Orthotripsy (Sound Waves) for Plantar Fasciitis



ASK THE PODIATRIST

 

A NEW TREATMENT FOR PLANTAR FASCIITIS

 

--Dr. Jay C. Goldstein

 

Q: I have had plantar fasciitis for over two years. Treatments have included rest, ice, new shoes, taping, injections, pads, and orthotic devices. I am about 50% improved, but still have daily symptoms. Running immediately exacerbates it and causes me to limp for two days afterwards. A friend mentioned a new treatment using sound waves. Would you recommend it?

 

 

A: For the three of you out there that have not yet had plantar fasciitis, I will begin by explaining briefly what it is.

 

The plantar fascia is a trapezoidal shaped band of connective tissue on the bottom of the foot. It begins at the bottom of the heel and extends to the ball of the foot. From the side of the foot, picture it as a guy wire joining the heel to the ball.

 

WHAT CAUSES PLANTAR FASCIITIS?

 

The guy wire can be stretched by several factors, including:

  1. weight gain

  2. weight lifting

  3. aggressive stretching of the foot

  4. running a longer distance

  5. running faster

  6. running downhill

  7. running on uneven terrain

  8. jumping

  9. twisting or pivoting

  10. excess pronation (rolling inward and/or flattening of the foot).

 

There are some other factors that may make plantar fasciitis more likely, such as fibromyalgia, arthritis, and gout.

 

TREATMENTS

 

There are many treatments for plantar fasciitis, including: rest, ice, taping, padding, more stable shoes, heel cups, oral anti-inflammatory medication, OTC foot appliances, custom foot orthotics, injections, massage, physical therapy, night splints, casts, and surgery.

 

In about October of 2000, the FDA approved a new treatment for pain on the bottom of the heel due to plantar fasciitis. It is called orthotripsy.

 

WHAT IS ORTHOTRIPSY?

 

Many of you may be aware of a treatment for kidney stones called a lithotripsy. The lithotripter is a large machine that uses energy waves aimed at the kidney to break up kidney stones into small pieces and enable them to pass out of the body in the urine, obviating surgery.

 

In Europe, several years ago, they began aiming similar energy waves at the bottom of the heel in order to treat heel pain due to plantar fasciitis. This treatment is called an orthotripsy. After several years, the FDA noted that the European patients had survived, so they authorized the treatment in the U.S.

 

The advantages of orthotripsy are:

  1. It only takes about 15 minutes.

  2. There is no incision.

  3. My patients are usually able to return to work a few days later.

  4. Most patients have relatively little postoperative pain.

  5. Many doctors are able to perform it without general anesthesia, using conscious sedation.

  6. One is not burning any bridges by having the procedure; the procedure could be repeated a second time, or surgery could still be performed if needed.

 

The disadvantages of orthotripsy are:

  1. Since the machine is expensive, and the procedure is performed in the hospital (outpatient), the procedure costs $3,000-4000.

  2. Some insurance plans will not cover the procedure, although during the past year, more have decided to cover it.

  3. My impression of the medical literature is that the average patient can expect about a 60% improvement, which is roughly what I have observed in my own patients.

 

A FEW CAVEATS

 

  1. The orthotripsy procedure is thus far only FDA approved for pain on the bottom of the heel due to plantar fasciitis. It is not approved for pain in the mid arch region.

  2. In view of the nature of the procedure and the expense, several of the easier treatments for plantar fasciitis should first be tried for at least six months.

  3. How (why) does the orthotripsy work? I’ll tell you: I don’t know (nor does anyone else). I think the energy waves probably beat the dickens out of the heel, causing Mother Nature (as usual) to rush in and begin healing the area.

  4. If one does have an orthotripsy, do not ignore the treatments and guidelines that were already instituted; continue wearing stable shoes, orthotics, etc.

  5. Similar to other treatments for plantar fasciitis, if one eliminates all of the treatments and safeguards, the plantar fasciitis may (and probably will) recur.

 

All things considered, I am glad to have this new weapon against a very common, and often frustrating problem. It is one more way to heal heels.

 

Dr. Goldstein is Board Certified in Podiatric Surgery, Podiatric Orthopedics, and in Podiatric Medicine. He has been running for many years, although sometimes he rests.