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Advanced Podiatry Services, Dr. Howard Penn, Lackawanna, NY


What is Extracorporeal Shock Wave Therapy?
What is Extracorporeal Shock Wave Therapy?ESWT is a fast and gently non-surgical method of reducing heel pain. It is derived from lithotripsy, a technique used today to disintegrate kidney stones without the use of invasive surgery. The EMS Swiss Doloclast device delivers pneumatically-generated high pressure shock waves that travel through the skin. Inflamed soft tissue and bone calcifications that receive these high energy pulses will heal stronger without harm to the surrounding tissues. Electricity is not sent into the body. High energy pulsations of ultrasonic waves stimulate the body’s natural self-healing process.

Who does this treatment benefit?
ESWT is especially beneficial for patients that have chronic heel pain and have not had much success with traditional therapies such as medications, orthotics, injections or physiotherapy. If you suffer from plantar fasciitis, heel spur syndrome or Achilles tendonitis, you are a candidate for this treatment.

Can anyone receive this treatment?
Dr. Penn will determine if you are a candidate for ESWT. It is reserved for special cases where other treatments did not provide adequate relief of pain. ESWT is a very safe treatment, however is not recommended for use of heel pain in children, pregnant women or people currently taking medications that inhibit blood clotting.

Does this treatment involve surgery or medications?
ESWT means that there is no surgery, no anesthesia, no injections and no medication.

What is involved in the treatment?
The procedure is performed in our office. After an evaluation of your medical history, Dr. Penn will carry out a simple manual examination of the painful area. The trigger point, or sore area over the heel will be located and marked. Ultrasonic transmission gel is applied to the foot. The ESWT hand piece is then positioned to gently and extensively transmit shockwaves over the injured area. The feedback you provide helps to determine the fine positioning of the applicator and the measurement of the impulse frequency. Once you are comfortable at a low level, the energy is gradually increased over several minutes.

How long does the treatment take?
A typical session lasts about 15 minutes. You will require one session per week for three weeks.

How soon can I expect results?
Most patients will notice improvement after the first treatment, however, overall healing continues for 3 months after the last treatment. Success rates with this treatment is approximately 70- 80%.

Are there any side effects with ESWT?
There are virtually no side effects with ESWT since no medication, surgery, injections, or anesthesia is involved. Some patients may experience a short period of slight tingling, warmth or numbness immediately after their treatment.

What are the symptoms of heel pain?
The most common cause of heel pain is plantar fasciitis. The main sign of plantar fasciitis is pain or stiffness on the bottom of the heel when first standing. The pain is often in the bottom inside edge of the heel, but can occur anywhere. The plantar fascia attaches to the heel. Patients often report that the pain moves around to different areas and can range from a dull ache to a debilitating sharp pain. The condition may come and go or be persistent for months to years.

What is the plantar fascia?
The plantar fascia is a thick fibrous band that supports the arch of the foot. It extends as a bowstring from the heel to the ball of the foot.

Why does plantar fasciitis develop?
The plantar fascia is relatively inelastic and does not stretch very well. Increased tension and overuse causes pulling and irritation at its attachment to the heel. This will occur most often in people who have structural problems with their feet, such as high arches or flat feet. Overuse of you feet, such as with those who are required to work long hours walking or standing on hard surfaces, are more likely to suffer from heel pain. Overuse associated with sports such as running, racquet sports and golf may increase your chance of developing heel pain. Weight gain and tight muscles contribute to the tension in the plantar fascia and make you more prone to its irritation. As well, improper shoe gear can encourage poor foot alignment and contribute to heel pain.

What are heel spurs?
Long standing irritation can cause formation of calcium deposits at the point where the plantar fascia inserts into the heel bone. The result is the appearance of a heel spur on x- ray. The spur itself is not the cause of pain. The terms heel spur syndrome and plantar fasciitis are often used interchangeably in medicine, and the cause and treatment for the conditions are the same.

What is Achilles tendonitis? What is Achilles tendonitis?
The Achilles tendon is the major tendon that attaches the large calf muscle to the heel bone. The back of the heel is the second most common location for heel pain. Achilles tendonitis occurs as pain and inflammation at the insertion of the Achilles tendon. It may also occur as a bursitis often associated with a "pump bump", or Haglund's deformity.

A palpable soreness or bump may be present on either side of the insertion of the tendon. X-rays will often show spurring and calcification in the tendon. Treatment is aimed at reducing the pressure and inflammation to the area with heel cups, orthotics, padding, medication and physiotherapy. Corticosteroid injections are not recommended.

ESWT (Shockwave Therapy) has been shown to be a highly effective surgical alternative in the treatment of insertional Achilles tendonitis.

How can Dr. Penn help you with heel pain?
Dr. Penn is a medically trained specialist who focuses specifically on the medical and surgical disorders of the foot and ankle. He will review your medical history, activities, shoes and any prior treatments, including orthotics, and will also conduct an examination of your joints, muscles, legs, feet and gait. Evaluation of x-rays will demonstrate the alignment of the joints and ensure that there are no stress fractures, tumors or other pathology present in the foot. Diagnostic musculoskeletal ultrasound will demonstrate the integrity of the plantar fascia and ensure that there are no ruptures, tumors or other pathology. A computerized postural and dynamic gait analysis will be performed to assess the way you stand and walk and assist to identify pressure areas, leg length difference and the effectiveness of previous orthotic therapy.

What treatments are available for heel pain?
The majority of patients who develop heel pain will improve significantly in a short time with combination of the following conservative treatments:

Controlling the position of the foot through:

  • Proper shoe gear
  • Taping the foot
  • Heel pads
  • Night splints
  • Custom orthotics or arch supports

Reducing inflammation through:

  • Rest
  • Ice
  • Anti-inflammatory medication
  • Injection of corticosteroid medication
  • Massage
  • Physiotherapy
Achieving and Maintaining flexibility with
  • Stretching
  • Range of motion exercises
What if I still experience heel pain after several months of following the above-recommended treatments?
In the past, for those patients who failed the benefit from the above-mentioned treatments, surgery was the only approach left to treat this condition. However, with the availability of the new Extracorporeal Shock Wave Therapy (ESWT) technology, there is now an effective non-surgical method to reduce heel pain.

Advanced Podiatry Services
Howard A. Penn, D.P.M.
1271 Ridge Road
Lackawanna, NY 14218
Tel: 716.824.9835
Fax: 716.827.7095
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