what is the success rate for shock wave treatment for heel spurs vs radio frequency therapy 2018

When should I consider shock wave therapy for plantar fasciitis?

It is important that patients try more traditional treatments for a period of at least six months to a year before considering shock wave therapy. For patients with plantar fasciitis, conservative treatment measures consisting of medications, ice application, exercises, and shoe inserts are often effective treatments.

Can shockwave therapy help treat chronic tendon problems?

Shock wave therapy has emerged as a possible treatment option for patients with chronic tendon problems. The procedure uses either pressurized air or electromagnetic pulses to delivers shock waves to the body to help treat a variety of chronic disorders, including:

Is shockwave therapy worth the cost?

Shock wave therapy is quite expensive, and whether or not it is an effective treatment is controversial. Each individual treatment can cost a lot of money and, depending on the form you choose, may end up requiring multiple treatments.

Does radial shockwave therapy work for heel spurs?

In the research Rompe, Schoellner & Nafe (2002) showed a satisfying clinical outcome after application of radial shockwave to heel spurs. Similar positive outcomes have been shown in various other studies (Krischek et al., 1998, Maier et al., 2000, Perlick, Boxberg & Giebel, 1998).

What is the success rate of shockwave therapy?

There is currently great interest in the use of Extracorporeal Shock Wave Therapy (ESWT) and in clarifying the mechanisms of action in tendon pathologies. The success rate ranges from 60% to 80% in epicondylitis, plantar fasciitis, cuff tendinitis, trocanteritis, Achilles tendinitis or jumper's knee.

Is shockwave therapy successful?

The overall success rates for all indications ranges between 60% to 80% depending on the conditions treated,. Read about the Shockwave therapy Success Stories from real patients with a variety of conditions.

Can shockwave therapy remove bone spurs?

Unfortunately, it is not a treatment that is covered by insurance, but studies show that it is an effective treatment. Between 80 and 90 percent of patients report reduced pain and inflammation, while up to 30% of patients showed reduction in the protrusion of bone spurs after repeated treatments.

How successful is shockwave therapy for plantar fasciitis?

The study also found that shockwave therapy began working within two weeks of application, with success rates between 48-88% (Urgurlar et al., 2018). As a non-invasive treatment to supplement a physical therapy program, shockwave therapy for plantar fasciitis is a great option.

How long does it take for shock wave therapy to work?

Most people who get shockwave therapy for ED will often see benefits within one to three months. The initial results (within the first several weeks) can be dramatic.

Does shock wave therapy work on feet?

Fortunately, there are many treatments available through a podiatrist that can alleviate pain and other symptoms associated with foot and ankle injuries and conditions. One such example is Extracorporeal Shockwave Therapy (SWT), commonly referred to as shockwave therapy.

Does shockwave therapy dissolve heel spurs?

Clinical outcome after ESW was satisfactory in 168 patients (82%) with a radiographically demonstrable inferior heel spur and in 81 patients (79%) without such a heel spur. The results showed no correlation between the presence or absence of the heel spur and the eventual treatment outcome.

What can I expect after shockwave therapy?

In the days following shockwave therapy, you may experience swelling and redness in the treated area. This can make your pain feel worse, but this is indicative of the healing process, is completely normal and will subside within a day or two.

How do you dissolve bone spurs naturally?

How to dissolve bone spurs naturally1 – Stretching. Stretching your toes, feet, and ankles can alleviate pressure and strain whether you experience a toe bone spur or a heel bone spur. ... 2 – Footwear. ... 3 – Ice packs. ... 4 – Vitamins and supplements. ... 5 – Massage therapy.

Can shockwave therapy cause more damage?

It is abundantly clear that Shockwave can do serious damage to tissues as well as local circulation. Employing Shockwave therapy too close to open or post surgical wounds could lead to not only degradation of the wound, but also further bleeding as well as delayed healing.

How long does shockwave therapy last for plantar fasciitis?

The shock waves penetrate the skin of the heel area to stimulate healing. You may feel some discomfort during the process and may feel a tapping sound from the probe. The treatment takes around 10 to 20 minutes per foot.

Who should not get shockwave therapy?

