ACORN April 2003
A Shocking New Treatment in Agoura
For photographs of this session click here -->
By Michael Zapf, D.P.M.
So what do you give someone who has tried everything to solve their heel
pain? How about a little sonic boom, right in the heel? The machine that
delivers this boom is coming to my office in June.
Heel pain is very common in adults; about one in four will experience it
sometime during their life. The pain is usually described as severe and sharp on
the bottom of the heel especially the first step in the morning. With a little
ice and rest some get better on their own. Others are helped when their family
doctor prescribes a course of anti-inflammatory medication and, possibly
exercises and heel lifts. The rest, and there are plenty left, end up in the
podiatry or orthopedic office.
If I may make a generalization, most orthopedics will next add a cortisone
injection or two, physical therapy and the recommendation to buy a good pair of
over-the-counter arch supports. (There was a report a few years ago in the
orthopedic literature stating that simple arch supports and the kind of
prescription orthotics that podiatrists make are equally successful in treating
heel pain. As a result of this article many orthopedists are skeptical about the
orthotics prescribed by podiatrists.) The few people who are left with pain at
this point are told that the pain is temporary and will go away in a few months
or are given the option of heel surgery. Those that opt for waiting are usually
rewarded with less painful feet but some remain with pain and can get quite
frustrated.
Podiatrists also do all of the above but we find some arguments with how the
orthopedic orthotic study was done and believe that a custom orthotic is often
helpful. We will apply a special strapping that will mimic, at least for a few
days, a prescription orthotic. If the tape helps when the ice, arch support,
heel lift and anti-inflammatory medications have failed, we usually will make a
pair of prescription orthotics that fit into the shoe. The orthotics seem to
help about half of the people that failed the above therapies. It has the added
advantage of being simple to use by just slipping them into the shoes you wear
everyday. Every podiatrist has many patients who received pain relief only after
receiving orthotics. We might be guilty of too much reliance on these devices
but it is hard to stay away from such a successful therapy. But we also have
some patients who fail all of our therapies and are also very frustrated.
While often successful, traditional heel surgery can have some significant
complications. Every once in awhile the heel bone can fracture and sometimes
patients trade heel pain for an equally or more painful problem on the outside
of the foot. As with almost any surgery, the occasional surgery patient can be
worse off after traditional surgery than they were before.
There is now a possible answer for those who failed conventional heel pain
treatment and do not want traditional open surgery. The answer is harnessing
shock waves, focusing them on the under side of the heel bone and "shocking"
them into submission. The machine we use is made by the same companies that make
shock wave machines for kidney and ureter stones. Up to now the machines for the
heel were few and far between and very expensive to use. The co-payment to use
the one in Van Nuys, for example, can run from $2-12,000 (!) or more. I am happy
to report that a new company has come to Southern California and podiatrists
have already begun treating patients. Our experience is the same as those
nationally; about 60% - 70% of resistant heel pain patients have significant
improvement with the procedure called ESWT (extra corporeal shock wave therapy)
when all other treatments have failed.. Complications, aside from sometimes just
not working, are almost non-existent. The machine is also useful for chronic
Achilles’ tendonitis and the calcium bumps that form where the Achilles’ tendon
inserts on the heel bone.
Until the company who owns the machine finishes negotiations with a local
surgery center, they have agreed to bring the machine to my Agoura Hills office.
It will be here for the first time in mid June. They will do the insurance
billing and have agreed to a reasonable patient fee: either the usual co-payment
and deductible or $500, whichever is lower.
As far as I know this is the first time local podiatrists have used the
machine. I have several resistant heel pain and Achilles’ tendon patients who
could benefit from this therapy. I am anxious to report back on the results.
Dr. Michael Zapf is a Board Certified podiatrist with , along with Dr. Darren
Payne has offices in Agoura Hills and Thousand Oaks. For more information on
heel pain and shock wave therapy either call his office (818) 707-3668 or visit
the office web site: www.conejofeet.com.
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