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Extracorporeal Shock Wave Therapy

Discussion in 'General Issues and Discussion Forum' started by Dieter Fellner, Oct 20, 2004.

  1. Paul Bowles

    Paul Bowles Well-Known Member

    Several studies also show doing nothing also works if you leave it long enough. So I could add to your statement Don by saying that if you do nothing and leave the patients alone you will have spontaneous resolution on its own accord. So does the ESWT really work or is the "time" you are giving for the individuals body to react just spontaneous resolution or natural "disease" process taking its course?

    I had an old English professor who used to say to me:

    "I drink Scotch and water and I get drunk, I drink Gin and water and I get drunk, I drink Vodka and water I get drunk - maybe I should stop drinking water because it is making me drunk!"

    Food for thought?
     
    Last edited by a moderator: Jan 8, 2009
  2. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis.
    Greve JM, Grecco MV, Santos-Silva PR.
    Clinics. 2009;64(2):97-103.
     
  3. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors.
    Chuckpaiwong B, Berkson EM, Theodore GH.
    J Foot Ankle Surg. 2009 Mar-Apr;48(2):148-55.
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Extracorporeal Shock Wave Therapy in Inflammatory Diseases: Molecular Mechanism that Triggers Anti-Inflammatory Action.
    Mariotto S, de Prati AC, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H.
    Curr Med Chem. 2009;16(19):2366-72.
     
  5. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    An in house trial I have recently been conducting with patients who have been unsuccessfully treated with stretching, massage, insoles, night splints. Who have had symptoms for longer than 12 months. Some have also had steroid injection.
    Have now received 3 treatments ESWT (Spectrum) one week apart set 2500 impulse; count 500 at 1.5 bar; frequency 10. then the remaining 2000 count between 2 and 2.5 bar (some of the participants found the treatment very uncomfortable).
    The initial results do not seem promising as all participants feel their symptoms are worse. The analgesic effect for the first 500 impulses did not appear to work. Only two of the participants were able to withstand the probe being fully depressed during treatment.
    my main question seen as this is my first experience of using this equipment; is this outcome within 'normal' limits?
    Comments and advice would be appreciated.
    I will follow the participants up at 3 months and 6 months.
    I will keep you informed of the progress.
     
  6. Paul Bowles

    Paul Bowles Well-Known Member

    Charlotte how do you know at 3 months and 6 months spontaneous resolution will not occur?

    Lets say that at 3 months 50% of your cohort report resolution - will you credit ECSWT or potentially the stretching program, footwear changes, orthoses they had received previously?

    When is "improvement" or "resolution" considered to be due to the intervention?

    I think at this point in my career I am personally more interested in how clinicians measure improvement in their patients - rather than what actually gets patients better. I also think patients are becoming more akin to this as n a daily basis I get asked by patients: "How will you measure my improvement?"

    Glad you are giving it a crack clinicaly Charlotte and I look forward to hearing your personal opinion and results of follow up - thanks for posting!
     
  7. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    That was the point I had made to the rep. who had supplied the equipment for our trial (spontaneous resolution).
    I dont think we will be purchasing this anytime soon.
    thanks for the reply (we used the foot function index questionnaire for the weekly intervention and will do so in the follow up information in 3 and 6 months).
    Again we have found flaws with using this questionnaire. Outcome scores so far have noted an improvement in most participants scores. However, clinically the patients feel their symptoms have become worse.
    I will keep you posted
    thanks
     
  8. Paul Bowles

    Paul Bowles Well-Known Member

    Also may be of consideration that although symptoms may not resolve/become worse did their function improve. i.e. Even though they still have pain, can they walk further, perform more activities?

    Food for thought.....
     
  9. eddavisdpm

    eddavisdpm Active Member


    Charlotte:

    I am uncertain at what time after treatment you are assessing "initial results?"
    The effects of ESWT take 3 to 6 months to occur.

