Howard Burkett, DPM 
Family Foot Health
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Heel Pain and Extracorporeal Shockwave Treatment

Do you suffer from HEEL PAIN?
Like millions of Americans, do you wake up in the morning, step on a hard floor and feel a sharp pain in your heels? Within 10 or 15 minutes of hobbling around, you find that the pain isn’t quite as bad as it was? After getting dressed, the heel pain is now a lesser annoyance and somewhat tolerable – so you go on about your daily routine? If this sounds familiar, you may be suffering from any number of conditions which cause heel pain such as plantar fasciitis, heel spurs, stress cracks, inflamed adventitious bursa, and neuro-fibrosis.

What is Plantar Fasciitis?
Plantar Fasciitis is a common cause of heel pain that involves the band of fibrous connective tissue (plantar fascia) that runs from the heel bone to the ball of the foot. The plantar fascia may become strained over time and partially tear or stretch along its length or at the point of insertion into the heel bone. This leads to inflammation, pain, and may be accompanied by the growth of a bone or heel spur. Common symptoms include experiencing sharp heel or arch pain upon waking up and taking the first step of the day. Symptoms may decrease during the day but often flare up again in the late afternoon or evening.

Conservative Treatment
Conservative treatment is usually successful in relieving the inflammation and pain of plantar fasciitis. However, it may take an extended period of treatment, even upward of a year, to relieve the pain. Conservative treatments include rest, ice, arch support, tape, night splints, orthotics, non-steroidal anti-inflammatory medication such as aspirin or ibuprofen, and steroid injections.

Conventional Surgery
Surgery may be indicated for patients who fail to benefit from conservative treatment. The conventional surgical approach, an Endoscopic Plantar Fasciotomy, involves making an incision and then severing, or releasing, part or all of the plantar fascia.

Extracorporeal Shock Wave Treatment (ESWT) is a safe and effective, non-invasive (no incisions) alternative that eliminates many of the risks associated with conventional surgery. ESWT is indicated for patients who have experienced heel pain for six or more months and have not responded to conservative treatment. ESWT delivers high-energy sound waves, or acoustical energy, to the affected area to create a micro trauma that promotes revascularization and triggers the body’s natural repair mechanisms. The FDA first approved high-energy ESWT for chronic proximal plantar fasciitis
in October 2000. ESWT is also commonly used for other conditions such as Achilles Tendonitis.

Benefits of ESWT include non-invasive treatment, a high success rate, single treatment protocol, and fast recovery with quick return to work and normal activities. Studies have shown very high success rates in eliminating or significantly reducing pain.

What Happens Before, During and After ESWT Treatment?
BEFORE: Patients will be instructed to discontinue medication containing aspirin or non-steroidal anti-inflammatory medications (e.g. Motrin) for several days before treatment (and most likely for up to 30 days following treatment) unless otherwise instructed by the treating doctor. Patients will be asked to stop eating and drinking a number of hours prior to treatment due to the use of anesthesia.

DURING: Treatment typically lasts 20 to 30 minutes and is performed on an outpatient basis in a surgical center. To avoid discomfort during treatment, most doctors administer a local anesthetic at the point of pain and perform the procedure with the patient under intravenous (conscious) sedation.

AFTER: Patients may experience discomfort in the treated area after the effects of anesthesia have subsided. Some bruising, swelling, and temporary numbness is normal and expected. In the immediate days following treatment, many doctors will recommend RICE – Rest, Ice, Compression, Elevation. For 1 to 2 weeks, patients may continue to have the same type of pain experienced prior to treatment.

For 4 weeks following treatment, patients are advised not to participate in stressful activities (e.g. jogging, heavy housework, yard work, participating in sports) involving the affected area. Patients can then typically resume normal activity. Heel pain patients are typically instructed to avoid flat shoes such as sandals and slippers; continued use of orthotics may be encouraged.

Healing is generally complete at about 12 weeks, although patients may continue to experience additional reduction in pain thereafter.

 

 



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