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Plantar Fasciitis

What is a Plantar fasciitis?

heel-painPlantar fasciitis, formerly called “policeman’s heel” in the United Kingdom, is a painful inflammatory condition caused by excessive wear to the plantar fascia of the foot or biomechanical faults that cause abnormal pronation of the foot. The pain usually is felt on the underside of the heel , and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing.
Causes and Risk Factors of Heel Pain

Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition. This condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.
Common Treatment of Plantar Fasciitis

Conservative treatments for heel pain include rest, physical therapy, heel cushions, anti-inflammatory medications, steroid injections, taping, orthotics, shoe modifications, night splints and casting. Fortunately, conservative treatments have an approximately 90% success rate. In years past, surgery for chronic plantar fasciitis was required when conservative treatments had failed; but today, a new treatment is available called Extracorporeal Shockwave Therapy (ESWT).

What is ESWT?

Extracorporeal shockwave treatment is a non-invasive, non-surgical treatment option for the intense, persistent heel pain associated with chronic plantar fasciitis. “Extracorporeal” means “outside the body”. Shockwaves, also known as pressure or sound waves, are generated from a special device, and focused onto the targeted tissue. The shockwaves are delivered outside the body to trigger an individual’s own repair mechanisms. Shockwave therapy was originally developed to break up kidney stones in the body. The FDA approved this therapy in the early 1980s; and today it is the standard treatment of choice for kidney stones. An important benefit of this therapy is that it’s delivered outside the body, so many of the risks associated with surgery are eliminated. Doctors around the world, especially in Europe, have successfully used this technology since the early 1990s.

The ESWT treatment takes about 30 minutes and is performed under local anaesthesia and/or ‘twilight’ anaesthesia. ESWT is an out-patient procedure and does not require an overnight stay in the hospital.

Am I a candidate for ESWT?

Prior to undergoing ESWT treatment, the patient must have been diagnosed with chronic plantar fasciitis for at least six months. Only after the patient’s symptoms fail to respond to three conservative treatments should ESWT be administered. Conservative treatments include rest, physical therapy, heel cushions, non-steroidal anti-inflammatory drugs (ibuprofen, acetaminophen, etc), cortisone injections, taping, orthotics, shoe modifications, night splinting and casting. In years past, surgical intervention for chronic plantar fasciitis was required when these other treatments had failed. Today, ESWT is available as an alternative, non-invasive treatment option.

Your health history should be reviewed with your doctor to see if this treatment is appropriate for you. ESWT is not recommended for patients with certain conditions. Patients with pacemakers and patients taking medications that may prolong or interfere with blood clotting (coumadin) are not candidates for ESWT. Also, children or pregnant women are not considered appropriate candidates for ESWT. ESWT is not appropriate for individuals suffering from acute plantar fasciitis.

Side Effects of ESWT

Compared to surgery, ESWT has fewer side effects and a much shorter recovery time. The most common patient complaint is some minor pain or discomfort during and after treatment. Other side effects might include minor skin bruising, reddening, or swelling of the treated area. However, these possible occurrences usually resolve within a few days. The risks associated with surgery and general anesthesia are eliminated

The Day of ESWT Treatment

On the day of the procedure, you (the patient) will arrive at the treatment location approximately one half hour before the scheduled appointment. There you will meet your physician and the ESWT technician. After fulfilling the brief registration requirements, you will recline in a comfortable chair or bed with your injured foot resting on a large, fluid-filled cushion.

Typically, an ankle block utilizing local anesthetics is administered to numb the afflicted area. Other methods of anesthesia may be used upon your physician’s request. After localizing the inflamed fascia, the injured heel receives several thousand shockwaves during this 20 minute outpatient procedure.

Post operatively patients are discharged directly home from the treatment centers. SUN Orthopaedic will provide post-treatment instructions imperative to your recovery.