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May 20, 2002


Emory Doctors Relieve Chronic Heel Pain with New Shock Wave Therapy System – A First in Atlanta

Chronic heel pain, known as plantar fasciitis, affects some 2.5 million people each year in the United States. It is a common injury among runners and others who spend a lot of time on their feet. Those who are overweight or have high-arched feet also face a higher risk of developing plantar fasciitis.

Now a new machine at Emory University, and in Atlanta, uses shock wave therapy to relieve this chronic foot pain. The Food and Drug Administration (FDA) recently approved the Dornier's Epos Ultra, developed by Dornier MedTech. "Since its approval, people from all across the country have been calling to find out about this new therapy," says Christoph Zenker, D.P.M., assistant professor in the Department of Orthopaedics at Emory. Dr. Zenker treats the majority of patients undergoing shock wave therapy.

"Plantar fasciitis is a condition that does not get better with simple rest," Dr. Zenker points out. "However, once it is diagnosed, it is very treatable."

Before one can become a candidate for this procedure, all other more conservative treatments must be exhausted, according to Dr. Zenker. Those treatment methods including icing the foot, stretching the foot with various exercises and trying standard anti-inflammatory medications. Oftentimes, doctors will encourage patients to try prescription orthotics (prescription shoe supports).

"These conventional treatments will usually help 95 percent of the affected patients," says Dr. Zenker. "For the other five percent, if the patients do not respond to any of the care mentioned and if their pain has lasted six months or more, then they may be candidates for the Dornier's Epos Ultra."

The machine works by using shock waves to break apart old scar tissue to help bring in new blood flow or new blood vessel formation, a procedure called neovascularization. Shock waves stimulate or trigger the body's own repair mechanisms, helping the body to heal itself. The shock waves are delivered through a water-filled cushion on which the foot rests. The machine's ultrasound imaging system helps doctors to pinpoint the exact treatment site. No anesthesia is needed for the therapy, but the foot can be numbed with an ankle block before the procedure begins. The treatment takes 15 to 30 minutes and is performed in the doctor's office.

Because this is a non-surgical procedure, the risks and costs are greatly reduced. Potential side effects include some pain and bruising for several days after the treatment. Those with existing clotting or bleeding problems could experience some bleeding with the new blood flow. Heavy activity (running, exercising, other sports activities) should be avoided for about four weeks following the treatment, then patients can gradually return to their normal activities. The treatment costs $1,000 at Emory, much less than similar therapies. Some insurance companies are covering the treatment on a case-by-case basis.

"Shock wave therapy was originally developed to break up kidney and gall stones for healing purposes," says Lamar Fleming, M.D., acting chair of the Emory Department of Orthopaedics and primary researcher of this therapy. "We first saw this machine in the German pavilion during the 1996 Summer Olympics in Atlanta. Trainers were using it to help ease heel pain in German athletes. Several years later, we started our own double-blind study using the Dornier and found the success rate of this treatment to be over 80 percent effective for chronic heel pain."

Doctors around the world, especially in Europe and Canada, have successfully used this same shock wave technology since the early 1990s. For more information about this treatment or to schedule an appointment, please call the Emory Health Connection at (404) 778-7777.

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