GlobeAndMail

A sound method for healing the heel

Sonic shockwaves are being used to break up diseased tissue and get people with chronic plantar fasciitis on their feet again

By ERIN POOLEY
Friday, July 30, 2004 - Page A11

Jamie Zimmerman suffered with excruciating foot pain for almost 10 years before he discovered a treatment for plantar fasciitis that uses "tiny sonic explosions" to break up diseased tissue in the heel and stimulate the growth of healthy cells.

The 36-year-old volunteer firefighter was diagnosed with the condition -- an inflammation of the plantar fascia ligament at the bottom of the heel that can lead to chronic heel pain -- in his mid-20s.

"I went to podiatrist after podiatrist and wore orthotics but it didn't take the pain away. The pain was so bad in the morning, I couldn't even stand up. I'd just fall right to the floor," said Mr. Zimmerman.

Sheldon Nadal, a Toronto podiatrist who treated Mr. Zimmerman with extracorporeal shockwave therapy (ESWT) in March, 2002, said his patient noticed an 80-per-cent improvement in the first two months.

After a second treatment on his left foot, the pain disappeared completely.

"It changed my life. I started to play golf and baseball again," said the 185-pound Mr. Zimmerman, who lost 70 pounds after two of the non-invasive treatments.

For the majority of patients with plantar fasciitis, conservative treatments, including anti-inflammatory medications, cortisone injections, orthotics and physiotherapy, are usually effective.

But for the 10 per cent of individuals with a chronic form of the disease -- defined as pain that lasts for more than six months -- surgery used to be the only option.

Individuals with plantar fasciitis typically notice symptoms when they wake up in the morning, at the end of the day, or after resting from a long walk.

It is estimated more than one million Canadians suffer from this debilitating condition that can range from "a mild to moderate ache to knife-like pain."

"It really is a miserable problem. Even though you rest, it doesn't get better. It has to be treated aggressively. Every day you think it's going to get better and it does not," said Nadal.

Various factors contribute to plantar fasciitis, including overuse in sports, trauma to the heel, footwear with poor shock absorption, obesity and chronic fatigue syndrome.

Nadal said shockwave therapy "is much safer than surgery" and typically requires only one treatment before patients begin to see results.

There is a small possibility of infection or nerve irritation from the injection of a local anesthetic.

The procedure takes about an hour to complete and usually results in mild tenderness to the affected area for a few weeks. Nadal said most people "feel very little" during the treatment, although some patients experience a mild degree of discomfort.

The treatment, pioneered in Germany in the early 1990s and based on a procedure used to treat kidney stones, has been available in North America for the past five years. It is also being used by physiotherapists and orthopedic surgeons to treat chronic inflammation in places where tendons attach to bones, including the elbow, shoulder and knee.

Seventy-five per cent of patients with chronic plantar fasciitis experience "a 50- to 100-per-cent improvement with one treatment," said Nadal, who added most patients begin to see improvement in three months.

Robert Chelin, a Toronto podiatrist and former president of the Canadian Podiatric Medical Association, said it's important to see a doctor for diagnosis in order to rule out other causes of heel pain, including tuberculosis, infections, fractures, bone tumours, bursitis and heel spurs.

Plantar fasciitis can be diagnosed with a soft-tissue scanning procedure such as a CAT scan or MRI, a blood test, a bone scan or a consultation with a doctor.

Mr. Chelin said shockwave or lower-frequency radio wave therapy is not recommended for individuals with tumours or those taking blood thinners.

Plantar fasciitis injury

Plantar fasciitis is a serious, painful, and progressing illness that occurs when the long, flat ligament on the bottom of the foot develops tears, inflammation, or ruptures.

Plantar fascia

This ligament extends from your five toes, along the bottom of your foot and is attached to your heel. When you run or walk, you land on your heel and raise yourself on your toes as you shift your weight to your other foot, causing all your weight to be held up by your plantar fascia. Such repetitive force can tear the fascia from its attachment on your heel and cause plantar fasciitis.

Tips for treating acute plantar fasciitis

  • Wear shoes at all times in order to support the foot and heel.
  • Ice the affected area for three to four minutes a day.
  • Perform foot exercises recommended by your doctor.
  • Purchase an over-the-counter arch support.
  • Take non-prescription anti-inflammatory medication.
  • SOURCE: DR. SCHOLL'S PODIATRY INFORMATION LIBRARY