefoot during the healing process.
• Wear supportive shoes.
• In some cases, orthotic devices (shoe inserts) will be prescribed.

Although patients sometimes feel they can return to normal activities right away, the physician will determine when that is appropriate for your situation. It is important to use caution and follow the doctor’s instructions to avoid injuring the treated foot. Because ESWT temporarily reduces or eliminates the sensation of pain, patients sometimes become too active too soon.

What if it doesn’t work?
Although most patients with Plantar Fasciitis respond to non-surgical treatment, a small percentage of the patients may require surgery. If you happen to be one of the (3%) that did not respond to the conservative care or ESWT surgery is still an option. Your podiatric foot and ankle surgeon will discuss the surgical choices with you and determine which approach is best for you.

What costs are associated with ESWT?
Some insurance companies pay for ESWT. If your insurance company happens to be one of the ones that does not we do have a cash pay option and financing is available. If you choose the cash pay option or financing available to you due to a denial from your insurance company you may also wish to appeal their denial. We will help you with the appeal.

We will bill your insurance company $3,500 for the procedure. You will be expected to pay 20% (approximately equal to your co-pay and deductible) at the time of treatment. Our fee does not include anesthesia or the physician's fee. If we receive a denial on the claim we will appeal their decision. We will need a letter from you and your employer requesting the insurance company cover the procedure. If the insurance company agrees to cover the procedure you will be reimbursed any monies you have paid, less any deductible and co-pay. If the insurance company denies the appeal you will not be responsible for any additional charge.

What is the Future of ESWT?
Like many other innovative noninvasive therapies, ESWT is an evolving technology. As the body of information on this technique continues to expand, the result will be additional uses for ESWT that will benefit more patients in the future.

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