ESWT For Plantar Fasciitis: What Do The Long-Term Results Reveal?

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Author(s): 
Lowell Weil, Jr., DPM, MBA

1. Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop. 2010; 39(5):227-31.
2. Hammer DS, Rupp S, Kreutz A, Pape D, Kohn D, Seil R. Extracorporeal shockwave therapy (ESWT) in patients with chronic proximal plantar fasciitis. Foot Ankle Int. 2002; 23(4):309-13.
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4. Weil LS Jr., Roukis TS, Weil LS Sr., Borrelli AH. Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and a comparison of results to fasciotomy, J Foot Ankle Surg. 2002 May-Jun;41(3):166-72.
5. Weil L Jr., et al. Long-term results of extracorporeal shockwave treatment for chronic plantar fasciitis. Presented at the International Society for Medical Shockwave Treatment Annual Meeting, Chicago, June 2010.
6. Taylor DW, Petrera M, Hendry M, Theodoropoulos JS. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med. 2011; 21(4):344-52.

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Richard Bouche, DPMsays: November 3, 2011 at 3:33 pm

Lowell,

You discuss high vs. low energy shockwave. How do you define it? How do energy levels compare with the various systems available (i.e., mJ/mm vs. barr vs. kV?

Thanks,

Richard Bouche, DPM, FACFAS

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arthur kaplan, DPMsays: November 3, 2011 at 3:35 pm

Can you give any advice on which high-energy ESWT device your group prefers to use?

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Ed Davis, DPMsays: November 16, 2011 at 10:56 am

Lowell,

Rich Bouche, DPM, brings up a point that the industry needs to better address: a more uniform manner to describe energy delivery to tissue.

I use the Swiss Dolorclast based on your recommendation. The results are very good and I want to thank you for the good advice.

The machine, using radial shockwave type technology, uses the "bar" for measurement which is a unit of pressure as opposed to energy delivery which is often measured in mj/mm sq. Energy delivery measures the end effect and is referred to in the literature. Rompe endeavored to establish the minimum energy delivery required to achieve a therapeutic effect. That was an important endeavor as we later saw the critical Buchbinder study, in which subtherapeutic energy levels were delivered and concluded that ESWT was ineffective based on such flawed experimental design.

The distinction between low" and "high" energy appears to have been de-emphasized in recent years as energy or pressure levels delivered are a continuum and what really counts is the total energy delivered to the tissue. The original US model was to use fewer shocks by utilization of more expensive machines capable of more intense energy delivery, which required anesthesia.

Our medical-political system took that artificial distinction and over-emphasized the distinction for insurance coding and reimbursement services. The low vs. high energy debate really was a non-issue in Europe and Canada.

Regards,

Ed

Ed Davis, DPM, FACFAS
San Antonio, Texas

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