Malignant tumors, metastasis, multiple myeloma, and lymphoma in the treatment area have to be seen as contraindications for treatment with radial and focused shock waves with low and high energy. Cancer itself, in the form of the underlying disease, is not a contraindication for ESWT [4].

What is shock wave therapy?

Shock Wave Therapy, or Extracorporeal Shock Wave Therapy (EWST), is a non-invasive treatment that involves the delivery of shock waves to an injured area to promote healing. This treatment produces highly effective shock waves that initiate biological regeneration processes at the cellular level.

How many types of shock wave therapy are there?

There are 3 types of true shock wave therapies and 1 assumed type that is not a true shock wave therapy

What is a shock wave?

Shock waves are acoustic pulses with high positive pressure, fast and steep rise time followed by comparatively small negative pressure (tensile wave).

What is the most extensively described issue in shock wave science?

The angiogenic effect of shock wave treatment is probably the most extensively described issue in shock wave science.

How fast does a pistol shrimp fire off a shock wave?

Watch how its claw opens and shuts to fire off a powerful water jet at speeds up to 30 metres per second (67 mph). Note, the high-speed water isn’t what harms its target – it’s the resulting shock wave.

What is ESWT therapy?

Extracorporeal shock wave therapy (ESWT) was originally used for the treatment of renal stones. In the 1990s, ESWT became popular in Germany for certain soft-tissue disorders, including calcifying tendonitis of the rotator cuff, humeral epicondylitis, and plantar fasciitis [10]. It is now applied worldwide for the treatment of musculoskeletal complaints. In the USA, the Federal Drug Administration approved the use of ESWT in the treatment of chronic proximal plantar fasciitis in 2000. Shockwaves are pressure disturbances that propagate rapidly though a medium [10]. Attenuation of the wave is dependent on the medium used. In air, a wave dissipates quickly. However, water is an excellent medium. Most treatment protocols use a water medium and a coupling gel before penetrating tissue. Generation of shock waves is electromagnetic, electrohydraulic, piezoelectric, or pneumatic. The first three methods focus the wave to a very specific area, whereas, focusing is not involved using the pneumatic method [10]. In animal models, ESWT stimulates soft-tissue healing primarily by inhibiting afferent pain-receptor function and by enhancing angiogenesis. Basic science studies show that ESWT may increase blood flow to the treated site and induce an inflammatory-mediated healing process. Treatment protocols utilize either low- or high-energy waves. Low-energy shock wave therapy does not require local anesthesia but does require three to four applications. In contrast, high-energy shock wave therapy can be applied in one visit but requires local anesthesia. Controversy revolves around whether the use of anesthesia compromises clinical outcomes [35]. In theory, the infiltration of local anesthesia may interfere with the focusing of the shock wave to the site of maximal discomfort [35]. Also local anesthesia may alter the inflammatory response and angiogenesis ESWT invokes. Regional anesthesia may be of use as it can provide comfort for the patient without compromising the results of SWT. The type of anesthesia that is most beneficial has yet to be determined.

What is posterior heel pain?

Differential diagnosis of patients with posterior heel pain includes retrocalcaneal bursitis and superficial tendo Achilles bursitis or “pump bumps” [11, 29]. Achilles tendinopathy will often present with soft-tissue swelling, local tenderness, and crepitus [31]. In early stages, focal swelling and tenderness are limited to a small area (see Fig. 1). Crepitus is the result of an exudation around the tendon and is more commonly found in the acute stage. It can be accentuated by active dorsiflexion and plantar flexion of the foot. Thompson’s test is negative. Radiographs rarely show calcification of the soft tissues surrounding the tendon or the tendon itself [29]. The lateral radiograph may show a prominent superior tuberosity of the os calcis. Ultrasounds of athletes with chronic Achilles tendinosis have found that this modality accurately demonstrates both tendonitis and tendinosis of the tendon [19, 20].

What is the treatment for Achilles tendonitis?

Standard treatment regimens include activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading. There is a lack of consensus regarding treatment. Even so, most athletes will respond to this regimen. However, conservative management will prove to be inadequate for a subset of patients. When conservative therapy fails, other noninvasive treatment measures may be considered. Extracorporeal shock wave therapy (ESWT) has been used in soft-tissue disorders including lateral epicondylitis, plantar fasciitis, and calcific tendonitis of the shoulder. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is lacking. This article explores the role of shock wave therapy in the management of recalcitrant Achilles tendinopathy in patients attempting to avoid an invasive intervention.