    A few things to consider:

    ESWT has little or no effect on true plantar fasciitis. ESWT is a treatment for plantar fasciosis which is a long term painful degnerative process of the plantar fascia. Consider: http://www.japmaonline.org/cgi/content/abstract/93/3/234

    The inclusion criteria for the majority of studies is often based on patients who have had plantar fasciitis for a protracted period (perhaps as little as 6 months) or who have been refractory to conservative treatment. There remains significant interdisciplinary variability in the treatment of plantar fasciitis. As such the inclusion of individuals based on VAS scores and treatment history can be problematic. Here is how I like to view the treatment process (from a post I had written on another site):

    "Lets go back to the treatment triad because it is fundamental to understanding the process. Acute PF is basically a sprain of the fascia, it is an inflammatory condition. It thus can be treated successfully with anti-inflammatories -- oral or injections or cortisone plus the use of soft heel pads or inserts (acute PF can sometimes progress to chronic PF but lets leave that out for simplicity's sake for now).
    Plantar fasciitis that persists or becomes chronic does so for one of two reasons....
    ...abnormal or excessive strain persists on the fascia. This may be due to work conditions, poor shoegear, poor body mechanics: subtalar joint overpronation, midtarsal joint oversupination, tight achille-gastrosoleus, tissue quality deteriorates. This can occur due to chronic inflammation which leads to tissue damage, genetic factors leading to poor connective tissue quality or a combination of both.

    The 3 "legs" of the triad thus have different "height" at different times.
    Initially the first leg, "inflammation" is by far the predominant process. As such expect modalities such as cortisone shots to work reasonably well in the first few weeks or few months, then gradually decrease in effectiveness with time. As time goes on and PF persists, the second leg must be focused on. The body can and does repair itself and if that is not happening then one must remove impediments, ie. find and remove the biomechanical problems preventing that from occurring. Look carefully at the second leg from 6 weeks to 6 months. Inflammation and tissue damage occurring for extended periods of time (say greater than 6 months) will compromise the body's ability to repair tissue. The tissue becomes badly scarred and devascularized. This is the point where the third leg predominates -- tissue quality. So ESWT is really the great breakthrough as a modality for affecting tissue quality. One is accomplishing very little in aiming an ESWT machine at PF which is of adequate tissue quality.

    Now, one caveat, PF often waxes and wanes in the early stages for a number of patients so the "stages" I discussed cannot be affixed to firm time periods. For example, a patient can low grade chronic PF for years, change jobs to one that requires more standing and develops a bout of acute PF superimposed on the chronic process.
    Ed Davis, DPM"

    I had written the item several years ago before the term "fasciosis" became popularized.

    Fasciosis can be recognized, sonographically, by increased thickness of the fascia at the origin and a region of fascia characterized by intrafascial hypoechogenicity with decrease and/or loss of the normal fibrillar tissue pattern. Such findings are consistent and would be the ideal inclusion criteria for patients undergoing ESWT.
    Clinically, I have consistently observed patients with sonographic findings of fasciosis demonstrating thinning of the fascia and improved tissue quality (decrease in the region of hypoechogenicity and improvement in the fibrillar pattern of the fascia) in 16 to 20 weeks. Studies focused on sonographic changes have largely used the criterion of tissue thickness. http://www.springerlink.com/content/l2hpgvuhaa7cc87b/ I do not beleive that it is coincidental that Hammer, et. al. in this study are seeing a 79% improvement rate because their inclusion criteria was more specific.
     
  10. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Ed - Can you explain why they take 3-6 months to occur and how can you ascertain whether it was the ECSWT that actually provided the relief?


    How do you know the fascia was not already thick? Previous bouts of inflammation? It could have been there all along.

    But clinically my local chiro tells me he consistently see's improvement in fasciosis patients with the use of "foot levellers". I am still trying to work out what that means! ;) But I am sure it doesn't mean what he/she thinks it does!

    Which is a mistake - because clinically the fascia may not return to normal thickness and even worse this is an extremely poor indicator of clinical outcomes (see my comment above).

    I am really trying hard to understand the whole ECSWT thing - but I keep hitting hurdles which cause me to ask more questions. These questions are routinely answered by people in a "round a bout" sort of way.

    I am not a ECSWT basher - I just want some clear and concise answers backed up by simple to understand research.
     
  11. eddavisdpm

    eddavisdpm Active Member

    Paul:

    1) It appears that the human body has significant difficulty in dealing with chronic inflammation. An example is the chronic inflammation of arteries which leads to "repair" of the damaged vessel walls with cholesterol plaques. Keep in mind that the mechanism of laying down an atherosclerotic plaque is one designed to occur but becomes pathologic when in excess or when the process becomes continual. Tendons and ligaments, respond to chronic repetitive excessive stress/strain by thickening and becoming fibrotic and eventually, hypovascular. The thickened fibrotic tissue is resistant to new blood vessel formation or neovascularization. That is why Harvey LeMont, in the study noted primarily degenerative changes but not inflammatory changes in patients with fasciosis. ESWT presumably converts chronic inflammation to acute inflammation. That inflammatory process leads to the increased production of humoral factors, growth factors, fibrinolytic enzymes, etc. which lead to tissue remodeling. What we are witnessing, sonographically, is evidence of such remodeling. Why three to six months? All I can speculate is that that is how long the neovascularization process takes.

