PLANTAR FASCIITIS HELP WITH EXTRACORPOREAL SHOCKWAVE THERAPY IN THE BAY AREA

  • Ready to leap out of bed without the pain of plantar fasciitis?
  • Dance again with extracorporeal shockwave therapy (ESWT)
  • ESWT is safe and shows better long term results than cortisone or surgery

COMMON SYMPTOMS OF PLANTAR FASCIITISPlantar Fasciitis is treatable with ESWT

  1. Stabbing foot pain near the heel
  2. Pain in arch of foot
  3. Aching feet in the morning upon weightbearing
  4. Can feel better when feet are warmed up

WHAT IS PLANTAR FASCIITIS?

Your plantar fascia is a strong ligament that spans from your heel to the base of your toes.  Imagine the bones that make up your arch as a hunting bow.  Your plantar fascia is the bow string.  When too much pressure is exerted downward on the bow/bones the bow string takes stress and gets inflamed.  This is especially true at the insertion of the plantar fascia on the heel.  Inflammation leads to adhesions or scar tissue in the plantar fascia. It can even become a calcified heel spur. This is where the Piezowave 2 (The brand of extracorporeal shockwave therapy we use) comes into play.  

ESWT is the #1 FDA treatment for pantar fasciitis
hunter's bow

WHO GETS PLANTAR FASCIITIS?

Around 10% of people will have plantar fasciitis in their lifetime and the chances go up with age.  It’s the teacher at Los Gatos high school on his feet all day, the person who carries the mail to your Bay Area job, the guy selling popcorn at the San Jose Sharks game or the nurse at the Los Gatos Surgical Center.  Add a weight problem to being on their feet all day and the problem is escalated. 

HOW CAN SHOCKWAVES HELP?

Treatment with ESWT for Plantar Fasciitis gained FDA approval in 2000.  With the Piezowave 2 high energy sound, or acoustic, waves are introduced into the soft tissues of your feet at 5 to 15mm deep.  Your normal tissue moves with the sound waves like water that has been displaced by a stone.  Scar tissue within the plantar fascia is brittle and does not bend like healthy tissue.  The calcifications break on a microscopic level.  Blood that was blocked from flowing can then re-enter damaged tissue (revascularization) and lead to tissue regeneration [2].  With visits at 1 to 2 times per week, your plantar fasciitis will be in a healing process that may take 6 to 8 weeks.  Some symptoms will be gone sooner and some may take longer.  This is a conservative estimate.  

We also look for taut muscular knots called trigger points that refer pain to the plantar fascia.  A 2014 study showed treating the trigger points in the calf muscles in combination with the plantar fascia was more effective than just the plantar fascia [23].

RISK FACTORS FOR PLANTAR FASCIITIS

  • Weak muscles of the foot that don’t share the load
  • Tight calf muscles leading to decreases flexibility
  • Flat feet or excessively high arches
  • Poorly fitted or old shoes
  • Excessive standing
  • Wearing heels all day and then going running
  • Being overweight

WHAT MAKES THE PIEZOWAVE 2 DIFFERENT FROM OTHER ESWT? Plantar Fasciitis and Extracorporeal Shockwave Therapy- ESWT

Piezoelectrically derived shockwaves are the most specific, controllable and effective shockwaves on the market to help you with plantar fasciitis.  As you will see below, the research on ESWT for plantar fasciitis is showing very good results.  However, if the research was done with piezoelectrically sourced shockwaves, the results would even be more profound.

The visit frequency with Piezowave 2 is 1 to 2 times per week.  The mechanics of your foot, ankle, knee and overall posture will also be analyzed to search for an underlying cause.  There may be come chiropractic adjustments to the bones of your foot and home-care given at the time of your visits.   Home-care can be a huge benefit.  The following are some suggestions.

HOME CARE DURING ESWT

  • Avoid all anti-inflammatory medication including over-the-counter NSAIDS
  • Do not use ice as it will interfere with the healing process
  • Protect your plantar fascia from further irritation
  • Massage/stretch calves and plantar fascia (especially before you get out of bed)
  • Begin strengthening exercises as they are prescribed
  • If trigger points are present, use lacrosse ball dialy to apply pressure on them
  • Use of orthotics can be beneficial

The speed of recovery varies depending on the severity of the plantar fasciitis and the ability to avoid re-aggravation.

