Extracorporeal Shockwave Therapy (ESWT) is a treatment modality that involves the application of pressure waves to diseased tendons and ligaments.
The term “tendinitis” refers to an inflamed tendon and the term “fasciitis” refers to an inflamed ligament, often the plantar fascia which is the large ligament that supports the foot. Inflammatory conditions often respond to anti-inflammatory medications, ice and massage and tend to be self limiting. There are cases in which conventional treatments for tendonitis and fasciitis persist. Cases of plantar fasciitis that persisted despite treatment became known as “intractable” plantar fasciitis. Surgical treatments were often utilized in that scenario.
In 2003, Harvey Lemont, DPM of the Temple University School of Podiatric Medicine, microscopically analyzed tissue taken from the plantar fascia on 50 cases of plantar fascia surgery performed for recalcitrant plantar fasciitis. He discovered that none of the tissue demonstrated inflammatory changes but showed degenerative changes instead. So called “recalcitrant plantar fasciitis” is not fasciitis at all but plantar fasciosis.
Plantar fasciosis means degeneration of the fascia, a slow degradation or breakdown of the fascia. Tendinosis means degeneration of a tendon. Achilles tendinosis, in which the Achilles tendon breaks down, often leads to ruptures of that tendon. The causes of tendinosis and fasciosis are not completely understood but chronic inflammation appears to be the culprit. Our bodies are designed to handle acute inflammation well but have difficulty dealing with chronic inflammation. Chronic inflammation of joints leads to degenerative arthritis. Chronic inflammation of arteries leads to atherosclerosis or narrowing of the arteries. Chronic repetitive strain on tendons and ligaments over long periods of time appears to induce degenerative processes.
Extracorporeal Shockwave Therapy (ESWT) involves the application, in the office, of 6000 “shocks” or pressure waves to the affected fascia or tendon and is divided into three sessions about 4 to 7 days apart in which 2000 shockwaves are delivered per session. Patients can return to work the same day but are asked not to run for 24 hours after each treatment.
The fascia or diseased tendon then remodels or rebuilds over a period of 12 weeks. This process can be observed under diagnostic ultrasound. ESWT is not a symptomatic treatment although the area treated can feel better in three weeks. It is a curative treatment, and the cure can be demonstrated to occur better than 85% of the time via ultrasound.
It is important that the initial patient exam be able to distinguish between tendinitis and tendinosis, fasciitis and fasciosis. Shockwave treatment for plantar fasciitis generally does not work for fasciosis or suffice for Achilles tendon treatment. The advent of office based high resolution ultrasound allows the clinician to immediately render an accurate diagnosis. We utilize the Sonosite Edge, which provides high resolution images of the fascia, tendons, ligament and even nerves.
While some patients experience a slight soreness after their treatment, this pain subsides quickly, and the procedure itself is generally painless.
Yes. For many patients who opt for extracorporeal shockwave therapy, surgery becomes unnecessary and pain relief can be achieved without pain and with significantly reduced cost and downtime.
If you are looking for the best podiatrist in San Antonio, Texas, you’ve come to the right place. Foot and ankle ailments shouldn’t put you on the sidelines. If you or a loved one are in need of a foot doctor, visit our office at , or call us at to get more information.