The Fastest and Most Permanent Solutions with ESWT Treatment

Your persistent foot pain finally ends!

Non-surgical "Shock Wave Therapy" for heel spurs!"

High-heeled shoes, which women cannot give up, can cause certain problems when worn constantly. One of these is heel spur. Fortunately, there is a method that solves the problem: ESWT...

Heel spur, which occurs as a result of the failure of healing at the area where a membrane on the sole of the foot attaches to the heel, presents with pain and a localized stinging sensation. It is generally seen in the 40-60 age range. Although a bony problem comes to mind when hearing the term "heel spur," this is not the actual condition. The special connective tissue located in the sole of the foot (plantar fascia) has the ability to absorb 20-25% of the pressure borne by the foot. This tissue that envelops the sole of our foot, from the heel to the toes, becomes damaged and tears occur if our foot is subjected to excessive strain. The tissue inflammation and hardening that occurs due to the injury presents a bony appearance protruding from the heel due to the ligament being attached to the heel bone. This protrusion, visible on X-rays, is called a heel spur. For more detailed information about the heel spur, which severely restricts daily living activities, and the curious ESWT method, Medistate Kavacık Hospital Physical Therapy and Rehabilitation Specialist Assist. Assoc. Dr. Ilker Garipoglu and Physiotherapist Yavuz Sultan Selim Kavrik explain.

In Which People Is Heel Spur More Common?

Heel spur formation is generally more common in women, those with high arch feet and flatfoot problems, individuals who must stand for long periods during the day, those engaged in jobs or sports that put strain on the feet, those with excess weight, and those who frequently choose inappropriate footwear. The risk of heel spurs is also much higher in individuals with problems such as lateral or inward foot pronation. Additionally, genetic factors also play a role in the development of heel spurs.

For What Reasons Does It Occur?

Among the main causes, we can mention the presence of excess weight. When it comes to excess weight, the body wears out while carrying it, causing pain in the heel area. Because the feet bear three times the weight of the body, this causes damage to the feet. Additionally, heel spur problems may also occur in people who have difficulty walking. Problems such as putting more weight on a specific area of the foot or one foot in particular while walking can cause heel spurs. Improper shoe choice is also among the significant factors that lead to heel spurs; Hard-soled and poorly made shoes cause pain in the heels, which can lead to heel spurs.

Do Not Confuse with Other Foot Pain!

Pain in the heel is a normal condition when the foot is excessively tired. However, if pain accumulates in the heel despite prolonged sitting and pain is felt when pressure is applied, this indicates a heel spur problem. The first and most important symptom of a heel spur is heel pain. Patients experience the most severe pain during the first hours of the day, that is, in the first few steps after getting out of bed. This pain feels as if there were a nail under the heel when pressure is applied.

The pain originates directly from the heel and does not radiate from another area into the foot. If it is a normal pain, it occurs entirely in a localized area and is accompanied by a stinging sensation. It may also manifest as severe pain felt upon waking in the morning that subsides on walking throughout the day, pain in the feet upon standing after sitting for a long time, or pain after prolonged walking. In addition to pain, heel spurs can also cause gait disorders such as waddling and inward-turning walking.

What is Eswt?

ESWT (Extracorporeal ShockWave Therapy), briefly called ‘shock wave therapy’, is a new form of “non-invasive” (non-interventional intervention-free) treatment based on focusing the generated strong sound waves on a desired area of the body through an ellipsoid-shaped steel dish. The working principle is based on the propagation of externally generated currents as sound waves in tissue.

In Which Cases Should It Not Be Applied?

It should not be applied to the neck area, the head, or areas near nerves. Pregnant women, children not yet completed their growth period, patients taking medications that prevent blood clotting, and patients with a heart pacemaker are excluded from treatment. Apart from temporary redness that may appear on the skin, there are no complications. The patient can resume daily activities after the procedure.

Advantages of ESWT Treatment

• Outpatient treatment option No need for anesthesia Rapid result attainment Drug-free treatment option High success rate Improvement in quality of life

The Diagnosis Process of the Disease…

Physical therapy examination is of primary importance in the diagnosis of heel spur. The diagnosis is made based on the patient's history and clinical condition. If pain is felt when pressure is applied under the heel during the examination, an X-ray is requested, and if necessary, MRI and blood tests are performed.

You Can Take Daily Precautions

In case of a heel spur diagnosis, it is important for the patient to first avoid activities that cause pain. For example, patients should not walk barefoot at home, should wear soft-soled slippers, and should prefer sports shoes instead of shoes with hard soles if possible. In addition to these measures, silicone heel pads can also be used.

Massage And Cold Application Are Also Good For Patients

In the treatment of heel spurs, first of all, massage and cold applications are used along with pain-relieving creams. The massage should be performed by pulling the toes back, applying cold to the heel for 5 minutes, and then applying the pain-relieving cream. This treatment should be repeated 4-5 times a day. In most patients, the symptoms resolve without additional treatment when combined with massage and the use of soft-soled shoes. It should be remembered here that heel spur is a slowly progressing condition, and its healing will not occur overnight. It may take 3-4 weeks for the pain in the heel to subside.

