A 20-minute office procedure is increasingly being used to treat chronic heel pain that resists conventional treatment, helping people avoid the need for surgery.

Extracorporeal shock wave therapy (ESWT) treats plantar fasciitis, the most common cause of heel pain. The condition occurs when the thin layer of tough tissue supporting the arch of the foot becomes inflamed. People feel pain just under the heel bone, especially when first getting out of bed in the morning.

“Eighty percent of people get this at some time in their lives,” said Dr. Howard Stone, a podiatrist with The North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. The average patient is 35 to 55 years old. The condition is caused by changes in foot structure and tightening of the Achilles tendon complex that come with age, Stone said.

ESWT is a noninvasive procedure using high-intensity shock waves that target the site of inflammation, which is where the plantar fascia attaches to the heel bone. The shock waves increase blood flow to the area, which promotes healing. The procedure is done under local anesthesia and patients can return to work the next day.

Most people with heel pain respond to conventional therapies, including anti-inflammatory drugs, physical therapy, orthotic devices, corticosteroid injections and night splints. The five to 10 percent who don’t respond to these therapies are candidates for ESWT.

In 2002, the Food and Drug Administration approved ESWT for the treatment of chronic heel pain that is unresponsive to conservative therapy. “We use the Epos Ultra by Dornier MedTech, which uses guided ultrasound to see exactly where the thickened fascia is and target shockwaves to that area,” Stone said. The technology is similar to lithotripsy, used to break up kidney stones.

“We’ve had excellent experience with shock wave therapy,” said Dr. Michael Weisman, head of podiatry at Evanston Northwestern Healthcare. “We’re finding more and more with shock wave therapy we’ve avoiding the small percentage of patients who need surgical intervention.”

Weisman uses the guided ultrasound equipment as well. “It increases safety and precision,” he said. “The key part is that we’re using a high-energy single treatment device.” The device gives off an acoustic shock wave measured in millipascals, or bars of pressure. Each click administers one acoustic shock. The intensity of pulses increases over the 20-minute treatment.

“Our success rate is over 80 percent,” Weisman continued. “It’s very cost effective when you consider it keeps some people out of the operating room.”

Some methods of delivering ESWT may be more effective than others. “ESWT is a very good option to treat heel pain in patients who have failed all other options prior to surgery, but study results are mixed,” said Dr. Anand Vora, orthopedic foot and ankle surgeon at Northwestern Memorial Hospital. “It’s very dependent on the type of shock wave therapy being used.” The best type is high-energy shock wave therapy, he said.

The procedure is offered at Northwestern Memorial Hospital but used sparingly since most patients seem to improve after more traditional treatments, including proper stretching and correction of foot positioning, said Vora.

Typical physician fees are $500 to $1000. Some insurers cover the procedure. Blue Cross and Blue Shield of Illinois, the state’s largest insurer, does not currently cover the procedure for the treatment of plantar fasciitis.

Robert Cosme, 51, of Gurnee, had ESWT in July 2003 after conventional treatments failed to stop his heel pain. “I was very skeptical at first, since it’s a fairly new procedure. What attracted me was that there’s no surgery involved. I’m very happy with the results.”

The procedure is also offered at Rush North Shore Medical Center in Skokie.

By Terri Yablonsky Stat
Special to the Tribune