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Extracorporeal shockwave therapy


Extracorporeal Shock Wave Therapy or ESWT is best known for its uses in the treatment of kidney stones (Extracorporeal Shockwave Lithotripsy).

In more recent years this type of technology has become popular in the treatment musculo-skeletal conditions. Presently it is only FDA approved for treatment of plantar heel spurs, plantar fasciitis and tennis elbow. In the future approval may be given to treat patella tendinitis, shoulder tendinitis, achilles tendinitis, pseudoarthrosis, stress fractures and shoulder calcification. There is also an FDA study to treat recalcitrant diabetic wounds.

There are a couple of theories as to how ESWT helps promote healing. The most accepted one is that the microtrauma of the repeated ultrasound shock wave to the affected area creates neo-vascularization (new blood flow) into the area. It is this new blood flow that promotes tissue healing. The second theory is that in chronic pain, the brain has "forgotten" about the pain and is doing nothing to heal the area. By having shock wave therapy a new inflammatory process is created and the brain can react to it by sending the necessary body nutrients down to the area to promote healing.

For treatment of heel pain the FDA study criteria is quite specific. A person has had to have experienced heel pain for at least six months, had at least three other types of treatments (cortisone injections, oral anti-inflammatory medication, orthotics, physical therapy, etc.) without relief.

Contraindications for this procedure include: neurological and vascular disease of the foot, history of rupture of the plantar fascial ligament, open bone growth plates, pregnancy, implanted metal in the area (bone screws and pins) and people on medication that interferes with blood clotting such as coumadin and prophylactic aspirin.

The procedure use to be performed in an out-patient setting, under local anesthesia, lasting up to 30 minutes in duration. Now with newer technology it can be done without anesthesia in the physician's office in less than 10 minutes. The patient is able to walk out on their own power with the major complaint of a thumping feeling on their heel. View a short video of the procedure

Because re-inflammation is being introduced, the patient cannot take anti-inflammatory medication afterward, nor should they ice the area. Tylenol with codeine is usually given.

For some patients the relief is instantaneous, for others relief may not occur for upwards of six months and unfortunately for others the treatment may not work at all.--Mbmitnick 22:50, 2 January 2007 (UTC)Dr. Marc Mitnick


ReferenceS

Foot pain explained

International Society for Musculoskeletal Shockwave Therapy

The Journal of Bone and Joint Surgery-March 2002, Article 335


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