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Frequently Asked Questions on Heel Pain Treatment

How long do you have to have pain before being considered for the new procedure?

We let the Diagnostic Ultrasound tell us if you are a candidate. Normal plantar fascial thickness is 3.2 mm with no signs of signal change (dark color) in the fascia. Anything from 5.5 – 10 is considered chronic. We also take into consideration how many painful episodes you have had and your previous treatment.

How successful is the procedure?

To answer this, we invite you to read our success stories from our patients. To quantify the answer, the procedure is 95% successful at reducing pain from 10 on a pain scale to less than 3.

Is the relief immediate? What is the recovery?

Patient response varies in the first 4 weeks after the treatment. Some are immediately relieved, but most do not start to experience relief until the 3rd week of recovery. So some patience is in order here. All patients are told NOT to expect immediate relief but to wait for 4-6 weeks. At the 6 week post op mark, patients are interviewed and asked how they are doing. If they are greater than 70% improved, they are discharged and will follow up monthly until a complete cure is achieved.

What if I am not cured?

About 5% of the patients we treat will opt for a second treatment with additional ESWT at the 6 week post op mark. These patients have shown marked improvement in pain, but may be at 50% and want to get to 100%. The second treatment is delivered after the 6 week mark to make sure that the patient has not plateaued in recovery, and could include Radial ESWT treatments (smaller units that require no anesthesia), or full ESWT high intensity with additional cobalation.  Often, patients may have some residual pain NOT where the original pain was located.  For instance, the side of the foot may be tender.  This is usually due to compensation from walking on the outside of the foot during the painful fasciitis episode.  Treating pain from compensation will help the patient get back to all normal activities.

What is success after a second treatment?

About 98%! We usually prepare patients for the possibility of additional treatment before the first treatment, but only perform this if necessary. Before a second treatment is scheduled, patients must show some improvement in symptoms. As a general rule; as long as at least some improvement is noted after the first treatment, the second treatment should get you to over 80% improved.

Why is a second treatment necessary at all? Shouldn’t I be cured in one treatment?

ESWT, Topaz and FAST technology are very effective, minimally invasive and get you back on your feet the next day, but we know from experience that these treatments affect patients in different ways. What we do know is the additive nature of this treatment; more is definitely better. So we will give more if needed, and more usually gets the job done.

Is the relief lasting?

Yes. Once you are cured, the pain usually does not return unless you are very abusive to your feet. You should be able to go back to sports, running, etc. Even if you have a re occurrence, it is usually very mild compared to your original problem.  Remember, once properly diagnosed, we are treating the plantar fasciitis and EVERYTHING else that comes from the compensation from this painful condition.  It is common to have pain on the outside of the foot and even up the side of the leg from attempting to walk on the outside of the foot due to the original problem.  We are experts at this.

Where can I have the procedure performed?

At Mid County Surgery Center and Feet For Life Centers in St. Louis, MO.

Does the procedure require anesthesia?

Yes. IV anesthesia is used with a local. A complete ankle block is necessary. You should not feel anything. You are put to sleep for 5 min while your ankle is blocked. You will be in an OR under the care of an anesthesiologist or nurse anesthetist. This is the safest way to deliver the treatment as you must be still. While some providers use General Anesthesia, we feel that this is way overkill and not necessary at all.

What can I do immediately after I am discharged from the surgery center on the day of the procedure?

We recommend that you return home and rest. You will be in a post op boot for 10 hours after surgery to prevent trauma to your foot / ankle as you will be discharged numb from the local. When the local wears off and you can feel your foot, you can return to your regular footwear and activity.

When can I run?

You may return to controlled stationary bike within 1 week of treatment.  We recommend waiting for 6 weeks before jogging or treadmill.  We recommend slow jogs at first until you completely heal.  Your running style and footwear GREATLY effect your condition. Our doctors can arrange a consult with a running footwear specialist for you.

What is your post op protocol?

BE PATIENT! Even though many patients experience immediate relief, it will usually take 4 or 5 weeks to start feeling better. During this time, you should be purchasing and wearing less restrictive footwear for at least 2 hours a day in order to passively stretch your Achilles tendon.  Much of our long term post op protocol involves making sure patients do not fall into the bad habits that caused the problem in the first place.  This information is invaluable!

What about my arch supports?

You may need to wear your devices until you build up foot strength. Remember, orthotics are restrictive and will eventually weaken your feet. They are necessary, to help heal injury and in some cases to support a very pathologic foot. See our website for more information on this.

How safe is the procedure?

Extremely safe! We can’t stress this enough. You will be in very qualified hands. Our facility and staff are the best. We perform approximately 120 procedures a month in our AAAHC approved center. All machines are state of the art and Dr. Horwitz has more experience with this treatment than anyone in the world. He studied and perfected the combination procedure after 25 years of treating heel pain.

What if I have been diagnosed with stress fracture of the heel?

This is more common than you might think. In fact, ESWT is approved in Europe and the US for the treatment of stress fractures. This is because in order to heal, fractures need flow too. It is common to have all of the signs and symptoms of stress fracture when you have chronic heel pain. Often a doctor will order a bone scan and interpret that scan as positive for stress fracture if it is hot enough. Chances are very good the plantar fasciitis and calcaneal stress fracture occur together, along with Cuboid Syndrome and Achilles Tendonitis. Even Sesamoiditis and forefoot pain (metatarsalgia and capsulitis) are aggravated because patients with chronic heel pain tend to transfer weight to the balls of the feet and outside edges when the pain gets too severe to walk normally. The point is that ESWT  EFFECTIVELY TREATS ALL OF THESE PROBLEMS! This is why the treatment works so well!

Does this procedure treat nerve pain also?

ESWT and Cobalation procedures can make nerve pain feel better, but are not indicated at this time for nerve pain.

What can be done for nerve pain?

During your initial consult, you will be asked questions about the type of pain you are having. Often, chronic fasciitis presents as dull aching, shooting and tingling pain. We will determine the cause of the shooting, numbness and tingling at the time of your visit. Smaller, non-invasive procedures can be done to handle the nerve pain. See the sterile alcohol treatment for neuritis section of our website.

Is the Achilles tendon treated the same way that plantar fasciitis is?

Yes. These procedures work well for Achilles Tendonitis also.  Be aware that Achilles tendon pain with large bone spurs may need more involved surgical treatment.  We try to start will the minimally invasive ESWT if we feel that at least 70% improvement can be gained.

How many procedures related to the newest ESWT / Topaz combination has Dr. Horwitz and Dr. Staschiak done?

To date, well over 2000.