    2) How do we know that it was ESWT that created the process above? The reason is likely to be the absence of any other treatment applied at the time above and beyond the conservative treatments already in place that failed to effect any such changes coupled with the consistency of such sonographic findings.

    3) "How do you know the fascia was not already thick? Previous bouts of inflammation? It could have been there all along." Paul - I do not understand this question. The findings we seen sonographically are at the time of diagnosis of fasciosis. We are observing a gradual process. An evolution from acute inflammation that, left untreated or undertreated, becomes chronic. The chronically inflamed, swollen fascia gradually thickens over time, becomes more fibrotic, dense and hypovascular. We, obviously, are not performing sonography of individual patients over the years to view this progression just as we do not do angiograms to follow the narrowing of arteries ove time. Patients are most commonly seen when symptoms become sigificant.

    4) The Foot Levelers, like other customized prefab orthotics or even custom orthotics are not likely to significantly affect fasciosis. Keep in mind the concept of the "treatment triad" I suggested; orthotics will affect the second leg, not the third leg of that triad. If the second leg is large and the third leg small, then orthotics may have an effect. Dr. Wedemyer is a chiropractor who posts here. He is familiar with aggressive soft tissue mobilization techniques like Graston or ART which can have an affect on fasciosis.

    Regards,

    Ed

    Ed Davis, DPM
     
  12. eddavisdpm

    eddavisdpm Active Member

  13. Paul Bowles

    Paul Bowles Well-Known Member

    Thanks Ed,

    I will have a read tonight.

    Cheers.
     
  14. Charlotte Darbyshire

    Charlotte Darbyshire Active Member

    The rep who has supplied the equipment indicated that some change should be found with the treatment from weeks 1 to 3 (improvement in symptoms).
    I have looked at other literature sources that noted a follow up at 3 months and 6 months proved to be more promising. However, is this again solely the result of ESWT?
    thanks
     
  15. eddavisdpm

    eddavisdpm Active Member

    Charlotte:

    I am not familiar with the company you are using.
    Some patients obtain temporary symptomatic relief which is a form of hypoanalgesia created by the shockwaves. That is not to be confused with the long term effect of tissue remodeling.

    How does one know that the 3 to 6 months effects are soley the results of ESWT? First, one must consider patient selection. If the patients truly have had all reasonable conservative therapies without relief and if the pain has been long term, then, by process of elimination one must assume that it was the ESWT. Most studies go by just that with the improvement measured by subjective information such as VAS scores. I feel that diagnostic ultrasound or sonography provides more objective information and would hope that future studies include such data. It takes years to develop sonographic signs of fasciosis so if those signs are mitigated or eliminated in 3 to 6 months post ESWT, then it is likely that the ESWT did the job.

    Ed
     
  16. Paul Bowles

    Paul Bowles Well-Known Member

    So how then do outrule the fact that it was not nature regression? After all research does show fasciosis has a limited life span! Whats to say you just weren't the "lucky last" to try and treat prior to regression occurring?

    The process of elimination theory you suggest just is not scientifically sound.

    Sure point taken about VAS scores not beng the "be all and end all", however I would argue that diagnostic images such as ultrasound show very little between chronic state fascioisis and resolved fasciosis. I have never seen a post treatment ultrasound which shows the plantar fascia returning to a "normal" thickness (sub 3mm). However the patient remains pain free with complete clinical resolution.



    Again, I would argue that sonographic signs of fasciosis are present even in the sub clinical phase in the form of inflammation - which is clearly visible. As I stated above I have never seen the fascial thickness return to sub 3mm post fascisosis, so what other "sonographic signs" are you talking about Ed?

    Also what are your thoughts on chronic fasciosis and progression from tissue inflammation to bone oedema. You know, those patients who don't respond at all to high dose NSAID's, yet respond really well to opioid analgesics? How does ECSWT work with them?
     
