Extra Corporal Shock Wave Treatment (ESWT)

Extra Corporeal Sound Wave Treatment (ESWT) is commonly used for the treatment of soft tissue and bone disorders around the foot and ankle.
Originally known as Lithotripsy, sound wave technology is similar to a small sonic boom resulting from a super sonic jet breaking the sound barrier. Formerly used to break up kidney stones, in the early 1990's it was discovered that this high intensity sound wave had benefit on wound and fracture healing. Since 1993, ESWT has been used on a regular basis in Europe for the treatment of painful tendonitis (tennis elbow), plantar fasciitis (heel spur) and to treat fractured bones that did not heal normally.
Mechanism of Action
Sound wave utilizes a high intensity sonic pulse, which can be focused on a target area in and around the foot and ankle. Although the exact mechanisms for the technology is not fully known it is believed that micro-trauma will ultimately repair and increase in development of blood supply to the area. Some have linked the mechanism to tenderizing meat by pounding a tough piece of steak with a wooden mallet and making it more soft and pliable. Often chronic problems of tendons and ligament involve infiltration of scar tissue overlying these fibers. ESWT is thought to break up this scarring and allow the body to regenerate new and improved tissue to the area.
Equipment
The equipment used to deliver ESWT is highly advanced and has been evaluated by the FDA. These types of technologies are in common use throughout the world: Electrohydraulic, Electromagnetic and Pregoelectric. The equipment consists of a computerized device with a movable arm that allows the physician to position a water-filled rubber bladder targeting the precise point of pain.
Treatment
After confirmation of exact positioning, the computer is then set to deliver 1000-40000 high energy sonic pulses at a pre-determined intensity level. It is recommended the procedure be performed under local anesthesia in the office or twilight sleep in an ambulatory surgery setting or hospital.
Recovery
Following the procedure, patients are asked to take it easy the remainder of the day. The day after the procedure, almost all patients are able to resume normal activities. Significant pain relief was noted by 80% of the patients within a week following the procedure. No immobilization is required.
Results
Clincal studies have shown a 70% success rate while using ESWT to treat plantar fasciitis and other tendon problems involving the foot and ankle. 70% of patients treated have had a reduction on a 0-10 pain scale by at least 5 for their condition. No patients have gone on to invasive surgical procedures. No patients have been made worse and no patients have developed complications from the ESWT. Full clinical benefits are fully realized 2-3 months following the procedure.
Costs
Costs are dependant upon the location of pain and the time required to treat the condition. Many insurance companies do not cover the cost of ESWT treatment. In the Washington DC area BCBS does cover ESWT.

Diagnostic Ultrasound

What is diagnostic ultrasound?
Diagnostic ultrasound or musculoskeletal ultrasound is a non-invasive test used to evaluate the soft-tissues (tendons, ligaments, nerves, muscles, etc.) of the foot and ankle. It is similar to sonar used on submarines by the military and fetal ultrasound used by OB-GYN doctors to evaluate the developing baby. In experienced hands, the images and information obtained from the ultrasound can provide as much information as much more expensive and time-consuming tests such as MRI and CT-Scans.
What is involved?
Diagnostic ultrasound is quick and painless. The entire process can usually be completed during your regular office visit and involves simply placing some gel over the areas to be inspected and using a small probe to explore the tissues. Since the ultrasound waves are harmless (otherwise they would not be used on developing babies) this test never causes any pain at all.
What is diagnostic ultrasound used for?
We use this test to evaluate and document problems such as tendonitis, heel pain, pinched nerves and neuromas, puncture wounds caused by stepping on glass or wood, and deep infections in the foot and ankle regions.

Diabetic Feet

What are diabetic foot problems?
Foot problems are the leading cause of hospitalization for the 16 million people in the U.S.A. who have diabetes. It is estimated that 15% of all diabetics will develop a serious foot problem at some time in their lives. Nervous system impairment (neuropathy) is one of these serious complications and results in loss of feeling in your feet and hands. This problem affects about 70% of people with diabetes. This is a serious problem for several reasons: First, as opposed to your hands, your feet are hidden inside your shoes and socks and easily forgotten since they are out of view and often not looked at by your family doctor or endocrinologist during office visits. When you can't feel your feet you may purchase shoes that are too small and tight for your feet and socks that have wrinkles or creases in them. This can result in too much pressure on your feet and create corns and callouses, which, if not treated properly, can cause an open sore that can become infected.
Second, neuropathy not only damages the nerves that give your feet sensation but also the ones that control the muscles in your legs and feet. When these muscles are affected the foot begins to develop problems such as bunions, hammer and claw toes, stiff high-arched feet, or even a completely flat foot called a "Charcot" deformity.
Finally, neuropathy can affect the nerves that normally allow your feet to sweat and stay soft and supple. When this happens, your feet are much more likely to dry out and develop cracks in the skin called "fissures" which, if not treated properly, can result in an open sore that could become infected.
What are the symptoms?
Unfortunately, you may not notice any symptoms until you develop an open sore. However, the presence of burning and tingling in your feet and toes is a sign of developing neuropathy and should be evaluated. The presence of corns and callouses, bunions, hammer and claw toes, and any other changes in the shape of your feet and toes should be a sign that something is wrong and be evaluated by your podiatric physician. Obviously, any area that is red and/or swollen, any bloody stains on your socks, or an open sore should be evaluated by your podiatric physician immediately to prevent serious complications.
What are the treatment options?
Treatment options depend on the symptoms you have and the presence of any associated foot and toe deformities. Neuropathy is best treated by maintaining your blood sugar levels within the range that your family doctor or endocrinologist recommends for you. If this does not help, the are a number of prescription medications that can be used to lessen your symptoms.
If any structural problem exist in your feet, you should buy shoes that are made of soft, natural, breathable materials (leather, suede) which offer good soft support to the arches and plenty of room for the toes. It is best to buy your shoes at the end of the day when your feet are at their largest so that you don't buy shoes that are too tight. Purchase socks that are made of soft, breathable materials and have no seams in them to avoid too much pressure on the tips of your toes. Inspect your shoes for any sharp seams or pressure spots and make sure that nothing has been misplaced inside your shoes (like car keys). Evaluate the bottom of your feet and in between your toes daily. If you can not reach your feet use a hand mirror to view these areas or have a family member help. Do not use "medicated" pads or "corn removing" products since they contain a strong acid which does not differentiate between normal and abnormal skin and can create a chemical burn or even an open sore and infection. Also, do not trim your own calluses since you may go too deep, creating an open sore.  
What does professional treatment involve?
The best treatment is to prevent problems from developing in the first place. You may benefit from a simple shoe modification or special insole (orthotic) to help distribute pressure across the bottom of your feet and help prevent open sores from occuring. If an open sore is present, there are a number of new prescription medications that have been developed specifically to speed up the healing time of these sores. We are part of a handful of institutions in the U.S.A. involved in clinical trials with some of these products. If surgery is necessary, it is aimed at correcting structural problems in your feet and toes. Diabetics under good control and with adequate circulation are candidates for elective surgery that can be highly beneficial in preventing long term problems.