WHAT IF I’VE BEEN MISDIAGNOSED?

Other maladies can mimic plantar fasciitis.  This is why we will evaluate the structure of your foot to see if there are any bony misalignments, trigger points that radiate into your painful areas, possible tears in your soft tissue or impingement syndromes.  

Realize, however, that when the Piezowave 2 is working on your foot you will feel it working.  This is not a machine that just sprays the area with sound waves.  The waves are very specific and, if they find areas of discomfort, there is benefit.  It may be from another part of the plantar fascia, a tendon (often the peroneus longus, posterior tibial or flexor hallucis longus tendon) or even in a joint but healing will be taking place. If a differential diagnosis is needed, this may involve looking to the lower leg, taking an x-ray or referring for an MRI evaluation.  We have referred to Dr Josh Donaldson in Los Gatos for PRP injections and this has been a very effective adjunct after a course of ESWT when symptoms are not 100% gone.

PLANTAR FASCIITIS AND ESWT RESEARCH

Research papers on ESWT are extensiveBefore delving into the research on this godsend technology, I must say that much of the research is used with soundwaves derived from “radial shockwaves”.  This is a valid way to derive therapeutic doses shockwaves, however, it cannot compare with the Piezowave 2.  I stated this above but just wanted to reiterate.  Also, studies are done with fewer shockwaves delivered and fewer visits than you will receive.

That being said, studies show plantar fasciitis with a 34% to 88% success rate with extracorporeal shockwave therapy.[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. Now couple that with the best technology on the market, chiropractic adjustments and proper rehab.  The success rate climbs higher when that holistic approach is taken.

In 2002, the Journal of Bone and Joint Surgery published a study showing a significant alleviation of pain and enhancement of the ability to move and perform [15].

Again in 2002, in a significant population, Wang et al found 75.3% without any symptoms, 18.8% significantly improved and 5.9% somewhat improved.  This was after a one year follow up[17]. In scientific method, researchers attempt to eliminate variables by narrowing treatment down to one therapy.  You, however, will have the benefit of the clinical setting where a multifaceted approach will be to your advantage.

A 2010 study showed corticosteroid injections to have better short-term results than ESWT, however, when the results were analyzed over the long duration, the shockwave showed better results [19]. Then when you look at the long term damage steroids like osteoporosis, tendon rupture, fascia rupture, suppression of cellular metabolism, retardation of collagen synthesis and others, there is no comparison [22]. ESWT is the clear winner.

When using ESWT to treat plantar fasciitis, some practitioners use a local anesthesia.  Studies show that ESWT is not as effective when the treatment includes the use of anesthesia. [20,21].  We do not use anesthesia in our office as the treatment is uncomfortable but not painful or unbearable.  You will, absolutely, be able to handle the treatment.  Make sure to tell us if you would like us to turn the intensity down.  The treatment will be just as effective.

We have offices in San Jose and Los Gatos and you can find the Piezowave 2 in our Los Gatos office. (408) 274-2244