  17. eddavisdpm

    eddavisdpm Active Member

    Paul - Natural regression and a limited lifespan for fasciosis? What research are you referring to? We are talking about patients who have generally exhausted conservative treatment and may be candidates for plantar fascia release surgery.
    The "lucky last" idea just does not hold water as we are seeing what are essentially the worst or recalcitrant cases demonstrating a consistent cause and effect. We do not necessarily expect the plantar fascia to return to what you term "a normal thicness (sub 3 mm)" First of all, I would not consider sub 3 mm to be the norm and am not sure where you get that number. Rompe places "normal" thickness at about 3.5 mm but that is an average for the entire population and does not take into effect variations in body weight and activity levels. What we are looking for is a substantial change in BOTH the thickness of the fascia and the tissue quality based on what we expect normal fascia to look like, neatly organized and parallel fibers (normal fibrillar pattern). Those two findings are very consistent. I think that experimental design has been adequate to demonstrate that although it would have been wonderful to have more studies and large sample sizes.
    Paul: see my explaination above. Ed

    Paul: Bone edema can occur at any stage and is may be consistent with chronic repetitive strain, or, if significant, a stress reaction or stress fracture. The response of patients to analgesics is not an item that I can correlate to ESWT.
    One would expect NSAIDs to work best when there is a predominance of inflammatory changes but not as well in the absence of such. Again, per Harvey LeMont, biopsies in patients with fasciosis show minimal, if any, inflammatory tissue. Ed
     
    Last edited by a moderator: Nov 30, 2009
  18. Paul Bowles

    Paul Bowles Well-Known Member

    So are you saying ECSWT should only be used on patients who have exhausted all avenues bar surgical?

    But even the worst cases resolve without treatment...Have you read Dr Karl Landorfs research in this area? Natural disease regression is a pretty simple term and can easily be applied to plantar fasciosis. You might want to do a quick article search on this.

    Thats just what the research says - don't shoot the messenger....

    You want to argue over 0.5mm? Come on now....

    Its an average, why would it?

    I am no expert, but I can show you a many ultrasounds from my clinic which look "neatly organized and parallel fibers (normal fibrillar pattern)" in patients who have thickened fascia greater than 3.5mm and who are clinically in an active pain state.....


    Agreed - the research does indeed show this - then why do so many people respond to NSAID's? I guess what I was getting at is do patients who DONT respond to NSAID's but DO respond to opiods (i.e. those with bone oedema) also respond to ECSWT and is it the same response?


    Thanks Ed...
     
  19. eddavisdpm

    eddavisdpm Active Member

    Paul:

    I am not saying that ESWT should only be used in patients who have exhausted conservative treatment measures and are ready for surgery but that that category of patient includes a high percentage of those with fasciosis. Why? Because we have been limited in our ability to treat fasciosis directly. It has been our hope that by controlling inflammation and pathomechanics that the tissues would improve and that is indeed often the case. Podiatrists now have a couple of tools at their disposal for direct treatment of the region of fasciosis - ESWT and Topaz. Chiropractors may use Graston or ART (Active Release Techniques). I will look up the research from Landorf.

    Plantar fascia can be thickened due to intrafascial edema, fibrosis, fasciosis or a combination of such factors. For that reason, use of plantar fascial thickness or use of an absolute number such as 3.0 mm can be misleading. It may be helpful for you to list the references from which you are obtaining the numbers on thickness though. It is the change in the appearance of the fascia, ie. changes in thickness listed in a percentage basis and tissue quality changes that count.

    The normal fibrillar pattern I am listing is not a finding that necessarily correlates to the absence of pain as one can have acute plantar fasciitis despite sonographic findings which are non-degenerative in nature. I often see patients with acute plantar fasciitis with the hypoechogenicity located not within the fascia; often between the fascia and calcaneal tuberosity or even superficial to the fascia. Loss of the normal fibrillar pattern correlates to a degnerative process, or in the acute, traumatic scenario, rupture of a tendon or fascia.

    Opiates are centrally acting and will decrease the perception of pain irrespective of the source so I am not ready to establish correlations based on patient opiate response.

    Regards,

    Ed
     
  20. Don ESWT

    Don ESWT Active Member

    Charlotte,
    I am interested in the calculation that are used by the manufacturer of your machine.
    The Dornier EPOS Ultra uses milli joules per square mm. What is the equivalent?

    For a successful treatment you require 1500mj/sq mm. These numbers were worked out 20 years ago by Dornier. There is a lot of applied maths to get everything right when using these machines.

