Podiatrists and orthopedic surgeons have been successfully treating pain associated with plantar fasciitis and bone spurs for many years with conservative treatments. However, in some cases the need for surgery arises as the only way to deal with the growing pain. Thankfully, there is an exciting and successful therapy now available to patients which in most cases will completely eliminate the need for surgery. That therapy is called High Intensity Shockwave Therapy (also referred to as Extra Corporeal Shockwave Therapy, or ESWT), and Agoura Los Robles Podiatry Centers are proud to say that we are one of the first, if not the first, offices in California to have a Shockwave Therapy machine available full time in the office. That means we can provide our patients a much faster response to their heel pain, and we can provide this service at the cheapest price possible because we have no middle men involved.
Who is a great candidate for High Intensity Shockwave Therapy?
Generally speaking, Shockwave Therapy is reserved for people who have had heel pain for more than six months, and have tried at least three “first-line” treatments. First-line therapy for these conditions consists of medical treatments such as oral and injected anti-inflammatory or cortisone, taping, orthotics, arch supports, night splints, cast immobilization, massage, stretching, manipulation and/or physical therapy. Our offices are able to provide all of these treatments to our patients, including the help of our two in house physical therapists.
While anyone can have High Intensity Shockwave Therapy performed on them with doctor approval there are two catches. The first being that insurance companies are even less likely to cover the procedure if you have not had heel pain for more than six months, and have not tried three “first-line” treatments. The second being that High Intensity Shockwave Therapy is actually proven to be less effective, the less severe the case is. Due to the nature of the procedure,(“shocking” your system into knowing that your heel pain is not the norm) should you only have heel pain for say, two months, then the procedure becomes less effective because your body may still be working on the healing the pain, etc. In that situation, it is far more likely our doctors would recommend a “first-line” treatment from the list above, as we can provide all of them to you in office.
What exactly is Shockwave Therapy?
Shockwave Therapy is the evolution of a previous treatment used for kidney stones. The technology was originally created as a means of non-surgically breaking up kidney stones, and is now instead focused on the heel. Sound waves are pushed through the skin towards the heel, and as they hit the bone or insertion site of the plantar fascia, they will cause micro-trauma. Micro-trauma? Doesn’t that sounds like a bad thing? Well, much in the same way you build muscle by breaking it down so it can grow back denser, shockwave therapy causes your body to react to the newly found micro-trauma. So now, where the body once refused to heal the area, new blood vessels begin to form, and the body’s natural healing process is triggered as a response. Another way to look at it would be to imagine that the body has accepted the painful heel as being “normal”, and the micro-trauma caused by the sound waves “shocks” the body into remembering how to go about healing this chronic painful condition.
How is the procedure done?
Shockwave Therapy is administered in our office, and we like to say it will take approximately 45 minutes from start to finish. The patient is seated in a reclining examination chair, and positioned so that their heel rests against the machine. The head (where the sound waves come out from)of the Shockwave machine will be placed right against the patient’s heel, and a conductive gel is placed on the heel to maximize contact. The machine has a power setting that ranges from 3 to 7 in .5 increments. We start all patients at 3 in order for them to get used to the feeling, and then we raise the intensity a half a number at a time in order to acclimate the patient. As we approach the power level of “5”, we enter into the therapeutic range, which is where we need to be to ensure the best possible results. Due to patients having varying pain thresholds, we are ready and willing to use local anesthesia in order to ensure that a power level of 5 is reached. 2800 sound wave pulses are produced for each procedure, which is what takes approximately 45 minutes. After the procedure is finished you are able to put your regular shoes back on, and walk as you would normally.
Certainly there is no need to bring in an anesthesiologist, or go to a hospital or surgery center for High Intensity Shockwave Therapy. Due to this, the costs associated with shockwave therapy for heel pain, and other foot problems, are brought down to a very affordable level.
It is very important to note, should we be required to use local anesthesia on the right foot, the patient will not be able to drive a car, as their foot will be numb. We strongly suggest to all of our patients that they have a plan in place should the need for a ride home arise.
What Are The Risks and Complications?
The beauty of choosing High Intensity Shockwave Therapy is that, other than the anesthesia, there is no real risk of harm, or complication. At the end of the procedure either your body is “shocked” into making you better, or it is not. In our experience no one has ever been made worse as a result of using this therapy. This seems to be true with our colleagues across the world that have used High Intensity Shockwave Therapy on their own patients, and we have not heard anything to the contrary.
It should be noted that High Intensity Shockwave Therapy is not advised for pregnant women, children, people with pacemakers, people on an anticoagulant like heparin, or who have a history of bleeding problems. If you are one of these people, the doctor could suggest that you wait to have Shockwave Therapy, or they may point you to another method of dealing with your heel pain.
The Initial Examination
All patients seeking heel pain relief will be required to have an initial examination in one of our offices. Heel pain is a complicated problem in the sense that it can have one of many possible causes. It is very important that our doctors be able to confirm a patient is an appropriate candidate for Shockwave Therapy. Once the doctors have a chance to confirm the diagnosis, they will inform the patient of all the treatment options, Shockwave Therapy or not. The initial examination will include some tests; these can include x-rays, blood work, ultrasound imaging, MRI, arterial circulation test, and nerve conduction study. While that sounds like a lot, the most common test performed is ultrasound imaging of the problematic foot. This is done in the office, and gives our doctors a clear image of the soft tissue and bone in order to evaluate which treatment suits that patient. It is rare to order the other tests mentioned for heel pain, but occasionally they are needed to help confirm a diagnosis. High Intensity Shockwave Therapy is not usually a first treatment for heel pain, as mentioned before, so please be aware that there is always a possibility a patient could not be a candidate for this treatment. If you are traveling from a long distance, please let our receptionists know if you want to try and have the exam and therapy performed in the same day, if you are a candidate for High Intensity Shockwave Therapy then we can have that time scheduled ahead of time.
What are the fees?
While fees for High Intensity Shockwave Therapy can run as high as $3,800 in some practices, and much higher than that should a patient we required to go to a surgery center to have access to an anesthesiologist, Agoura-Los Robles Podiatry Centers is able to keep the price low with our in-house machine.
The first fee would be the initial exam, which can be covered by most insurance plans, and should you not have insurance, it would be a $100 out of pocket charge.
The procedure itself is $500 a foot.
Most insurance companies refuse to pay for High Intensity Shockwave Therapy procedures, but you are welcome to call your own insurance company and see if the procedure is covered. The code number used for High Intensity Shockwave Therapy is 28890. Please keep in mind that you will be responsible for all copayments and deductibles, and prior to performing the procedure we will let you know exactly the fees for which you will be responsible.
You can also apply for CareCredit, a healthcare specific credit agency, at this link here. Carecredit has two basic payment plans that help meet each individual’s needs, and we encourage you check them out on their website. One is a No Interest Plan, to be paid off in 3 to 24 months. The other is an Extended Payment Plan with competitive interest rates, to be paid off in 24-60 months.
Can Shockwave Therapy be used for another other problems?
High Intensity Shockwave Therapy has been found useful for many foot complaints. It has been used successfully by our doctors for the following disorders:
- Achilles tendinitis
- Achilles tendon insertional calcifications
- Posterior tibial tendinitis
- Peroneal tendinitis
- Painful accessory navicular bones
- Sesamoiditis
- Neuromas
We admit that the literature is lacking for the treatment of some of the conditions listed above, but the frequency of success, and the lack of negative side effects make the attempt to treat these conditions worthwhile.
To make an appointment, or find out more information about Shockwave Therapy at Agoura Los Robles Podiatry Centers, please call 818.707.3668.