Extracorporeal Shockwave Therapy (E.S.W.T.) for Heel Pain
People can often be confused about the terms plantar fasciitis and heel spur. While the two are actually related, they aren’t the same. Plantar fasciitis is when the plantar fascia becomes inflamed. A heel spur is a hooked bone that forms on the heal and is associated with the other condition, plantar fasciitis.
Plantar Fasciitis is the most common cause of heel pain. It is the inflammation of the fascia located at the bottom (plantar) of the foot. Once the plantar fascia is over stretched due to the repetitive stress of daily activities or certain conditions, it will develop small tears which attach to the heel bone. These small tears may cause the plantar fascia to become inflamed resulting in heel pain.
Picture of Plantar Fasciitis
What causes Plantar Fasciitis?
There are many causes of plantar fasciitis. Some are due to bio-mechanical factors (i.e. high arches, flat feet, Achilles tendons, restrictive flexibility in the calf muscles), repetitive activity (walking, running, jumping on hard and even very soft surfaces, standing for long periods of time) and/or aggravating factors (obesity, carrying heavy objects, wrong shoes, etc.)
What are the Symptoms?
Many people notice acute heel pain when they first get out of bed in the morning or stand up after resting for a long period of time. This is due to the fact that the plantar fascia is tight and load is applied after it has been at a protracted rest.
The plantar fascia has not been allowed to gradually stretch and lengthen. Hence, people experience tension and pain in the heel. Walking it off will minimize the pain because the fascia is “warming up”, but the pain will eventually return if not worsen.
Heel Bone Spur Symptoms
Many people develop bone spurs without even knowing it. This is because many bone spurs occur without symptoms. However, if the spur is pressing on tissues or other bones or is causing a tendon or muscle to rub, that tissue may break down over time, causing tearing, swelling, and pain. Bone spurs can also result in calluses and corns to help cushion the bone spur.
What is E.S.W.T.?
E.S.W.T. is an acronym for Extracorporeal Shockwave Therapy. High energy sound waves are applied non-invasively to the body.
The study of shockwaves began in the 1950’s. It was discovered that shockwaves were able to break apart ceramic plates, placed in water. The first reported case of kidney stone destruction was in 1971. In 1996, shockwaves were used to treat a European soccer player with Achilles tendonitis at the Atlanta Olympic Games. The first reported case to treat plantar fasciitis was in June 1997.
How does E.S.W.T. work?
No one really knows just how ESWT acts to relieve pain. There are several different theories which include: altering cell metabolism and generating mechanical stimuli that may result in neovascularization (new vascularization) of the targeted area. If neovascularization does occur, the effect may be that the enhanced local circulation could promote the healing process (tissue regeneration).
Additionally, it is said to cause vasodilation of the area, increasing nitrous oxide, which causes an analgesic effect (absence of pain in response to stimulation which would normally be painful). Shock Wave therapy turns a chronic condition into an acute condition. It is easier to control an acute situation versus a chronic condition.
Why should I consider E.S.W.T.?
Any surgery can by risky and complications may arise. After a lengthy surgical procedure you may have scarred tissue and there is no guarantee that the pain will not return. As with all invasive surgeries, you might be required to stay overnight for observation. This is not only costly, but an inconvenience. Your recovery time is longer, you are restricted from daily activity for at least one month, you are uncomfortable and you are taking an unnecessary risk. This treatment can be considered as ‘surgery without a blade’.
Since E.S.W.T. is a non-invasive procedure, there is no recovery period. Patients may return to work the very next day following the therapy. The results can be immediate or the pain may diminish over a period of time after receiving treatment. Typically improvement is seen within the first 2-4 weeks and by 12-16 weeks the pain is gone or significantly reduced. It is advised that you restrict yourself from any heavy lifting (20lbs) or rigorous sport activities for at least 4 weeks. In effort to aide the healing process, Dr. Mechanik may choose to order any combination of physical therapy modalities, i.e.TENS unit, night splint, fracture walker, etc.
A typical treatment lasts approximately 30-40 minutes.
We Can Help You
As director of the Colorado Foot Institute, Dr. Mechanik is Board Certified in Foot Surgery and Board Certified in Reconstructive Rear Foot and Ankle Surgery. He has the medical and surgical skills to treat your foot conditions. He and his family are natives of the Denver area.
Dr. Mechanik received his Doctor of Podiatric Medicine (DPM) degree from the the Dr. William M. Scholl College of Podiatric Medicine which is part of the Rosalind Franklin University of Medicine and Science, a national leader in medical education.
Dr. Mechanik then went on to complete a twenty-four (24) month post-graduate Residency training program in Foot and Ankle Surgery. Dr. Mechanik further advanced his surgical training when he completed his twenty-four (24) month Fellowship program in Lower Extremity Musculoskeletal Surgery. During his fellowship, Dr. Mechanik worked side by side with an orthopedic surgeon, when he tackled the most complex and challenging foot and ankle conditions and surgeries.
Dr. Mechanik is dual board certified in Foot Surgery and Reconstructive Rearfoot/Ankle Surgery. He is a Fellow of the American College of Foot and Ankle Surgeons and a Diplomate, American Board of Foot and Ankle Surgery.
Dr. Mechanik is one of the few podiatrist in the United States with his extensive training. Dr. Mechanik sees patients from all over Colorado, the United States, and Internationally. Dr. Mechanik treats adult and pediatric foot and ankle conditions.
The Colorado Foot Institute and Dr. Mechanik’s practice is exclusively limited to treating conditions of the foot and ankle. Dr. Mechanik personally sees and follows every patient from start to finish.