    Another question - How large is the machine? (Desk top or as big as a desk)
    Is it RSWT or ESWT??

    Don Scott
     
  21. Don ESWT

    Don ESWT Active Member

    Ed,
    Long time no hear? How are things?

    Don Scott
     
  22. Paul Bowles

    Paul Bowles Well-Known Member

    .....
     
    Last edited: Dec 2, 2009
  23. Paul Bowles

    Paul Bowles Well-Known Member

    Oh I am sure we are reading the same references......3.0mm or 3.5mm its arbitrary surely.

    Thanks for the responses Ed - its good having a civilized chat occasionally!
     
  24. eddavisdpm

    eddavisdpm Active Member

    Hi Don:

    Things have been busy. I relocated from the Seattle area to San Antonio in early 2007; left my Siemen's Sonocur behind. It was a shame that Siemens produced and sold the machines but did seemingly little or nothing to support the technology. EMS produces an RSWT machine and opened a US branch office in Dallas a while back. They lent me a machine for 3 months to test. The results were good but I was just starting out here so I did not have the numbers to make a good decision.

    Hope all is well with you.

    Send me an email when you get a chance: ed@sanantoniodoc.net

    Ed
     
  25. eddavisdpm

    eddavisdpm Active Member

    Paul:
    Thank you. The issues surrounding ESWT have always been interesting not just from the standpoint of science but by observing the politics of science and medicine.
    Ed
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures.
    Lohrer H, Nauck T, Dorn-Lange NV, Schöll J, Vester JC.
    Foot Ankle Int. 2010 Jan;31(1):1-9.
     
  27. NETHSA66

    NETHSA66 Welcome New Poster

    Hi All, thank you for your posts on this subject. I would like to share my experience using ESWT since 2002. We tested several modalities and decided on an electrohydraulic device capable of medium and high energy soundwaves. We have since that time treated over 850 indications. We have conducted apprx. 250 treatments on plantar fascia injuries. Our patients come through a referral network of orthopaedic and sports specialist. Most cases would have failed to respond to at least two other treatment forms and would have a case history of at least 9 months. We utilise 1400 shocks per session and administer 3 sessions one week apart without the use of pain blockade. In over 87% of our cases patients return to activity with increased function and reduction in pain symptoms without use of pain medications. We will be conducting a follow-up with all our patients again in Feb. 2010 to collect and update our data as to the long term efficacy of their tx outcomes and will post that at such time.
    Our patients comprise of elite athletes as well as joe bloke-weekend warriors.
    In New Zealand the ACC currently funds ESWT related to an injury, they have been funding this since 2005. An audit conducted in end 2008 found that there was a 87% success rate for the ACC's patients. They are now considering funding more indications. The NZ Academy of Sports, SAS, Police Health Plan currently fund all indications when referred by a physician.
    The debate about ESWT will carry-on for years; however regardless of the conflicting data in litreture, the concensus is that ESWT is safe, its use has expanded into cardiology, wound healing and now more recently into erectile dysfunction. What technology has been able to escape redundancy for over 30 years?
    Fact is that it is not a panacea, but when utilised on properly, using the right treatment protocols, it does produce good results. It should be used in conjuction with physiotherapy and orthoses where approriate. My two cents worth -
    Ken Craig - New Zealand
     
  28. Don ESWT

    Don ESWT Active Member

    Ken,
    Welcome to Podiatry Arena. Your 87% rate bodes well for you activities/aims. It is interesting also that you mention cardiovascular healing. Are you using the shockwave on the lower lodes to create new vascular pathway for the blood to bypass the blockages or is the shockwave repairing the muscles around the heart??

    Don Scott
    Wollongong
     
  29. NETHSA66

    NETHSA66 Welcome New Poster

    Hi Don,
    I do not have the exact mechanism of actions for cardiovascular applications as i am not in that field and have limited exposure to it, however i do know that it is currently gaining acceptence and is used at the Essen-Mayoi clinic in Germany. What i know is that the aim is to trigger angiogenesis from viable arteries building a functional bypass and therefore the patinet would not be / be on limited nitrates, post treatment. Approx 9 sessions over 9 weeks is needed and cost is way lowere than a bypass surgery.
    Should you want more information on this, i can get the right person to contact you.
    Regards,
    Ken
     
  30. Paul Bowles

    Paul Bowles Well-Known Member

    Remember Don you can't "legally" call yourself a Cardiologist until July 1st in NSW!!!

