Serving Amherst, North Tonawanda, Lewiston, NY & Beyond

Pain beneath the heel or arch when standing or walking is commonly referred to as heel pain or plantar fasciitis. This is a very common condition which often develops slowly and insidiously and frequently results in a progression in intensity if left untreated. Plantar fasciitis can be seen in patients experiencing a rapid weight gain, can occur following a trivial injury (such as a stone bruise), beginning a running program too aggressively, wearing flip flops or sandals for a prolonged shopping trip or walking or improper use of an inclined treadmill. Plantar fasciitis can often be seen in people showing weak structural integrity of their foot due to abnormal biomechanics. Classically the pain is worse after periods of rest, worse in the early morning or after long periods of standing or walking. The foot often shows no abnormal visual changes such as swelling, redness or elevation in skin temperature.

The plantarfascia is a strong connective tissue band which forms the base of the triangle in the foot, connecting the front of the foot (metatarsal heads) with the back of the foot (heel).

Diagnostic ultrasound is performed in the office and is a very cost effective method to directly image the plantarfascia allowing measurements to be taken at the point of insertion. The plantarfascia often becomes enlarged with inflammatory conditions such as plantarfasciitis. Ultrasound can easily confirm the continuity of the fascia and is helpful to identify any tears of the fascia or masses within the fascia. This can rapidly help rule out other causes of pain and determine the most effective treatment option for you.  

Common treatment options often involve stretching exercises, night splints, heel cups, physical therapy manipulation with anti inflammatory modalities, ice and massage, oral anti-inflammatories, injectable anti- inflammatory medications such as cortisone injections, pre fab arch supports, prescription arch supports and in more resistant cases, radial shock wave therapy.

The overwhelming majority of patients completely respond to conservative, non- surgical treatments.

Some cases of heel pain are mistakenly identified and treated as plantarfasciitis when they may have a completely different etiology or cause. Some of these less common causes could include;  nerve compression syndromes including tarsal tunnel syndrome or herniated spinal disc with radiculopathy;  undiagnosed  inflammatory arthritis, tumors of the plantarfascia, tendinopathy of the peroneus longus tendon, torn or ruptured plantarfascia, stress fracture of the heel, tumors of heel  bone, just to mention a few.

  • Note: It’s always wise to first consult your doctor prior to initiating any treatment or taking any medication.

Contact Our Podiatrist Office Today

If you are experiencing heel pain and are searching for an experienced podiatrist, look no further than Dr. Harry Zirna. Dr. Zirna has been providing relief to those experiencing chronic foot and ankle pain since 1985. Serving residents in Amherst, North Tonawanda, Lewiston, and all the surrounding communities in WNY. Call today to schedule a visit at our Lockport, NY office.

The Swiss DolorClast®

Serving Amherst, North Tonawanda, Lewiston, NY & Beyond

20150525 AZCF2139 2Extracorporeal Shockwave Therapy or ESWT, as it is commonly referred to, is a non-invasive, non-surgical option for the treatment of intense and relentless heel pain associated with the chronic condition known as Plantar Fasciitis.

The Plantar Fascia is a strong ligament structure (tensile strength of 4000 lb/sq. inch) that helps to maintain the structure and arch of the foot. It extends from the base of the toes to the heel bone or calcaneus bone.

The Plantar Fascia is almost as wide as the foot and plays an important role in the support of the foot.

Plantar Fasciitis is the condition caused by overuse or injury. When the Plantar Fascia is strained due to overuse, improper shoes, or poor foot structure it gets irritated and tender. The resulting inflammation causes the symptoms of pain that include: a burning sensation on the sole of the foot, and recurring foot pain especially after getting out of bed in the morning or sitting.

Plantar Fasciitis is diagnosed by a Podiatrist, based on patient history and examination.

Research in ESWT that began in the 1980's has evolved into a treatment best suited for heel pain sufferers who have been unsuccessful in managing pain through the use of stretching, icing, orthotics, cortisone injections and conventional over-the-counter pain relievers. ESWT using the DolorClast® Method offers a high rate of success.

