I have tremendous heel pain but I do not
want anybody (even you, Dr. Zapf ;-) ) cutting on my heel. What are my
options?
Great News! A Shocking New Way To Treat Heel Pain:
ESWT
In February of 2001
Dr. Michael Zapf was
one of
the first podiatrists (or doctors of any kind for that matter) certified to
provide shock wave therapy for patients with heel pain. More
recently Dr. Darren Payne attained certification and also offers this service to
our patients. High power shock waves,
produced by a 20,000-volt spark plug, or other sound
generating mechanism, focused on the heel can result in
significant pain relief even if all other treatments have failed. The treatment,
called extra corporeal shockwave therapy (ESWT) has been available for
in Europe since the mid 1990s and was approved in the United States
in about 2000. The FDA approved
the procedure in early 2001 for use on resistant heel pain.
Our certification means that we are able to offer
this unique service to our patients for relief of heel
pain. The machine we use is brought to us by United Shockwave
Therapy and it is an Ultrasound Guided for better accuracy.
A link to this ultrasound guided
machine (with video) is found here: -->
Patients report on Shock Wave
Treatment --->
Beware of the $56,000 dollar heel
surgery ..>
Kay's Experience -->
As a recap to the foregoing monograph, heel pain is a common foot problem and
is a frequent cause of visits to our office. The pain can range from the mild
annoyance of a "stone bruise" to a cause of missing work,
school or your turn on the field or court. 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.
We believe that the true cause of the pain is an
abnormally strong pull of the plantar fascia on the heel bone. With our
in-office ultrasound we can actually measure the thickness of the plantar
fascia. The normal thickness of this fascia is about 2-4mm and symptomatic
plantar fascia can get as large as 8 or 10mm or larger. For appointment
purposes, we keep the ultrasound machine in our Agoura Hills office.
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 orthotics. 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 only local anesthesia. During the
treatment the device is aimed at the heel and 3800 shocks are directed at the
painful area. This takes about 18 minutes. Afterwards the heel is sore for a few days and
occasionally the heel
is "black and blue" for a few days more. In most studies a majority of
patients are happy with the procedure and back to regular activates with less
pain in 2 to 4 weeks. In one double blind study with patients at seven different
medical centers, 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
[shock] "Wave
Good-bye" to resistant heel pain.
February 27, 2007 - comments from
Dr, Zapf - the number of ESWTs I do has dropped dramatically, I must have done
more than 100 during my first 5 years of the procedure but I am seeing fewer
resistant heel pain patients. I still do not shy away from the procedure. I find
the statistics in my office are: 1/3 of patients find it a miracle therapy, 1/3
find it helps and 1/3 are not much helped. NO ONE HAS BEEN MADE WORSE.
Most insurance companies still do not cover the procedure and that is a mistake.
The ESWT companies charge a lot for the procedure and that is also a mistake. If
you have resistant heel pain that had not been helped with conventional therapy
it is still worth a try. Call me if you want to explore this more.
MZ
A QUESTION I RECEIVED 5-5-2001
My wife has been suffering heel pain for the last 12 months
due to a heel spur. Though the severity has diminished since she has
switched to wearing shoes with an elevated heel, she feels that she has come
to a place where the condition is not improving and is considering a more
aggressive treatment.
We would like you to evaluate her as a candidate for shock wave
treatment. There are no podiatrist in our area that offer this treatment.
We live near Fort Bragg CA. and it will be quite a problem
getting to your office. However, if she is helped by this line of
treatment ,it would be worth it.
Thanks
G& D
Dear G&D,
Thank you for the vote of confidence. I understand how frustrating it can
be to have heel pain that is not getting better. Before you make a trip to
Agoura there are several things you need to think about. First, read the
Patients Guide to Heel Pain elsewhere on this web site. You will find that
most any garden variety podiatrist should be able to do an outstanding job
evaluating and treating your wife's heel pain. You need to make sure you are
not dealing with a stress fracture of the heel bone. Once you know it is
mechanical heel pain please go through the gamut of heel pain therapy with
your local podiatrist.
I strongly believe in the value of treating the underlying mechanical
problem with functional orthotics. I know that the mechanics of foot
function are important in your wife's case because you tell me that she
feels better in an elevated heel. Please do not consider the surgery unless
you have tried a good pair of orthotics. Once she has orthotics I would
suggest a cortisone injection or two. If these are not helping enough, then
consider adding a night splint to stretch the plantar fascia and the Achilles'
tendon for several hours a night. If all these fail then she becomes a
surgical candidate.
I believe that the Epos Ultra, OssaTron
and other shockwave machines will someday become the first level of surgery
when conservative therapy has failed. Unfortunately, it is early in the game
(I write this on May 6, 2001) and insurance companies are still reluctant to
authorize treatment. If your insurance company will not reimburse you for the
surgery, the surgery center I am using is charging a flat cash fee of $3000
for use of the machine. This is in addition to my own modest fees. If you have
tried conservative therapy to the extent you want and you are ready for
surgery this is what you will have to pay.
With this understanding, please give my office a call. You will need to
make one trip down for my evaluation and we can do your surgery on the
OssaTron the next day. Please call your insurance company first and ask of
Extra Corporeal Sock Wave therapy is a covered service for long standing heel
pain. See if they are calling it experimental or unproved or if they will pay
for it.
I hope this helps.
Michael Zapf, D.P.M.
1