Can SWT be used for Achilles tendon?

Uncontrolled pilot studies suggested that SWT can be an effective treatment for patients with chronic noninsertional Achilles tendinopathy [28, 33]. More recent randomized controlled trials have substantiated these positive results [5, 32, 36]. In the largest of these studies Rompe et al. enrolled 75 patients in a randomized triple-arm trial to compare eccentric loading, repetitive low-energy SWT, and a wait-and-see policy. SWT was administered without local anesthesia in weekly intervals with a primary follow-up of at least 12 weeks. At 4 months from baseline, 60 vs. 52 vs. 24% reported symptoms “completely recovered” or “much improved” [36]. For all outcome measures, eccentric loading and SWT did not differ significantly but showed significantly better results than the wait-and-see policy [36].

How long does shockwave therapy take for plantar fasciitis?

A: Shockwave therapy for plantar fasciitis usually takes 3-4 sessions and we see a 70% success rate. Our physicians can also discuss other options once they get a sense of your exact condition.

How long does it take for a foot to heal after shockwave?

However, even if you are pain-free directly after your procedure, we recommend refraining from any activity that may be stressful to your foot for at least two days. It typically takes several months to reap all the pain-reduction benefits of shockwave therapy.

What is Extracorporeal Shockwave Therapy?

This is when conservative treatments like stretching, physical therapy, and orthotics fail to provide adequate pain relief.

How does shockwave treatment work?

What to Expect During Shockwave Treatment. Using a specially-designed handpiece, EWST works by focusing shockwaves directly at the painful part of your foot. The shockwaves produce micro-traumas to the tissue that’s causing your plantar fasciitis.

How long does it take for shockwave surgery to heal?

Normally, patients receive three shockwave treatments over as many weeks . Low-intensity EWST always takes place in the office, requires no anesthesia and consists of three treatments.

What is shockwave therapy?

Shockwave therapy produce s various levels of controlled trauma that causes the area to inflame and prompts natural healing to begin.

How does the body react to micro trauma?

Your body reacts to these micro-traumas by signaling for an increased blood supply to the painful area, as well as breaking down injured tissue and calcifications. In turn, blood vessel formation is increased and nutrients flood the area. Your body then heals itself.

What is shock wave therapy?

Shock wave therapy is quickly becoming a mainstay treatment for chronic recalcitrant plantar fasciitis, and many more applications for this therapy may exist. Many advances have been made in regard to this modality of treatment in just a few decades since it was first investigated in the 1950s. Much research has been conducted, revealing the physics and physiologic effect of shock wave therapy. Devices are now approved that produce shock waves for medicinal purposes by one of the three primary methods of shock wave generation. Studies and research are actively being reported and published that demonstrate shock wave therapy success rates comparable to those found in surgical intervention but without the risks inherent in surgery. In conclusion, ESWT has proved to be a viable treatment option for the intervention of chronic recalcitrant plantar fasciitis.

How long does it take to treat plantar fasciitis with ESWT?

All patients had been diagnosed and treated for plantar fasciitis for greater than 6 months and had failed at least 3 conservative treatment modalities. Each patient received 3800 shockwaves into the treated heel using the Dornier Epos Ultra ESWT machine. The average postoperative follow-up was 124 days (range, 33 to 255). Written subjective surveys evaluated pre- and posttreatment pain levels using a visual analog scoring system. The mean pretreatment score was 8.51 (range, 5 to 10), which improved to a mean follow-up score of 3.75 (range, 0 to 10). This represents an improvement in the mean VAS of 4.76, which is statistically significant ( P = .0002). Twenty-five of 30 patients reported some degree of improvement, with 5 experiencing no change. These early results indicate ultrasound-guided ESWT may be a useful tool in the treatment armamentarium for chronic plantar fasciitis.

What is ESWT for plantar fasciitis?

