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Dr. Scheinin is excited to be one of the first physicians in the country to offer a new and innovative non- surgical treatment for chronic heel pain.. The FDA has recently approved the use of the Dornier-Ossatron as a safe and effective method of reducing the discomfort associated with chronic plantar fasciitis. This treatment will help many suffers of heel pain avoid surgery.

Plantar Fasciitis
Each year over 40 million Americans suffer from "heel pain syndrome" often referred to as "heel spurs." The typical signs and symptoms for this problem are usually severe pain upon first arising in the morning. Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest. However, after sitting or resting later in the day then arising the severe heel pain returns. This intermittent pain often progresses to a daylong nagging pain. Conventional treatment for this extremely painful problem includes cortisone injections, use of custom made orthotics, use of non-steroidal anti-inflammatory medications such as Advil or Aleve, physical therapy and muscle stretching. Despite these techniques, the pain may persist for months or years.

Dornier-Ossatron
The Dornier-Ossatron is a shock wave generator, very similar to the shock wave devices used to treat kidney stones without surgery. This treatment provides ESW, " extracorporeal shock waves". " Extracorporeal" means "outside the body". The shock waves are created by a spark plug that is enclosed in a soft plastic dome filled with water. During the treatment, this dome is placed against the heel so that the shock waves pass through the dome to the heel. The treatment was recently found to be effective in treatment chronic proximal plantar fasciitis, a condition that causes pain in the heel of the affected foot.

Doctors know that many people who have heel pain get better with time, even with no treatment. Many people find relief after trying one or several conservative treatments previously mentioned. In difficult cases of proximal plantar fasciitis, open or endoscopic surgery may be performed.

Who Should Consider Having ESW Treatment for Chronic Plantar Fasciitis?
ESW treatment with the Dornier-Ossatron is for patients who have had heel pain for at least six months and who have tried three methods for treating their heel pain without success. In the Dornier-Ossatron clinical study, the treated patients failed to respond to at least three attempts at conservative treatment: two prior courses of non-invasive treatment including physical therapy and use of an orthotic device ; and one prior course of pharmacological treatment.

ESW treatment with the Dornier-Ossatron is for patients who can tolerate anesthesia prior to ESW procedure. The ESW treatment with the Dornier-Ossatron otherwise would be painful.

Who should NOT have ESW treatment for the proximal plantar fasciitis?
Because the Dornier-Ossatron has not been tested on people who have the following conditions, its effect, safety, and effectiveness on someone who has one of the following conditions is unknown:
What are the side effects and complications that could happen?
What will happen on the day of the ESW treatment?
Your doctor will probably ask you to come to the hospital or surgery center a few hours before the ESW treatment is scheduled. You should wear shorts or loose fitted clothing that can easily be rolled up to the knee of your affected leg. Otherwise, you may be asked to change from your own clothes into a hospital gown. The staff may take your temperature, pulse and blood pressure and ask you some questions about your general health. They will also make sure you have signed a consent form for the ESW treatment.

The ESW treatment may cause some pain or discomfort, so an anesthetic is commonly given before the procedure. Usually, this will be a local anesthetic or a regional anesthetic called a heel block. You will be asked to rest comfortably on your back while your doctor holds your foot up to the Dornier-Ossatron shock head.

An ESW treatment for chronic proximal plantar fasciitis usually takes about 30 minutes. The ESW treatment is performed as an outpatient procedure; no overnight hospital stay is necessary.

What will happen after the ESW treatment?
Immediately after treatment, you will stay at the hospital or surgery center until the anesthetic wears off enough so it is safe for you to walk. Your doctor will probably ask you to restrict stressful activity involving the treated foot for 4 weeks after treatment. "Stressful activity" may include running or jogging, doing heavy housework or yard work, and participating in sports.

Some patients need a mild pain medication following ESW treatment. Although some patients in the clinical study felt immediate relief from pain after the ESW treatment, it is more common for it to take up to 6 weeks for pain relief to begin.

What are the expected results from ESW treatment?
Early clinical applications in Europe have proven the Dornier-Ossatron effective in 60-80% of treatment.

In the Dornier-Ossatron clinical study, most patients with chronic proximal plantar improved. One study was conducted by Richard Alvarez, M.D. at Memorial Hospital in Chattanooga, Tennessee. The study commenced on February 27, 1997 and included twenty subjects who averaged 21.4 months of heel pain prior to study enrollment. In the study, each subject was treated with a single Dornier-Ossatron treatment of 1,000 shocks. In 85% of the cases, subjects demonstrated significant improvement in symptoms (on the average, an 89% reduction in pain was experienced)

The study showed that the Dornier-Ossatron System is a safe and effective method for treating chronic heel pain syndrome. In the patients undergoing a repeat treatment following a failed primary treatment, the success rate was 90.5% based on the investigator's assessment and 52.3% based on the patient's self assessment. Since the investigator's assessment evaluates pain localized at the insertion of the plantar fascia into the heel bone, this discrepancy suggest that other problems may be causing the heel pain.

Your doctor will ask you to return to the office for a follow up visit, probably at about 4 weeks after your Dornier-Ossatron treatment. Please check with your doctor about this follow up visit.

I have more questions about ESW treatment for heel pain. How can I get more information?
Talk to your doctor if you have any questions.

In order to use the Dornier-Ossatron to treat chronic proximal plantar fasciitis, Dr Scheinin had to undergo extensive training, which not only allowed him to learn how to perform the ESW treatment, but it also included information about shock wave energy in general, and information from the Dornier-Ossatronclinical study. Therefore, he is the best one to talk to if you have any questions or concerns about ESW treatment for chronic proximal plantar fasciitis with the Dornier-Ossatron.

Dr. Gary Scheinin
555 Knowles Drive, Suite 220
Los Gatos, CA
Telephone (408)378-5887