Extracorporeal Sound(Shockwave) Wave Treatment (ESWT) is commonly used for the treatment of soft tissue and bone disorders around the foot and ankle.
Originally known as Lithotripsy, sound wave technology is similar to a small sonic boom resulting from a super sonic jet breaking the sound barrier. Formerly used to break up kidney stones, in the early 1990’s it was discovered that this high intensity sound wave had benefit on wound and fracture healing. Since 1993, ESWT has been used on a regular basis in Europe for the treatment of painful tendonitis (tennis elbow), plantar fasciitis (heel spur) and to treat fractured bones that did not heal normally.
MECHANISM OF ESWT
Sound wave utilizes a high intensity sonic pulse, which can be focused on a target area in and around the foot and ankle. Although the exact mechanisms for the technology is not fully known it is believed that micro-trauma will ultimately repair and increase in development of blood supply to the area. Some have linked the mechanism to tenderizing meat by pounding a tough piece of steak with a wooden mallet and making it more soft and pliable. Often chronic problems of tendons and ligament involve infiltration of scar tissue overlying these fibers. ESWT is thought to break up this scarring and allow the body to regenerate new and improved tissue to the area.
Two different types of treatments are utilized by Dr. John: 1) A one time treatment high energy shock wave under anesthesia 2) multiple treatment low energy shockwave without anesthesia. With the low energy treatment utilizing the Swiss Dolorclast EMS device (most common treatment), patients provide biofeedback to guarantee exact placement of treatment. Some studies have shown that this is the most effective way to perform shockwave. Treatment is performed at intervals of 1-2 weeks and three treatments are typically performed with 2000 pulses delivered at each treatment and is performed in our office during a normal office visit time frame. No local anesthesia is needed and patient walk out of the office in their normal shoewear.
With high energy shock, IV sedation and local anesthesia is necessary for comfort and tolerance of the procedure and is performed at the hospital. After confirmation of exact positioning, the computer is then set to deliver 1000-3000 high energy sonic pulses at a pre-determined intensity level. Afterwards, patient are placed in a walking boot for 3 weeks.