The treatment releases high intensity sound waves in the tissue being treated around the fascia nerve, near the heel. The chronic inflammation that was causing the pain becomes an acute inflammation and the body responds by increasing circulation and cellular metabolism around the affected soft tissue.

ESWT stimulates the body's own healing processes, by treating the source of the pain. ESWT using the Swiss DolorClast® Method, does more than mask the pain, it offers a successful, long term solution in eliminating the pain.

Prior to being treated with ESWT, patients must have been diagnosed with chronic Plantar Fasciitis for at least 6 months. Only after a patient's symptoms fail to respond to at least three conservative treatments should ESWT be administered. These conservative treatments can include cortisone injections, night splints, heal cushions, orthotics, non-steroidal anti-inflammatory drugs, and casting. In the past, surgery was the only option available when conservative measures didn't work. Today, non-invasive ESWT offers an alternative to surgery and successful relief from chronic pain.

The Swiss DolorClast® Method is intended to be used by patients who are 18 years of age or older who have symptoms of chronic Plantar Fasciitis that have lasted for 6 months or more and who have tried other conservative therapies without success.

How shockwave therapy works

If your doctor determines that treatment with the Swiss DolorClast® Method is appropriate for you, your doctor will palpate your heel to locate the area of greatest pain.  It is there that the ESWT will be applied. Your feedback to your doctor will be important to locate the center of your heel pain. Coupling gel will be applied to your heel and treatment applicator will be held in contact with your heel. When the treatment begins, the shockwave impulses will be delivered at a low pressure, and then slowly increased to the target treatment pressure. This Method will allow you to adjust to any discomfort so that you will not need anesthesia to complete the treatment.

Application of the treatment protocol takes less than 5 minutes to complete.

Treatment with the Swiss DolorClast® Method requires you to undergo a total of 3 treatment sessions spaced 7-10 days apart in order to realize the maximum benefits of the treatment. Your doctor may also want you to return for a short follow-up visit to asses your response to the treatment. You should notice a gradual improvement in your heel pain over time. Significant improvement occurs over a period of 3 months, after your final treatment.

Frequently asked questions on ESWT

Who can receive radial shock wave therapy? 
Dr. Zirna will determine if you are a candidate for ESWT.   ESWT is a very safe treatment, however is not recommended for use in children (under 18),  over open growth plates, pregnant women or people currently taking medications that inhibit blood clotting.

What is involved in the treatment? 
The procedure is performed in the office. After an evaluation of your medical history, Dr. Zirna 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? 
Some  patients will report some improvement after the first treatment, however, overall healing continues for 3 -6  months after the last treatment. Success rates approach approximately 70- 80%.

Are there any side effects with ESWT? 
Some patients may experience a short period of slight tingling, warmth or numbness immediately after their treatment.

What are heel spurs? 
Long standing inflammation can cause the formation of calcium deposits at the point where the plantar fascia inserts into the heel bone or along the course of the plantarfascia.   The spur itself is not actually the cause of pain.  

What is Achilles tendonitis? 
The Achilles tendon is a major tendon that attaches the calf muscle to the heel bone.  Achilles tendonitis occurs as pain and inflammation at the back portion of the heel, at the insertion of the Achilles tendon. It may also cause a bursitis often associated with a "pump bump", or Haglund's deformity.   A sore bump may be present on either side of the heel at the insertion of the tendon.   X-rays will often show a bone enlargement or spur with calcification inside the tendon. Treatment is aimed at reducing the pressure and inflammation to the area  through the use of heel cups, heel lifts, orthotics, padding, medication and physiotherapy. Cortisone injections are not recommended in this area due to their potential to cause tendon rupture.    The Achilles tendon can also become enlarged and show a fusiform swelling due to micro tears within the tendon.  This is known as tendinopathy. 

ESWT can also be effective at treating Achilles tendinitis.

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