CONTEXT: Extracorporeal shock wave therapy (ESWT) is increasingly used for plantar fasciitis, but limited evidence supports its use. OBJECTIVE: To determine whether ultrasound-guided ESWT reduces pain and improves function in patients with plantar fasciitis. DESIGN: Double-blind, randomized, placebo-controlled trial conducted between April 1999 and June 2001. SETTING: Participants were recruited from the community-based referring physicians (primary care physicians, rheumatologists, orthopedic surgeons, and sports physicians) of a radiology group in Melbourne, Australia. PARTICIPANTS: We screened 178 patients and enrolled 166; 160 completed the 15-week protocol. Entry criteria included age at least 18 years with plantar fasciitis, defined as heel pain maximal over the plantar aspect of the foot of at least 6 weeks' duration, and an ultrasound-confirmed lesion, defined as thickening of the origin of the plantar fascia of at least 4 mm, hypoechogenicity, and alterations in the normal fibrillary pattern. INTERVENTIONS: Patients were randomly assigned to receive either ultrasound-guided ESWT given weekly for 3 weeks to a total dose of at least 1000 mJ/mm(2) (n = 81), or identical placebo to a total dose of 6.0 mJ/mm(2) (n = 85). MAIN OUTCOME MEASURES: Overall, morning, and activity pain, measured on a visual analog scale; Maryland Foot Score; walking ability; Short-Form-36 Health Survey (SF-36) score; and Problem Elicitation Technique score, measured at 6 and 12 weeks after treatment completion. RESULTS: At 6 and 12 weeks, there were significant improvements in overall pain in both the active group and placebo group (mean [SD] improvement, 18.1 [30.6] and 19.8 [33.7] at 6 weeks [P =.74 for between-group difference], and 26.3 [34.8] and 25.7 [34.9] at 12 weeks [P =.99], respectively). Similar improvements in both groups were also observed for morning and activity pain, walking ability, Maryland Foot Score, Problem Elicitation Technique, and SF-36. There were no statistically significant differences in the degree of improvement between treatment groups for any measured outcomes. CONCLUSION: We found no evidence to support a beneficial effect on pain, function, and quality of life of ultrasound-guided ESWT over placebo in patients with ultrasound-proven plantar fasciitis 6 and 12 weeks following treatment.PMID: 12234230 comments and full text in our message board

How does ESWT work?

The FDA has approved the use of some ESWT machines for heel pain and tennis elbow. ESWT devices evolved from lithotripters (a.k.a. kidney stone shock wave machines). The discovery of the beneficial effects of ESWT came as German researchers were trying to determine what type of high-pressure pulses could be sent through the body to disintegrate kidney stones without causing harm to surrounding tissue. In laboratory animals and humans, it was discovered (with some surprise) that surrounding tissue would often heal back stronger. Physical therapists use ultrasound machines that warm internal tissue by high frequency sound waves, but the ESWT machines send higher-energy pulses 2 or 3 times per second rather than continuous lower-energy waves. Electricity is not sent into the body. It may take as long as 12 weeks to see the full benefit of an ESWT treatment. The beneficial effect of the high-pressure waves may be from the growth of new blood vessels ("neovascularization") in small cavities that are created by the pulses. New blood vessels to an area of tissue would promote healing.

How much does ESWT cost?

Dr. Ed Davis of San Antonio TX offers a complete ESWT treatment (600 shocks of the Swiss Dolorclast) for $500. www.southtexaspodiatrist.com

Is extracorporal shock wave used for plantar fasciitis?

During the past decade application of extracorporal shock waves became an established procedure for the treatment of various musculoskeletal diseases in Germany. Upt to now the positive results of prospective randomised controlled trials have been published for the treatment of plantar fasciitis, lateral elbow epicondylitis (tennis elbow), and of calcifying tendinitis of the rotator cuff. Most recently, contradicting results of prospective randomised placebo-controlled trials with adequate sample size calculation have been reported. The goal of this review is to present information about the current cinical database on extracorporeal shock wave tratement (ESWT).PMID: 12085291

Is ESWT safe for chronic lateral epicondylitis?

Twelve weeks after treatment, the mean visual analog scale score for the entire group improved from 8.0 to 2.5 (P .05), and the mean RAND 36-Item Health Survey (Physical Functioning) score improved from 65.6 to 88.0 (P .05). Outcomes for 28 elbows (77.8%) were rated excellent or good on the Roles and Maudsley scale. There were no significant differences in outcome measures among the subgroups. There were no significant complications. ESWT is an effective treatment for chronic lateral epicondylitis. Worker's compensation status did not affect outcomes.