CHECK OUT SOME OF THE MANY RESEARCH ARTICLES ON ESWT & PLANTAR FASCIITIS

  1. Buch M, Knorr U, Fleming L, Theodore G, Amendola A, Bachmann C, Zingas C, Siebert WE: Extracorporeal shockwave therapy in symptomatic heel spurs. An overview. Orthopade. 2002, 31 (7): 637-44. 10.1007/s00132-002-0323-z.PubMedView ArticleGoogle Schola
  2. Chen HS, Chen LM, Huang TW: Treatment of painful heel syndrome with shock waves. Clin Orthop. 2001, 387: 41-6.PubMedView ArticleGoogle Scholar
  3. Chuckpaiwong B, Berkson EM, Theodore GH: Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors. J Foot Ankle Surg. 2009, 48 (2): 148-55. 10.1053/j.jfas.2008.11.001.PubMedView ArticleGoogle Scholar
  4. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L, Weil L, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H: Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008, 36 (11): 2100-9. 10.1177/0363546508324176.PubMedView ArticleGoogle Scholar
  5. Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L: Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007, 46 (5): 348-57. 10.1053/j.jfas.2007.05.011.PubMedView ArticleGoogle Scholar
  6. Hammer DS, Adam F, Kreutz A, Kohn D, Seil R: Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int. 2003, 24 (11): 823-8.PubMedGoogle Scholar
  7. Hyer CF, Vancourt R, Block A: Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. J Foot Ankle Surg. 2005, 44 (2): 137-43. 10.1053/j.jfas.2005.01.005.PubMedView ArticleGoogle Scholar
  8. Ibrahim MI, Donatelli RA, Schmitz C, Hellman MA, Buxbaum F: Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy. Foot Ankle Int. 2010, 31 (5): 391-7. 10.3113/FAI.2010.0391.PubMedView ArticleGoogle Scholar
  9. Kudo P, Dainty K, Clarfield M, Coughlin L, Lavoie P, Lebrun C: Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study. J Orthop Res. 2006, 24 (2): 115-23. 10.1002/jor.20008.PubMedView ArticleGoogle Scholar
  10. Metzner G, Dohnalek C, Aigner E: High-energy Extracorporeal Shock-Wave Therapy (ESWT) for the treatment of chronic plantar fasciitis. Foot Ankle Int. 2010, 31 (9): 790-6. 10.3113/FAI.2010.0790.PubMedView ArticleGoogle Scholar
  11. Norris DM, Eickmeier KM, Werber BR: Effectiveness of extracorporeal shockwave treatment in 353 patients with chronic plantar fasciitis. J Am Podi Med Asso. 2005, 95 (6): 517-24.View ArticleGoogle Scholar
  12. Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME: Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg – Am. 2004, 86 (10): 2216-28.PubMedGoogle Scholar
  13. Rajkumar P, Schmitgen GF: Shock waves do more than just crush stones: extracorporeal shock wave therapy in plantar fasciitis. Int J Clin Pract. 2002, 56 (10): 735-7.PubMedGoogle Scholar
  14. Rompe JD, Decking J, Schoellner C, Nafe B: Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med. 2003, 31 (2): 268-75.PubMedGoogle Scholar
  15. Rompe JD, Schoellner C, Nafe B: Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg- Am. 2002, 84 (3): 335-41. 10.1302/0301-620X.84B3.12460.PubMedView ArticleGoogle Scholar
  16. Wang CJ, Chen HS, Chen WS, Chen LM: Treatment of painful heels using extracorporeal shock wave. J Formosan Med Asso. 2000, 99 (7): 580-3.Google Scholar
  17. Wang CJ, Chen HS, Huang TW: Shockwave therapy for patients with plantar fasciitis: a one-year follow-up study. Foot Ankle Int. 2002, 23 (3): 204-7.PubMedGoogle Scholar
  18. Wang CJ, Wang FS, Yang KD, Weng LH, Ko JY: Long-term results of extracorporeal shockwave treatment for plantar fasciitis. Am J Sports Med. 2006, 34 (4): 592-6. 10.1177/0363546505281811.PubMedView ArticleGoogle Scholar
  19. Yucel I, Ozturan KE, Demiraran Y, Degirmenci E, Kaynak G: Comparison of high-dose extracorporeal shockwave therapy and intralesional corticosteroid injection in the treatment of plantar fasciitis. J Am Podi Med Asso. 2010, 100 (2): 105-10.View ArticleGoogle Scholar
  20. Labek G, Auersperg V, Ziernhold M, Poulios N, Bohler N: Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis. Zeitschrift fur Orthopadie und Ihre Grenzgebiete. 2005, 143 (2): 240-6. 10.1055/s-2004-832379.PubMedView ArticleGoogle Scholar
  21. Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L: Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Ortho Res. 2005, 23 (4): 931-41.View ArticleGoogle Scholar
  22. Yusuf Ziya Tatli and  Sameer KapasiThe real risks of steroid injection for plantar fasciitis, with a review of conservative therapies, Curr Rev Musculoskelet Med. 2009 Mar; 2(1): 3–9. Published online 2008 Sep 19. doi:  10.1007/s12178-008-9036-1
  23. A. Moghtaderi, S. Khosrawi, F. Dehghan, Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: a randomised, placebo-controlled trial, Adv. Biomed. Res. 3 (2014) 99.