    ;)
     
  31. Don ESWT

    Don ESWT Active Member

    Paul,
    I cannot wait that long, I need my knives now!!:butcher: But wait there I found one in my back.

    Those scientists in Germany are doing are doing a lot of study and research to help people and I hope it works.
    Who are we to boo ho studies carried out which prove the benefits of ESWT. Australia jumped on the only negative study carried out in Australia in 2000. That study was flawed and no one dared to refute the researchers data except Dornier. They had lent a machine to the University with instruction on how to use the machine but the the method of treating the subjects was wrong.
    Say someone goes online and uses the mistakes of the flawed results to their study, they will also get a negative result. A chain reaction results and then mare and more the studies become negative.
    Not having enough money to conduct research myself I rely on my peer to carry out real studies, results that they obtained themselves, without cooking the books.
    I know that, of the patients I have treated with ESWT for P/F I have 85% overall success rate, 92% male, 65% female. from this I can only surmise that women will not give up their fashion for the sake of relief.:deadhorse:
    I know my anecdotal result are not double blinded, how can they, I an charging my patient for a treatment. They expect a result. I would get into a whole heap of trouble from a BOARD for taking money and not providing the best possible treatment for that patient.

    Don Scott
    Wollongong
     
  32. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of High-Dose Extracorporeal Shockwave Therapy and Intralesional Corticosteroid Injection in the Treatment of Plantar Fasciitis
    Istemi Yucel, Kutay Engin Ozturan, Yavuz Demiraran, Erdem Degirmenci and Gursel Kaynak
    Journal of the American Podiatric Medical Association Volume 100 Number 2 105-110 2010
     
  33. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Intracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial.
    Dogramaci Y, Kalaci A, Emir A, Yanat AN, Gökçe A.
    Arch Orthop Trauma Surg. 2010 Apr;130(4):541-6.
     
  34. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy.
    Ibrahim MI, Donatelli RA, Schmitz C, Hellman MA, Buxbaum F.
    Foot Ankle Int. 2010 May;31(5):391-7.
     
  35. Zuse

    Zuse Active Member

    I did my dissertation on the treetments of planter fasciitis and this was one of them but all the papers i read said that there was no difference between the treeted group of people and the non treeted group!
    Intresting!
    Thanks!
    Zuse
     
  36. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    High-Energy Extracorporeal Shock-Wave Therapy (ESWT) for the Treatment of Chronic Plantar Fasciitis.
    Metzner G, Dohnalek C, Aigner E.
    Foot Ankle Int. 2010 Sep;31(9):790-6.
     
  37. DaVinci

    DaVinci Well-Known Member

    ...and the response in the control group was?
     
  38. nicpod1

    nicpod1 Active Member

    An interesting aside in this thread, perhaps (or not, but if you're a saddo like me in clinic on a Saturday morning and on Podiatry Arena whilst waiting for their first patient (doesn't get much sadder)) then it might be!

    One of the Physio departments I work in has just purchased a ESWT machine. There was initially some confusion as to whether this is the same as Lithotripsy (it isn't) as one of the Radiologists does this) and, in the process of trying to ascertain the difference between the 2 modalities, one of the ESWT reps revealed that ESWT was developed as a sham application for RCT's for investigating the effectiveness of Lithotripsy.......

    Lithotripsy and ESWT have remarkably similar applications though, so it makes me wonder whether the real question is not just the effectiveness of ESWT against no treatment / placebo, but what it the difference in effectiveness of Lithotripsy in comparison to ESWT and placebo!?

    However, I have had patients who have had benefit from both for TA / Haglunds issues, so something happens even if it is just a bit of vascular stimulation of some sort!

    Told you it was sad!
     
  39. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Plantar Fascia-Specific Stretching Versus Radial Shock-Wave Therapy as Initial Treatment of Plantar Fasciopathy
    Jan D. Rompe, Angelo Cacchio, Lowell Weil, Jr, John P. Furia, Joachim Haist, Volker Reiners, Christoph Schmitz and Nicola Mafful
    The Journal of Bone and Joint Surgery (American). 2010;92:2514-2522.
     
  40. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes.
    Yalcin E, Keskin Akca A, Selcuk B, Kurtaran A, Akyuz M.
    Rheumatol Int. 2010 Nov 26. [Epub ahead of print]
     
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