Shock _to the system
NASHUA – Kate Jackson is an elite athlete who competes in Ironman triathlons, events in which she swims 2.4 miles, bikes 112 miles and runs a marathon – all in one day.
But a few weeks ago, the pain in her heels – likely the result of overuse following months of heavy training – was so severe she could barely walk.
“Walking pain-free sounds good to me right now,” the 28-year-old athlete said while sitting in an examining room in the office of podiatric doctors Howard Bonenberger and Jennifer Sartori, waiting to undergo extracorporeal shockwave therapy.
The therapy was approved about 2½ years ago by the Food and Drug Administration for the treatment of plantar fasciitis, an inflammation of the thick band of fibrous tissue that runs from the heel to the base of the toes, causing pain that varies from uncomfortable to excruciating. The procedure, done at four podiatric medicine practices in Greater Nashua, is covered by some insurance plans, while others are awaiting longer-term studies.
The therapy, which has been used internationally for about a decade to treat chronic musculoskeletal conditions, works by delivering shockwaves from outside the body, causing millions of microscopic injuries that trigger the body’s repair processes. Since it is non-invasive, a patient can undergo the treatment in a doctor’s office and go home afterward, albeit usually with a designated driver, since the sole of the foot may be numb.
Bonenberger said shockwave therapy is not the first line of treatment for heel pain, but the procedure can make a dramatic difference for patients for whom conventional treatments have failed. He said most people improve with a combination of anti-inflammatory medication, ice and a properly fitted prescription shoe insert.
“About 4 percent may need shockwave or surgery,” he said.
Jackson was one of them. During an Ironman competition at Lake Placid, N.Y., in July, she said she ran the marathon part of the event on tiptoe because her heels hurt so much. Afterward, she could barely walk.
An exercise physiologist, Jackson tried all of the conventional treatments available. She stretched, took ibuprofen, wore a splint at night and used orthotics. She iced her foot and backed off her running.
But the pain persisted.
“I knew it wasn’t going away,” she said.
She said the inflammation of her fascia was so extreme that the normally 3-millimeter-thick band measured 9.1 millimeters on her right foot and 7 millimeters on the left one.
Jackson’s pain was off the charts.
In using shockwave therapy, Bonenberger and Sartori work with a technician who visits their office every six weeks, bringing a mobile unit he sets up _in an examining room.
About 20 minutes before the procedure, the doctor administers a local anesthetic to the heel area. When the procedure begins, the patient lies on his or her side on an examining table. The technician applies a gel that promotes transmission of the waves to both the foot and the device that houses the shockwave source.
The technician and physician monitor the procedure on a computer screen on which an ultrasound image of the foot allows them to visualize the fascia and aim the shockwaves at the right area. The shockwaves produce a physiologic change that begins a cascade of repair processes.
Bonenberger said some patients experience relief the next day, although he doesn’t evaluate results for at least a month. A brochure he distributes to patients states the healing process takes about three months to be completed.
While the results of shockwave therapy are impressive – about 81 percent of cases are successful – Bonenberger said treatment isn’t for everyone. A patient who has an infection, severe circulatory disease or possible fracture isn’t a candidate. Likewise, the treatment isn’t recommended for children, pregnant women, patients with pacemakers or those taking medications that could prolong or interfere with blood clotting.
But the technology is good news for many of the more than 2 million adults in this country who suffer with fasciitis.
“Once an injury occurs to the foot, because of abnormal biomechanics, the foot often can’t get better,” Bonenberger said, adding that about 90 percent of the cases he treats can be resolved without shockwave therapy or surgery. “The key to treatment is proper diagnosis.”
Amherst resident Maureen McFadden chose the therapy as an alternative to surgery. After suffering with heel pain for two years – the result of a repetitive stress injury – she sought several professional opinions and tried physical therapy, ultrasound, cortisone shots, a night splint and an anti-inflammatory drug before deciding on shockwave therapy.
“I was walking five days a week, not cross training,” said the sixth-grade teacher, who had the shockwave therapy several weeks ago.
Because she is the primary caregiver for her husband, who is recovering from a heart attack, McFadden said she could not afford the time off required after surgery. After undergoing the shockwave therapy, she went directly to the hospital to see her husband.
“It doesn’t stop you from doing anything,” she said. “There’s no time off.”
McFadden said she experienced immediate relief after the procedure. Her foot was still tender, but the shooting pain was gone.
Jackson said before the procedure, which lasted 17 minutes on each foot and sounded like a hammer ringing, she received four shots of local anesthetic in each foot. During the treatment, 3,800 shocks were administered to each foot.
“It hurt at times, but it wasn’t a hurt you couldn’t endure,” she said. “The cortisone shot was more painful.”
After the procedure, she said, her feet were sore and swollen, but two days later, she felt considerable relief in her left heel, while the right was slightly tender. She took a week off from work after her procedure, but on the fourth day, she cleaned her house and went to the gym, where she did an upper-body weight workout.
“It’s a wonder treatment because you’re able to get pain-free and get back to your life,” Jackson said. “You’re never on crutches. With surgery, you’re hurting for a while.”