Getting Shockwave Results With The Epos Ultra

By Gina DiGironimo, Production Editor

Plantar fasciitis is a common condition that affects over 2.5 million Americans. If conservative treatments fail, podiatrists are exploring the merits of extracorporeal shock wave therapy (ESWT), a non-invasive procedure, before considering surgical options. ESWT received FDA approval in 2000 for the treatment of plantar fasciitis. Earlier this year, a new ESWT device called the Epos Ultra (which includes built-in ultrasound technology) received FDA approval for the plantar fasciitis indication.
Those who have used the Epos Ultra have cited very favorable treatment results.
Lowell Scott Weil, Jr., DPM, MBA, the Director of Shockwave at the Weil Foot And Ankle Institute, says the device has produced “excellent results” and he has published an “ … 82 percent success rate with the treatment of chronic plantar fasciitis.” George Theodore, MD, who was one of the principal investigators for the FDA clinical trial of the Epos Ultra, says he has seen “60 percent improvement at three months and 80 percent improvement at 12 months.”
David Zuckerman, DPM, has performed ESWT for three years and recently began using the Epos Ultra. After one year of use, Dr.Zuckerman has seen a 92 percent average reduction in pain. His results are concurrent with published FDA studies on the Epos Ultra.

Understanding The Basics Of The Epos Ultra
So how does the Epos Ultra work? Well, it consists of three primary parts: the Ultrasound Imaging System, the Shockwave Therapy System and the Articulated Arm. The ultrasound enables you to achieve precise localization and high imaging quality, according to the manufacturer Dornier MedTech. Physicians can view a crosshair image that indicates the exact therapy focus.
Dr. Weil, a Fellow of the American College of Foot and Ankle Surgeons, says the ultrasound is a major benefit of the Epos Ultra in that it helps in guiding and ensuring accuracy in treatment. Dr. Zuckerman concurs, calling the ultrasound system “very efficient.”
The device’s Shock Wave Therapy System produces the actual shock waves that travel through the therapy head’s water-filled cushion which rests against the patient’s foot during treatment. According to Dornier, the shock waves over-stimulate pain transmission nerves, which helps reduce the patient’s sensitivity and pain.
The company adds that the device’s Articulated Arm allows for easy movement of the therapy head and enables you to get more of a pinpoint precision for the the area of treatment.
The device offers versatile, controlled power ranges (from 60-240 shocks per minute) and uses an electromagnetic shock wave emitter power source versus spark gap technology. You can perform the shockwave treatments in a hospital or outpatient center and they last about 30 minutes, according to Dornier. Dr. Zuckerman actually has a three-year-old company, Excellence Shockwave Therapy Group, that brings the ESWT technology to over 30 doctors’ offices and disperses ESWT on patients using a local anesthetic.

Addressing Cost And Reimbursement Concerns
As far as drawbacks go, Drs. Weil and Zuckerman say the cost of the device is a deterrent and the treatments are expensive. Dr. Theodore quotes the cost of treatment between $2,000 to $3,000.
Reimbursement is another sticking point. According to Dr. Weil, many insurance companies “incorrectly deem (ESWT) as experimental and balk at payment.” Dr. Zuckerman adds the Epos Ultra device has no CPT code available.

Final Thoughts
In comparison to other ESWT devices, Dr. Weil offers this advice: “Epos technology as an electromagnetic device carries less maintenance costs compared to electrohydraulic technology (Ossatron) costs.” In terms of clinical use, Dr. Weil says the Epos Ultra and other devices “treat the same pathologies and probably (do so) equally.”
Dr. Weil cautions against using the Epos or any ESWT therapy as a “quick fix.” While he has seen high success rates among patients, he believes you should only consider ESWT when conservative treatments have failed. He hopes that in the future, “ESWT will be a standard part of the orthopedic, podiatric, physical therapy and chiropractic practices.”


How are you getting the insurance companies to pay when claims are denied for "Unproven" or "Investigational/Experimental? We have tried submitting op notes, full med records and they still deny asking for scientific evidence. Any and all suggestions welcome. KP

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