shock_wave.html
Shock-wave Therapy Another Option for Plantar Fasciitis
For millions of Americans, plantar fasciitis can prevent them from putting
their best foot forward. The condition involves stabbing heel pain caused by
inflammation or overuse of the plantar fascia, the thick connective tissue that
stretches along the bottom of the foot.
At its worst, plantar fasciitis (pronounced fash-ee-EYE-tis) is debilitating,
severely limiting people’s movement, especially when they first begin to
move around in the morning. Sufferers commonly describe the pain as so intense
that it feels like knives are being thrust into their heels with every step.
First-line treatments include rest, stretching exercises, heat therapy, cold
therapy, shoe inserts, night splints and cortisone injections. For most people,
these therapies – combined with time – are enough to relieve their
pain and get them back to their daily routines. For people who don’t respond
to these treatments, surgery to release the plantar fascia sometimes is performed
as a last-resort.
Shock-wave therapy option
At The Cleveland Clinic, however, Robert Dimeff, M.D., primary care sports medicine
physician, offers patients another treatment option – one that is noninvasive
and requires less recovery time than surgery. Dr. Dimeff is using extracorporeal
shock-wave therapy to treat difficult cases of plantar fasciitis and other diseases
of the connective tissues, including tennis elbow and calcific rotator cuff
tendinopathy. Shock-wave therapy uses pulses of energy – similar to that
used to break up kidney stones – to relieve pain and promote healing.
Researchers are unsure exactly how the treatment works, but one popular theory
is that the shock waves further injure the inflamed tissue, prompting a healing
response from the body that causes more blood vessels to grow and more nutrients
to reach the injured tissue. The treatment also seems to provide a pain-relieving
effect.
Currently, higher-energy and lower-energy forms of the treatment have been
approved by the FDA to treat plantar fasciitis. Dr. Dimeff uses a lower-energy
version that causes less pain during the treatment and does not require a general
anesthesia. Typically, three to five weekly treatments of the lower-energy procedure
are needed. In roughly 10 percent to 15 percent of patients, Dr. Dimeff said,
one or two follow-up treatments are given three months later.
Procedure not for everyone
Though he has seen patients have great success with shock-wave therapy, Dr.
Dimeff cautions the procedure is not beneficial in all cases. In addition, he
does not recommend it until patients have used stretching, night splints and
other first-line therapies for at least six months.
"It doesn’t work for everybody, nothing does," Dr. Dimeff said.
"There are some people whose tissues just don’t heal well, and I can’t
fully predict that ahead of time."
Still, Dr. Dimeff has observed some trends since beginning to use shock-wave
therapy about three years ago. "People tend to do better who are a little
bit younger, who have problems with one side as opposed to both and who have
a higher pain tolerance," he said. "Perhaps this is because they can
tolerate more energy with the device, or perhaps people with a lower pain tolerance
just don’t stimulate a strong healing response."
Unfortunately, Dr. Dimeff said, one group that has not tended to respond well
represents a large percentage of heel-pain sufferers. "The group I have
that has not done well is the 50-year-old, overweight females who are fairly
inactive, who have two sore feet and who have been in pain for two years,"
he said. "Unfortunately, they don’t do well with any of the treatments,
including shock-wave therapy. Weight loss, rehabilitation exercises and time
often are most effective for them."
Dr. Dimeff is not the only physician who has had mixed results with shock-wave
therapy. Multiple research studies have recorded varying degrees of success
and, because of such research, not all insurance companies cover shock-wave
treatment.
In time, however, Dr. Dimeff anticipates a growing role for the procedure as
doctors and researchers learn more about it and refine its use. Dr. Dimeff already
is having success in using the treatment to help college and professional athletes
with acute muscle strains who need to get back into the game as quickly as possible.
For more information about the Cleveland Clinic Sports Health Center,
please visit www.sports-health.org.
This information is provided by the Cleveland Clinic and is not intended to
replace the medical advice of your doctor or health care provider. Please consult
your health care provider for advice about a specific medical condition.
© Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved
Story filed November 18, 2005
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