Acorn Article
February 2001
Shocking New
Therapy For Heel Pain
Lakers’ center
Shaquille O’Neil missed several basketball games in early February due to heel
pain. He should have been with me last Saturday. I attended a seminar on the
newest treatment for heel pain: shock wave surgery. In this procedure high power
shock waves, produced by a 20,000-volt spark plug and focused on the heel can
result in significant pain relief when all other treatments have failed. The
treatment, called extra corporeal shockwave therapy (ESWT) has been available
for 10 years in Europe but was only recently approved in the United States. The
only FDA approved ESWT machine in California is located at a local surgical
center.
Heel pain is
quite common. The pain can range from the mild annoyance of a “stone bruise”
to a cause of missing work, even if you are a million dollar athlete like Shaq.
Classically the pain is felt on the bottom of the heel with the first in the
morning or after other periods of being off of the foot. In the first few months
of heel pain the discomfort eases off after a few steps. In advanced cases the
pain can persist throughout the day. Sometimes a heel spur can be seen on an
x-ray. Heel pain with an actual spur on the x-ray is often more resistant to
treatment.
Most of the time
the pain can be successfully treated by over the counter anti-inflammatory
medications, heel lifts, stretching and shoes with some arch support. More
resistant cases can be helped with prescription strength in-shoe arch supports
called an orthotic. Sometimes a prescription anti-inflammatory medications or an
injection of a cortisone medication are prescribed. Fortunately more than 90% of
all heel pain patients are improved with these non-surgical therapies.
Unfortunately,
non-surgical methods fail about 10 times out of a hundred. One or two of these
people will choose to just live with their pain rather than face surgery. In the
past the others had to choose from a variety of traditional surgeries. The
surgery for heel pain involved cutting of the ligament involved, called the
plantar fascia, removal of the heel spur or both. Finally, there is an
alternative to traditional surgery, shock wave therapy.
Extra Corporeal
Shock Wave is patterned after the shock wave therapy machines that have been
used for 15 years to break up kidney stones. In the foot, ESWT is usually
performed under light sedation and local anesthesia. During the 30 minute
treatment the device is aimed at the heel and 2000 shocks are directed at the
painful area. Afterwards the heel is sore for a few days and sometimes the heel
is “black and blue” for a few days more. Shaq should note that some athletes
have been able to return to sports the next day. In one double blind study with
patients at seven different sites, the most common side effect from the
procedure was temporary pain and numbness occurring in 15 of 273 patients.
Success was reported by 62% of the patients after one treatment. When the
“failures” were subjected to a second treatment the success rate was an
astounding 90.5%. The success of this study led to the FDA approval of this
particular machine for heel pain.
ESWT is great
news for anyone who has heel pain despite six months of conservative,
non-surgical, care and for anyone who has heel pain despite having surgery. With
this technique you may be able to finally “Wave” good-bye to resistant heel
pain.
-30-
Dr. Michael Zapf
is a board certified podiatrist in private practice with offices in Agoura Hills
and Thousand Oaks. Dr. Zapf is one of only a few doctors certified to perform
shock wave therapy and is able to offer it to patients for relief of heel pain.
For more information please call his office at (818) 707-3668 or see the
“Shock Wave” link onto his web site: zfootdoc.com .
