Extracorporeal Shock Wave Therapy (ESWT)

What is Shockwave Therapy?

Shockwave Therapy is a fast and gently non-invasive, non-surgical method of reducing musculoskeletal pain from plantar fasciitis, tendonitis, and other soft tissue disorders in the foot and ankle. The technology is derived from lithotripsy, a technique used today to disintegrate kidney stones without the use of invasive surgery.  During high-energy radial shock wave therapy with the Zimmer EnPuls 2.0 Pro, a high-intensity mechanical wave is transmitted from a probe through the skin where it interacts with the tissues of the body.

This leads to a cascade of beneficial effects: The shockwave stimulates and reactivates healing to encourage new blood vessel formation, disrupts scar tissue, releases local growth factors and recruits stem cells; all of which accelerates the healing process. Additionally, shockwaves help to over-stimulate pain transmitting nerves, which can lead to a reduction in sensitivity and pain.

 

Podiatric Indications for Shockwave Therapy:

  • Chronic heel pain
  • Chronic Plantar Fasciitis (Fasciosis)
  • Achilles Tendinosis
  • Chronic Ankle Sprain
  • Mortons neuroma
  • Acute and Chronic muscle pain
  • Tendinosis of the foot and ankle
  • Fractures
  • Recalcitrant Neuroma
  • Chronic wounds

Why Consider Non-Invasive Shockwave Therapy?

This modality has been used with success for over 30 years in Europe and over 15 years in the United States. Shockwave therapy has been shown in numerous studies to be an effective treatment for chronic heel pain on both the bottom and back of the heel.  The success rates (70-85%) are equal to or greater than traditional methods including surgery without the risks, complications, and lengthy recovery periods a surgery may entail. Evidence based medicine also shows efficacy in treatments of other pathologies including muscle pain, tendonitis and neuromas to name a few.

Patients treated with shockwave therapy may bear weight and resume normal activities immediately following treatment with the exception of high impact exercises. Many patients find a significant and immediate reduction in their pain. Some patients will feel results gradually after each treatment.

Benefits of Non-Invasive Shockwave Therapy:

  • 70-85% success in relieving pain of plantar fasciitis and Achilles tendonitis
  • Patients can bear weight immediately
  • Similar results to surgical intervention without having surgery and without the post-operative surgical risks
  • Risks associated with surgery and general anesthesia are eliminated
  • Patients can return to work immediately
  • Most patients return to strenuous activity after 4 weeks
  • Completely non-invasive
  • Reduces potential need for other treatments
  • Fast, safe and effective

How is the treatment performed?

The Zimmer EnPuls 2.0 Pro is a machine with a small applicator that resembles an ultrasound wand. It is administered once a week for a series of 3 to 6 treatments with an average of 3.  Treatment intervals should not exceed one week for optimal results. Each treatment takes approximately 10 minutes depending on the location and number of areas treated.

Your favorite podiatrist at Kalmar Family Podiatry performs all your treatments. The doctor applies the applicator to the foot and administers the ballistic waves by moving over the affected area in a very slow, circular motion. During the treatment there may be some minor discomfort.

Is it safe?

Yes, this technology has been tested and studied for nearly 30 years and have confirmed its safely and efficacy. There are virtually no serious side effects.  Some patients may experience a short period of slight tingling, warmth or numbness immediately following treatment. These potential effects typically resolve within a few days.

Insurance Coverage:

Unfortunately, at this time no insurance company covers the cost of Shockwave Therapy. Some patients may be able to use your Flexible Spending Account (FSA) through your employer. If needed, an individual payment plan can be formulated, but a down payment will be collected during initial treatment visitation.

Here at Kalmar Family Podiatry our protocol is to perform 3 – 6 treatment sessions with each treatment typically 1 week apart. We strongly advocate shockwave therapy while you start or maintain a good physical therapy regimen for your injury. We then see you back in 4 weeks after your last treatment for a follow-up visit to check your progress.

For more information or to schedule a consultation please contact us at 631-549-0955.

Want to get geeky about it?  You can check out these peer-reviewed articles:

  1. Chang et al. Comparative Effectiveness of Focused Shock Wave Therapy of Different Intensity Levels and Radial Shock Wave Therapy for Treating Plantar Fasciitis: A Systemic Review and Meta-Analysis. Arch Phys Med Rehabil. Vol 93, Pages 1259-1268; July 2012.
  2. Fridman et al. Extracorporeal Shockwave Therapy for Interdigital Neuroma: A Randomized, Placebo-Controlled, Double-Blind Trial. Journal Of the American Podiatric Medical Association. Vol 99, No 3; May/June 2009
  3. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med. 2006 May;34(5):733-40.
  4. Gerdesmeyer et al. 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. The American Jounral of Sports Medicine, Vol 36, No 11, 2008.
  5. Kudo P. 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 Feb;24(2):115-23.
  6. Malay DS, Pressman MM, Assili A et al. (2006) Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot Ankle Surg, 45, 196 – 210.
  7. Notarnicola A, Morettia B. (2012) The biological effects of extracorporeal shockwave therapy (ESWT) on tendon tissue. Muscles, Ligaments and Tendons Journal, 2 (1); 33-37.
  8. Radwan YA, Mansour AM, Badawy WS. Resistant plantar fasciopathy: Shock wave versus endoscopic plantar fascial release. Int Orthop 2012;36:2147-56.
  9. Rompe JD, Decking J, Schoellner C et al. (2003) Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med, 31, 268–275.
  10. Saxena A. Extra-corporeal pulsed-activated therapy (“EPAT” sound wave) for Achilles tendinopathy: a prospective study. J Foot Ankle Surg. 2011 May-Jun;50(3):315-9.
  11. Saxena A, Fournier M. Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete. Muscles Ligaments Tendons J. 2013 Jan 21;2(4):312-6.
  12. Seok et al. Extracorporeal Shockwave Therapy in Patients with Morton’s Neuroma; A Randomized, Placebo-Controlled Trial. Journal of the American Podiatric Medical Association. Vol 106, No2, March/April 2016
  13. Speed C.  A Systemic Review of Shockwave Therapies in Soft Tissue Conditions: Focus in on the Evidence. British Journal of Sports Medicine 48:21;1538–1542;2014

Videos:

PF
https://www.youtube.com/watch?v=dKvcjM5Hq5w&list=PLE1B94A301401AEA8&index=17 

ACHILLES
https://www.youtube.com/watch?v=gXhccewcqVs&index=6&list=PLE1B94A301401AEA8 


 

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