Injection Treatments Accelerate the Healing Process

There are many other options available for treating patients who do not benefit from massage and cold therapy. The most commonly used method is injection under the heel. Before the injection, a numbing injection is administered into the heel or ankle to ensure the patient does not feel pain during the procedure. Here, either cortisone injections or PRP injections prepared from the patient's own blood are used. PRP is a method prepared from the patient's own blood that enhances healing. The goal of the injections is to accelerate the healing of non-healing tissue in the heel and relieve pain. Following this procedure, the pain subsides to a large extent. For patients whose pain persists after the initial treatment, a repeat injection can be administered 10-15 days later.

Healing Without Surgery with ESWT

For patients who cannot receive injections due to health issues or those who do not respond positively to this treatment, a method called ESWT, or "shock wave therapy," can be administered, and most patients recover with this procedure. This procedure is commonly referred to as "shock wave therapy" in the public. The bone protrusion seen is thought to be fractured, but the procedure performed is actually a controlled re-destruction of non-healing tissue in the heel region to increase the healing rate. In the method, approximately 2000-3000 sound waves are applied to the heel, initiating bleeding within that area. The shock waves generated are referred to as high-energy, and these devices deliver 10 times the energy of ultrasonic devices to the application area in a very short time (1 microsecond). Surgery is the last option in the treatment of heel spurs, and in most patients, treatment is successfully completed without the need for surgery. The ESWT method also offers patients a non-surgical, cortisone-free treatment option.

Will the Disease Recur After Treatment with ESWT?

One of the most significant advantages of ESWT treatment is its long-lasting effect. Clinical studies have shown that the disease does not recur within 1-2 years following treatment. ESWT treatment provides permanent healing through treatment targeting the causes of the disease. Additionally, since it utilizes the body's own healing mechanisms during treatment, the chances of recurrence are quite low once the disease is cured. One of the important factors here is that the earlier treatment is started, the better the results will be.

In Which Areas Is the ESWT Method Used?

• Acute pain and blunt injuries
• Radial humeral epicondylitis (Tennis elbow)
• Ulnar humeral epicondylitis (Golfer's elbow)
• Calcific Tendinosis (Calcific shoulder tendinitis)
• Trochanteric bursitis
• Patellar tendinitis
• Tibialis anterior syndrome
• Achillodynia (Achilles tendinitis)
• Plantar fasciitis
• Calcaneal spur (Heel spur)
• Chronic enthesopathies (Tendon irritations)
• Pseudarthroses (Non-union fractures)

How is It Implemented?

In the initial stage before the procedure, the problematic area is identified and marked based on X-ray, ultrasound findings, and palpation results. Ultrasound gel is applied to the marked area by focusing on the location of the disease. To prevent the effect of sound waves from diminishing, there must be no air space between the shockwave therapy head and the patient's body. The ESWT application begins with a very faint "click" sound that the patient will hear. The patient continuously hears this sound at short intervals and feels a very mild vibration in their body. Meanwhile, the focus point of the ESWT application is frequently checked. The energy level is increased gradually and in a way that does not disturb the patient. During the application, the power and amount of energy are adjusted according to the patient's comfort, the type of stone, and its location. The procedure is as painless as possible, or may cause mild pain that the patient can tolerate.

The Procedure Is Completed in 3 to 5 Sessions!

In ESWT treatment, session durations may vary depending on the number of shocks administered, frequency, and energy level; however, an average session lasts 20-25 minutes. In soft tissue applications, the patient is expected to be free of symptoms within a duration ranging from 3 to 5 sessions. Indeed, pain relief may be observed within a week from the first session. The ESWT method is a treatment that achieves success rates of 80% in shoulder patients, 70% in tennis and golfers' elbow, and 85% or higher in heel spurs. Shock wave therapy ESWT has been approved as a globally recognized treatment and has taken its place in clinics as a nanotechnology product. The treatment has been FDA (U.S. Food and Drug Administration) approved for heel spurs since 1997 and for tennis elbow since 2000.

Protective Measures Against Heel Spurs

• Choose shoes with good arch support or heel support. If your job requires standing on hard surfaces, stand on a thick rubber mat to reduce the pressure on your feet.

• Perform exercises to stretch the Achilles tendon behind your heel and the fascia under your foot. This is especially important before exercise.
• Stay at a healthy weight that is suitable for your height.
• Develop a good exercise habit. Gradually increase your exercise levels and wear supportive shoes.
• If you are running, replace it with other sports that do not cause heel pain.
• Wear supportive shoes as soon as you get out of bed. Walking barefoot or wearing hard-soled slippers can put pressure on your feet.
• If you engage in sports, you can consult your physiotherapist about warm-up exercises and physical endurance-building routines to prevent your pain from occurring..

References:

• U.S. Food and Drug Administration. FDA Approval and Device Regulation Information on Extracorporeal Shock Wave Therapy (ESWT).

• Gerdesmeyer L, Frey C, Vester J, et al. Radial Extracorporeal Shock Wave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis. American Journal of Sports Medicine.

• Buchbinder R. Plantar Fasciitis. New England Journal of Medicine.

• American Physical Therapy Association. Heel Pain–Plantar Fasciitis Clinical Practice Guidelines.

• Turkish Orthopedics and Traumatology Association. Heel Pain and Plantar Fasciitis Diagnosis and Treatment Approaches.