What You Should Know About Shockwave Therapy

Volume 17 - Issue 11 - November 2004
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Continuing Education Course #125 — November 2004

I am very pleased to introduce the latest article, “What You Should Know About Shockwave Therapy,” in our CE series. This series, brought to you by the North American Center for Continuing Medical Education (NACCME), consists of regular CE activities that qualify for one continuing education contact hour (.1 CEU). Readers will not be required to pay a processing fee for this course.

Extracorporeal shockwave therapy (ESWT) has been a subject of controversy as various experts have debated its efficacy in treating chronic plantar fasciitis. With this in mind, Lowell Scott Weil Jr., DPM, explores the various types of shockwave therapy and provides a thorough analysis of the literature on ESWT.

At the end of this article, you’ll find a nine-question exam. Please mark your responses on the enclosed postcard and return it to NACCME. This course will be posted on Podiatry Today’s Web site (www.podiatrytoday.com) roughly one month after the publication date. I hope this CE series contributes to your clinical skills.

Sincerely,

Jeff A. Hall
Editor-In-Chief
Podiatry Today

INSTRUCTIONS: Physicians may receive one continuing education contact hour (.1 CEU) by reading the article on pg. 61 and successfully answering the questions on pg. 66. Use the enclosed card provided to submit your answers or fax the form to the NACCME at (610) 560-0502.
ACCREDITATION: NACCME is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.
DESIGNATION: This activity is approved for 1 continuing education contact hour or .1 CEU.
DISCLOSURE POLICY: All faculty participating in Continuing Education programs sponsored by the NACCME are expected to disclose to the audience any real or apparent conflicts of interest related to the content of their presentation.
DISCLOSURE STATEMENTS: Dr. Weil has disclosed that he has received grant and/or research support from Healthtronics, EMS DolorClast, UMS Wolf and Orthometrix.
This article contains discussion of published and/or investigational uses of agents that are not indicated by the FDA. Neither NACCME nor HMP Communications recommends the use of any agent or device outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings.
GRADING: Answers to the CE exam will be graded by the NACCME. Within 60 days, you will be advised that you have passed or failed the exam. A score of 70 percent or above will comprise a passing grade.
TARGET AUDIENCE: Podiatrists.
RELEASE DATE: November 2004.
EXPIRATION DATE: November 30, 2005.
LEARNING OBJECTIVES: At the conclusion of this activity, participants should be able to:
• discuss the different types of technology used to create medical shockwave;
• cite the potential benefits of ESWT for patients with chronic plantar fasciitis; and
• discuss the recent literature on electrohydraulic, piezoelectric and radial shockwave therapy.
Sponsored by the North American Center for Continuing Medical Education.

What One Randomized Study Revealed About Electrohydraulic Shockwave

What One Randomized Study Revealed About Piezoelectric Shockwave

What One Randomized Study Revealed About Radial Shockwave

Author(s):

By Lowell Scott Weil, Jr., DPM, MBA

The electrohydraulic device showed that 60 percent of the active group improved by more than 50 percent while only 38 percent of the sham group improved by more than 50 percent. This compares favorably to the Ossatron FDA study results.

The piezoelectric study showed that 48 percent of the active group had an improvement of greater than 50 percent while 50 percent of the sham group had more than 50 percent improvement.

However, there was a greater improvement in the Roles and Maudsley criteria for the active treatment group than the sham treatment group, and the active failures had more improvement than the sham failures. Composite scores from all sites are still undergoing statistical analysis.

A third randomized, double-blind, placebo-controlled multicenter study used radial shockwave therapy. Although local anesthetic was available for patients who had severe pain during treatment, no one required the injections.

The study had a rigorous inclusion criteria similar to the aforementioned studies. Computer randomization determined whether patients were treated with an active handpiece or a sham handpiece every two weeks for three treatments. A blinded physician then followed these patients for three months.

For this study of 242 randomized patients, 125 received active treatment while 118 received the sham treatment. The active group improved their visual analog scale (VAS) of pain from a baseline of 7.1 to 3.6 three months after the treatment. The sham group improved from 6.7 to 5.9 at three months.

The active group significantly outperformed the sham group using the Roles and Maudsley criteria. Fifty-seven percent of the active group achieved successful alleviation of their morning pain while only 40 percent of the sham treatment group had this success. Fifty percent of the active group had success treating their activity pain while only 33 percent of the sham group succeeded with treatment of their activity pain.

Using ESWT To Treat Bilateral Heel Pain And Painful Morton’s Neuroma

A single center study focused on the use of ESWT for treating bilateral heel pain. Patients were only eligible for the study if they had been unsuccessfully treated for bilateral heel pain for greater than six months, they had a visual analog pain scale > 6, and systemic causes of the heel pain had been ruled out. Researchers sedated the patients and both heels received 6 to 10 cc of 0.5% Marcaine plain. Computer randomization determined which foot was to be treated.

Researchers used an electrohydraulic ESWT device at a level of 19 Kv and applied 2,000 pulses on the treated foot. The sham foot received no treatment. The patients then followed up with a blinded physician for three months.

This study showed that 70 percent of the active treatment group improved and 52 percent of the sham treatment group improved. Sixty-five percent of the active group improved by more than 50 percent while only 47 percent of the sham treatment group improved by more than 50 percent. Sixty-five percent of the active treatment group achieved a VAS of less than 3 while only 39 percent of the sham treatment group had a VAS less than 3.

According to the study, 4 percent of participants had no improvement in either foot while 39 percent of the participants had improvement in both feet.

A single center study focused on the use of ESWT for treating painful Morton’s neuroma. Patients were only included in the study if they had been unsuccessfully treated for Morton’s neuroma pain for greater than six months, they had a visual analog pain scale > 6, and they had been offered surgical treatment as an option to EWST.

Researchers sedated the patients and injected the third interspace with 3 to 5 cc of 0.5% Marcaine plain. Computer randomization determined whether the patients received active treatment or sham treatment.

Researchers utilized an electrohydraulic ESWT device at a level of 21 Kv and applied 2,000 pulses to the treated foot. The sham foot received no treatment. The patients then followed up with a blinded physician for three months.