Extracorporeal Shock Wave Therapy
Extracorporeal shock wave therapy, or ESWT, is a reasonably new treatment for painful plantar fasciitis / heel spurs / heel pain which is becoming more popular with recent improvements in the delivery device.
How does Shock wave therapy work?
ESWT delivers targeted shock waves to the painful area using a hand held ‘gun’ that taps the inflamed tissue. The shock isn’t an electric shock, it is a physical blow. Shock wave therapy is thought to work by causing micro trauma (or tiny spots of damage) to the thick gristle-like tissue that makes up the plantar fascia band. We usually reserve using shock wave for plantar fasciitis that is chronic – more than three months in duration. The body will come in and repair this new, acute injury and in doing so brings more blood flow and repair cells to the chronic injury where your body has ‘given up’ its repair effort.
It has proven useful to also shock the calf muscles and Achilles Tendon to treat heel spurs as these two structures are highly interdependent. This is done using a different shock head that goes deeper and broader than the one used on the less fleshy parts of the feet.
Like many medical procedures, there are pros and cons to the use of shock wave therapy. Our Brisbane podiatry clinic completed a ten patient trial run in September 2015 with the unit before we decided to incorporate it into our practice. The results were better than we had anticipated with very stubborn, long term conditions responding quite quickly. We also found good success with Achilles Tendon issues.
The potential downside to treatment is that it can be uncomfortable at the time of delivery and it can increase pain for a couple of days after. So far, we have found that patients tolerate quite different levels of stimulation on the heel and the delivery of ‘taps’ can be dialed up or down accordingly. Application to the calf is generally quite pleasant. We are currently only using the treatment on conditions where it has been present for more than three months. We don’t think that it will be as useful on more recent pain but will learn more as we go along.
What is the cost of Shock wave therapy?
The treatment is often done three or four times at an interval of 4 to 7 days apart. The cost of the sessions is ~$85 and, as we are podiatrists, the treatment attracts a health fund rebate between $20 – $50 depending on your level of cover. Item numbers for shockwave therapy are F014 and F145.
Lithotripsy for Plantar Fasciitis
There is both a high-energy and low-energy form of ESWT. The Brisbane Private hospital has a lithotripsy machine that delivers high powered shock to the bone of the heel. This is a much more intense treatment which causes more concentrated therapeutic damage to the tissue. It may be done under local or general aneasthetic. This treatment was originally used for breaking up kidney stones. We have used this as our ‘treatment of last resort’ previously with reasonable results but had preferred steroid injections ahead of this treatment due mostly to the pain of application and the cost of the treatment. You can visit their website here to learn more.
Steroid injections for Plantar Fasciitis
At this time, we are recommending low intensity shock wave plantar fasciitis ahead of steroid injections for plantar fasciitis at our Brisbane podiatry clinic. This is for two main reasons. Although there is some chance of increased pain for a few days after the treatment, there is no systemic affect on the whole body and the treatment is a walk-in walk-out one. Also, it seems likely that the long acting corticosteroid would be forced out of the tissue if shock wave was used after an injection, thus moving it away from the site of action.
If you wish to visit us to discuss treatment options, please use our contact page here. Be sure to let us know that you want to discuss shock wave plantar fasciitis treatment to ensure that we assign the correct practitioner to evaluate you.