Heel Pain - New Treatment

Extracorporeal Shockwave Therapy

What is ESWT?

Extracorporeal shockwave therapy, or ESWT, is a non-surgical treatment option for the intense, persistent heel pain associated with chronic plantar fasciitis. "Extracorporeal" means "outside the body". Shockwaves, also known as pressure or sound waves, are generated by a special ESWT device, and focused onto the targeted tissue. The shockwaves are delivered to stimulate and reactivate the body's repair mechanism to advance normal tissue healing. ESWT is an appropriate treatment option for approximately 5 to 10 percent of people suffering from plantar fasciitis - most others are successfully treated with traditional conservative therapies.

Am I a candidate for ESWT?

You and Dr. Horowitz will decide if ESWT treatment is right for you after looking at all the options. You could be a candidate if you have been diagnosed with chronic plantar fasciitis for at least six months and if your symptoms have failed to respond to three conservative treatments which may include rest, physical therapy, heel cushions, nonsteroidal medications (Motrin or other anti-inflammatories), cortisone injections, taping, orthotics, shoe modifications, night split and casting. In the past, surgical intervention for chronic plantar fasciitis was required when these other treatments had failed, but today, ESWT is available as an alternative, non-invasive treatment option.

What happens during treatment?

On the day of the procedure, you will arrive at the treatment location at the designated time prior to the scheduled appointment where you will meet Dr. Horowitz and the technician. After registering, you will recline in a comfortable chair or bed, with your affected foot resting on a large, fluid-filled cushion. Either an ankle block utilizing local anesthetics is administered to create a "numb" feeling throughout the foot or, if your physician chooses, IV sedation may be used to administer a light "sleep" until the procedure is complete. After localizing the inflamed area, the affected heel receives several thousand shockwaves during the approximately 20 minute outpatient procedure.

What happens after the treatment?

You'll be discharged from the treatment center and Dr. Horowitz will provide post treatment instructions and exercises necessary for your recovery. We advise you to have someone accompany you to the treatment facility. The recovery time is very short, and after a recuperative period, usually 24-48 hours, you should be able to return to normal daily activities. You may begin to feel relief immediately, or it could take from three to six months to improve.

Are there any side effects to ESWT?

Compared to invasive or endoscopic surgery, ESWT has fewer side effects and a much shorter recovery time. The most common side effects include temporary pain (bruising and soreness), swelling and petechiae (broken blood vessels that are generally of no concern). These possible occurrences, however, usually clear within a few days. Moreover, the risks associated with surgical incisions and general anesthesia are eliminated.

Who should not receive ESWT?

ESWT is not recommended if you have a pacemaker, if you are taking medications that may prolong or interfere with blood clotting (coumadin), or if you are pregnant. Your doctor can discuss other possible concerns with you. ESWT is not appropriate for individuals suffering from acute plantar fasciitis. Your health history should be reviewed with your doctor to see if this treatment is appropriate for you.