Extracorporeal Shock Wave Therapy for Chronic Achilles Tendonitis, ESWT for Achilles Tendonitis or Tendinitis, Pittsburgh PA
Suffix “itis” refers to inflamed, in this case used when fibers of a tendon gets torn, they get inflamed. Acute tendonitis is sudden inflammation, within few days, and is usually due to an overloading strain during a specific exercise movement, misstep or fall. Symptoms include but not limited to pain abruptly following a strain. Sharp pain at activity onset, can decrease in intensity your exercise progresses. The most significant pain is when jumping or pushing off. Stiffness in the morning, pain may return after exercise or longer periods of inactivity. Pain usually subsides when the ample rest is allowed, and may feel better with cold compression.
Some chronic Achilles tendonitis causes include:
- Untreated Acute Achilles tendonitis – inflexible or weak calves or tendons, with scar tissue (soleus or gastrocnemius)
- Not stretching or warming up before exercise.
- Wearing poor supporting shoes, such as high heels, this causes calf muscles to contract, thus providing little tendon slack
- Uneven or a change in terrain (hills) but trying to build up stabilizer muscles with training on actual uneven surfaces can also help remedy.
- High arches, fallen arches or pes planus (also called flat feet) causes stress on the Achilles tendon.
- Sometimes caused by arthritis, bony growths on the heel, can irritate the tendon.
- Some causes are improper before and after warm-ups, including stretching when doing jumping or running exercises.
- Previous achilles tears may leave scar tissue and a training regimen to build up inflexible or weak calf muscles.
What is extracorporeal shock wave therapy and how does it work?Extracorporeal Shock Wave Therapy, also referred to as ESWT, is a nonsurgical method that delivers high-energy acoustic (sound) waves to a targeted area in order to to treat various musculoskeletal conditions, including achilles tendonitis. ESWT works in 3 ways:
- Desensitization. Local anesthesia is administered prior to the procedure. However, the ESWT is a very powerful machine, and the targeted area will become increasingly desensitized throughout the procedure.
- It changes a chronic injury into an acute injury. Chronic injuries occur from overuse of an area of the body over an extended period of time. Achilles tendonitis is an example of chronic injury.
- Vascularization. During the ESWT procedure, microscopic and controlled injuries are induced. These injuries “jump start” the overall healing process by promoting the growth of new blood vessels in the achilles tendon (vascularization), and giving your body the tools that it needs to heal itself naturally.
Benefits of ESWT vs. Surgery
ESWT is a non-invasive procedure requiring only local anesthesia to the targeted treatment area.
- Surgery is an invasive procedure where you will need to be placed completely under general anesthesia.
ESWT has little to no downtime, other than not participating in overly strenuous activities for 2 months following the procedure.
- Following achilles tendonitis surgery, patients will be required to wear a protective boot and/or use crutches. The healing time following surgery is a minimum of 6 months.
Physical therapy is not needed following the ESWT for achilles tendonitis
- Several months of physical therapy is often required and needed following surgical correction.
While ESWT is not covered by most insurance companies, it is cost effective.
- Surgical procedures can be very expensive, especially if a patient has a high deductible or poor health care coverage.
Achilles tendonThe Achilles tendon is a band of tough, fibrous tissue found in the posterior ankle between a person’s calf muscle (gastrocnemius) and heel bone (calcareous). The Achilles tendon, sometimes referred to as the “heel cord,” is the strongest tendon in the human body, yet it is often the site of chronic and debilitating injury.
Function of the Achilles tendonThe function of the Achilles tendon is to allow the foot to bend. Injury to the Achilles tendon may prevent a person from being able to walk or stand, as the Achilles tendon is the main reinforcement in the ankle, holding the ankle in place.
Chronic Achilles tendonitisChronic Achilles tendonitis is one of the most common injuries to the Achilles tendon, occurring in 6 out of 100 inactive people and even higher in those who are active. Chronic Achilles tendonitis occurs from overuse, it may even be acute tendonitis left untreated or never been allowed sufficient rest, which results in inflammation from microtraumas in the tendon. These microtraumas happen over an extended period of time, which classifies this type of injury as chronic, rather than acute (a sudden, traumatic injury). Its common the tendon becomes inflexible and enlarged as scar tissue builds up. ESWT to treat Achilles tendonitis
Symptoms of Chronic Achilles tendonitisCommon symptoms of chronic Achilles tendonitis include:
- Foot Pain that occurs gradually, rather than suddenly
- Inflammation, which may be seen as a lump 2cm above the heel
- Pain while exercising
- Pain while performing daily activities, such as walking or standing
- Pain that increases while walking uphill or jumping
- Pain or stiffness that occurs after 30 minutes or more of rest
- Warm and tender to the touch
- Swollen or thicker Achilles tendon
- Most significant pain is when jumping or pushing off
Chronic Achilles tendonitis treatment NYCTreatments for Achilles tendonitis include:
- Resting and/or immobilizing the tendon
- Applying ice to the area to control inflammation and pain
- Exercises specifically designed to strengthen the Achilles tendon
- Wearing heel lifts in the shoes to relieve tension to the tendon
- Wearing orthotics in the shoes for support and protection
- Night splinting
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Injection or a non-cortisone, anti-inflammatory solution, into the tendon
- Extracorporeal Shockwave Therapy (ESWT)
- Surgery, although not recommended as this is an invasive procedure
Frequently Asked Questions
How do I know that I have Achilles tendonitis in Youngstown?Achilles tendonitis is diagnosed by a podiatrist specializing in foot and ankle injuries. A podiatrist can typically diagnosis Achilles tendonitis in Youngstown by:
- Reviewing the symptoms you tell him you have, such as pain when walking uphill or exercising
- A physical examination, such as feeling for inflammation in the tendon and moving the tendon in order to reproduce pain
Do I need to have X-rays taken to diagnosis Achilles tendonitis in Philadelphia?Diagnostic imaging, such as X-ray, is not typically needed in order for a podiatrist to diagnose Achilles tendonitis in Philadelphia. However, ultrasound imaging and MRI may be used if a diagnosis of Achilles tendonitis is not clear.
