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.
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.
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
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:
Anyone taking medications that may prolong or interfere with blood clotting
Anyone with a history of bleeding problems
Tarsal tunnel syndrome or other nerve entrapments
Fractures of the foot or ankle
Significant peripheral vascular disease (problems with the circulation in the
blood vessels in the legs)
What are the side effects and complications that could happen?
The ESW treatment may cause skin reddening or bruising of the treated foot,
which usually clears within a few days
The ESW treatment may cause numbness or tingling in the treated foot
The ESW procedure may cause the plantar fascia to tear
The ESW treatment may not help pain in your case. You may have episodes of pain
similar the pain you had before treatment. The pain may continue for a few days
to several weeks after treatment.
Shock waves directed to large blood vessels or to major nerves may cause damage
to these structures.
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
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
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
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
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