What is prolotherapy for plantar fasciitis?

Prolotherapy is a treatment that regenerates and strengthens weakened structures, such as the weakened plantar fascia ligament. When a patient comes in with plantar fasciitis, an evaluation is made as to what type of treatments will likely benefit the patient most. Often times we will look for the simplest treatment.

How to treat plantar fasciitis?

Typical protocol treatment for the problem of plantar fasciitis and plantar fasciopathy would be a possible cortisone injection, foot stretching exercises, and rubbing it with an ice pack or cup among other self-help remedies. These treatments can provide temporary relief but they treat the symptoms and do not assist in the repair of the foot integrity and structural instability. We have seen where cortisone injections can lead to tissue rupture or plantar fasciitis tears.

Why does my heel hurt?

Plantar fasciitis is one of the most common causes of heel pain. Plantar fasciitis involves pain and inflammation of the plantar fascia, a flat band of tough tissue supporting the arch of the foot that runs from the heel to the base of the toes.

Does cortisone help plantar fasciitis?

A January 2020 study in the Journal of Pain Research ( 7) suggests both cortisone and Hyaluronic Acid were effective modalities for plantar fasciitis and can improve pain and function with no superiority in 24th-week follow-ups, although cortisone seems to have a faster trend of improvement in the short term.

Is dry needling effective for plantar fasciitis?

A March 2019 study in The Journal of Foot and Ankle Surgery ( 4) suggested that dry needling would be as effective as the use of corticosteroid injections for treating Plantar fasciitis. The additional benefit would be avoiding the potential adverse effects of corticosteroids. To prove the point, the researchers of this study took patients diagnosed with Plantar fasciitis and prescribed them a 3-week nonoperative treatment regimen.

Can you use dry needling for plantar fasciitis?

A March 2019 study in The Journal of Foot and Ankle Surgery ( 2) suggested that dry needling would be as effective as the use of corticosteroid injections for treating Plantar fasciitis. The additional benefit would be avoiding the potential adverse effects of corticosteroids. To prove the point, the researchers of this study took patients diagnosed with Plantar fasciitis and prescribed them a 3-week nonoperative treatment regimen.

Does plantar fasciitis go away?

For many people, these treatments can be very helpful and even make the plantar fasciitis go away entirely or for the most part. Unfortunately, for the patients we see, these treatments did not work. The patients we see came to our clinics because they had become “difficult to treat plantar fasciitis patients,” and were being suggested to a possible surgery or other treatments. We do see patients who have had a cortisone injection, it may have worked for them for some time, but the plantar fasciitis returned.

How long does it take for a shockwave to heal?

Frairia & Berta (2011) say there is a critical window for healing after shockwave therapy, between 6-12 days. On this basis treatment for destruction should be performed every 5 days. In practice I don't worry too much about the actual time frame. If any heeling occurs it can be broken once more by further shockwave.

How many ways are there to use radial shockwave?

There are three main ways of using radial shockwave:

How high should the pressure be for a shock?

The higher the pressure setting normally the better but most patients can't tolerate high settings initially. Start at low pressure e.g. 60mj or 1 bar for 200 shocks then increase to 90mj or 2 bar for 200 shocks then 105mj or 2.5 bar. Anything at 105mj or 2.5 bar or more should have the desired effect. Weijers (2009) recommended 2.5 bar or above (equivalent of 0.22mj/mm 2 ).

How many shocks can you get from a stationary car?

1000 shocks if stationary. As high as 4000 shocks for a large area (Frairia & Berta, 2011).

What frequency should I use for muscle relaxer?

Generally higher values are used as these cause less pain. 15-30hz tends to be used as it can also relax the muscles (Nazarov & Gorozhani, 1988).

Does shockwave release substance P?

Shockwave mechanically stimulates the release of substance P (Maier et al. 2003). However this initial release is followed by a subsequent decrease in levels of substance P (and hence inflammation) at the 24 hour point as the nerve degenerates (Maier et al. 2003).

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