How can I treat Achilles tendonitis in Chicago?There are several options for treatment of Achilles tendonitis in Chicago. Conservative treatments, such as strengthening exercises, stretching, icing, resting, and wearing heel lifts and/or orthotics should become part of your daily routine in order to heal and prevent further injury to the Achilles tendon. Non-cortisone anti-inflammatory medications may also be injected into the Achilles tendon to help reduce inflammation. Cortisone injections may weaken the tendon and cause a rupture, so they are often not recommended, especially for active individuals. Extracorporeal Shock Wave Therapy, or simply ESWT, in Chicago is a very effective, non-surgical option to treat chronic Achilles tendonitis.
What should I expect during the EWST procedure in Baltimore?When you come the closest ESWT provider in Baltimore or your area, you will be placed comfortably lying on your side. The podiatrist will administer a local anesthesia to ensure that you feel no pain while you are having the procedure. Once your heel is completely numb, your foot will be placed on the therapy head bubble and against the ultrasound transducer. A trained professional will apply a gel to your skin and use the transducer to produce an ultrasound image of your achilles tendon. This image will allow us to target the area(s) of treatment. Once located, the procedure will begin, and 3,800 pulses will be administered over the next 18 to 20 minutes. During the treatment time, you should not feel pain, but you will feel pressure and what some have described as a “light rubber band snap” on the targeted area. You will also be able to hear the shockwaves as they are being produced. The treatment starts at the lowest intensity level, which you will hear as a slow tapping from the machine, and gradually increases to “therapy level” where you will hear an increase in the tapping. We want you to be as comfortable as possible during the procedure. Please feel free to read a magazine or even take a quick nap!
How long does an ESWT procedure take?The ESWT procedure typically takes 18-20 minutes per side, 36-40 minutes bilateral (two sides).
What should I expect following the EWST procedure in Philadelphia?Immediately following the procedure, your local anesthesia will not yet have worn off, so we recommend that you have a driver. You may notice some bruising or tenderness at the injection site. This is completely normal, however, if you have any concerns, please contact the podiatrist office where you had the procedure or call 724-991-0116. For the next 3 months, you should not take any antiinflammatories or apply any natural anti-inflammatories, such as heat or ice to the treated area. Anti-inflammatoires will slow down the healing process that is taking place. You make take acetaminophen (Tylenol) to help with any discomfort you may be experience. It is also recommended that you not engage in any overly strenuous exercise routines, such as powerlifting, squats, or kettlebell. Your body will continue to heal over the next 6 months following the ESWT procedure. If any time you have questions or concerns, please contact the podiatrist office where you had the procedure or call 724-991-0116.
I saw an advertisement for ESWT in Pittsburgh and am wondering, what is the effectiveness of ESWT for achilles tendonitis?In the experience of Pittsburgh podiatrists performing ESWT, there is a 92% success rate after 6 months following ESWT for achilles tendonitis. It is very unlikely that you would need to have a 2nd procedure done. Please take into account that ESWT in Pittsburgh is not a “cure all” and should not be used as the only means of healing. ESWT will give your body the tools it needs to effectively heal. However, you must help the healing process by continuing to stretch daily, icing in the evenings (after 3 months), and wearing supportive orthotics in your shoes.
I want to have ESWT in New Jersey. Will the ESWT be painful?During the ESWT in New Jersey, or a podiatrist office near you, you should not experience any pain. The podiatrist will administer a local anesthetic to the area prior to the procedure. As the ESWT machine is very powerful, it will also desensitize the area ensuring that you have a comfortable, pain-free experience!
What makes me a good candidate for ESWT in CIncinnati?Good considerations for ESWT include:
- A diagnosis of achilles tendonitis for 6 months or longer. If you are have not yet been diagnosed by a podiatrist or physician, please call to make an appointment at a participating podiatrist office providing ESWT closest to you 724-991-0116.
- Trying at least three conservative treatments, which have failed. Conservative treatments may include, but are not limited to, wearing plantar fasciitis arch supports in your shoes, taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, night splinting, and cortisone injections.
What makes me a poor candidate for ESWT?Poor considerations for ESWT include:
- Tarsal Tunnel Syndrome, ankle pain resulting from a compressed nerve
- Rupture of the achilles tendon, as confirmed with ultrasound
- Previous achilles tendon surgery
- Currently taking medications for anticoagulation, such as Coumadin or Xarelto