Cath Lab Digest

   The study revealed that 83 percent of the active treatment group improved by more than 50 percent while only 25 percent of the sham treatment group improved by 50 percent. Seventy-five percent of the active treatment group had a VAS of less than 3 three months following the procedure while only 25 percent of the sham treatment group had the same findings. Eight percent of the active treatment group had no improvement while 50 percent of the sham treatment group had no improvement three months following the procedure.

   No surgical procedure for heel pain, epicondylitis, calcific shoulder tendinitis, Achilles pathology or Morton’s neuroma has ever been subject to the rigors of a prospective, placebo-controlled, double-blind study the way ESWT has.

Final Notes

   At the Weil Foot and Ankle Institute, we treat plantar fasciitis for at least four months with a strict conservative protocol that has been detailed in multiple publications. A vast majority of patients will respond to that conservative approach in that time frame.

   After thoroughly ruling out other etiologies, we present patients with the option of ESWT or surgery to relieve their chronic heel pain.

   Financial concern is the only issue that keeps patients from choosing the surgery option. In some cases, we provide the treatment pro bono to those who would be best served but just cannot afford the treatment.

   At this time, one should consider ESWT a proven treatment for plantar fasciitis and part of any care pathway for physicians who treat the foot. In the future, research may reveal it appropriate to move to ESWT earlier in the treatment pathway if certain diagnostic criteria are met and show that ESWT is more likely to help than other conservative options.

   Additionally, it is possible that ESWT will actually reduce overall costs if less money is spent on non-productive conservative care and physician visits, and if there is less chance of lost productivity and days off work from pain, physician visits and surgical recovery. Employers and patients alike may be crying out for ESWT to be utilized and the health insurance companies will have to listen.

Dr. Weil is the Fellowship Director of the Weil Foot and Ankle Institute in Des Plaines, Ill. He is a Fellow of the American College of Foot and Ankle Surgeons.

CE Exam 125

Choose the single best response to each question listed below.

1. Numerous studies have proven that between ___ to ____ percent of people with plantar fasciitis will be treated successfully with conservative treatment over a six-month period of time.
a) 50 to 60
b) 90 to 100
c) 80 to 90
d) 60 to 70
e) 70 to 80

2. Which of the following musculoskeletal disorders has extracorporeal shockwave therapy (ESWT) been considered valuable in treatment?
a) epicondylitis
b) plantar fasciitis
c) osseous non-unions
d) tendonitis
e) all of the above

3. The electromagnetic principle of shockwave therapy …
a) is also known as spark gap technology.
b) was employed with the first generation of shockwave machines.
c) involves the passing of an electrical current through a coil, which produces a strong magnetic field.
d) employs a high voltage current which is applied to a substantial number of piezo crystals mounted on the inside of a sphere.
e) a and b

4. The piezoelectric principle of shockwave therapy …
a) is also known as spark gap technology.
b) was employed with the first generation of shockwave machines.
c) involves the passing of an electrical current through a coil, which produces a strong magnetic field.
d) employs a high voltage current which is applied to a substantial number of piezo crystals mounted on the inside of a sphere.
e) a and b

5. The focal point or area of maximum therapeutics is at some fixed distance away from the shock generator in all currently available shockwave devices except those with _______ technology.
a) radial
b) electrohydraulic
c) piezoelectric
d) electromagnetic
e) a and b