Lynne, 52 from Billericay was treated for heel pain (plantar fasciitis) at Spire Hartswood Hospital in Brentwood. Lynne’s condition had become very painful and was stopping her from having a normal life until she received shock wave therapy treatment also known as ESWT. This is her story.
Heel pain
Lynne has always been an active person. She walks her dog for a few hours every day, goes swimming, to the gym and enjoys cooking and entertaining friends. Lynne suffers from foot problems which includes plantar fasciitis (heel pain) in her right foot, so when she started to experience pain in her left foot she knew the warning signs and went straight to her GP.
“I knew what it was because I had it in my right foot but this was already worse. The pain would be at its worst when I had rested my feet, such as after I had woken up and taken my first step out of bed. When I went to the GP he referred me to see Dr Nagui Gendi and I used my private healthcare insurance to pay for my treatment privately at Spire Hartswood Hospital in Brentwood.“
Initial treatments
As a consultant rheumatologist, Dr Gendi was able to examine Lynne’s foot, assess the symptoms and confirm a diagnosis of plantar fasciitis.
“Dr Gendi suggested that we tried some non-invasive treatments first and so I tried orthotics (shoe supports). These helped a little but the pain soon got worse.”
Dr Gendi then treated Lynne with cortisone injections which provided Lynne with temporary pain relief. Although this had relieved her right foot of the same condition, the left foot did not respond as well and soon Lynne was back.
“I was happy to treat the condition moderately to begin with because you don’t want to over-treat a condition. However, Dr Gendi and I both agreed that my left foot was being stubborn and that a stronger treatment was required.”
Relief at last
Lynne had now been suffering with the condition in her left foot for several months and could no longer attend the gym or walk her dog and it was beginning to affect her life.
“I am used to being active. I enjoy my walks and swims and it was stopping me from getting on with my daily life. Also, when you live with pain every day you do learn to cope with it but it can get you down and I didn’t feel like entertaining friends or doing much else.
Dr Gendi sent me for an MRI scan to see exactly what was going on and the scan revealed an inflamed heel spur.”
Lynne’s condition was becoming long-standing, so Dr Gendi recommended that she underwent shock wave therapy treatment (also known as ESWT).
Treatment
Lynne underwent several half-hour sessions of shock wave therapy over a period of six weeks. She was also given a removable cast which she put on her foot and leg which allowed her foot to get some much needed rest.
The focussed shock wave therapy that Lynne had is also used (at a higher dose) for ‘blasting’ kidney stones and Lynne found the treatment a bit surprising.
“You have to lay on your front with your feet dangling over the edge of the bed. Then the machine is lined up to your foot and the team turn the machine on and it begins to ‘pulse’. It is an unpleasant feeling but they continue to do this until they can identify the most uncomfortable spot on your foot and then they turn the strength of the ‘pulse’ up.
After the first session I requested, and was given, pain relief which took the edge off of the sensation of the treatment. However, I would stress that it is totally worth it and the thing that made me continue were the results. Where everything else had failed, the shock wave therapy dealt with the condition.”
Recovery
Each treatment for Lynne lasted a total of 30 minutes (broken down into 10 minute mini sessions of treatment) and after each treatment Lynne recovered until she felt she was ready to walk and would go home a few hours later.
Lynne came into Spire Hartswood Hospital over a number of weeks and each time was looked after by a warm, friendly and professional team.
“The whole team at Spire Hartswood Hospital really looked after me. The shock wave therapy team were great and really made me feel as comfortable as possible. The hostesses always made sure I was fed and comfortable and I honestly only have good things to say about the Hartswood team, they were all commendable.”
Getting her life back
“Once I started the shock wave therapy treatment I began to see the results quickly. I could put my weight on my foot and started to feel some hope of getting my life back. “
Lynne completed her series of treatment and says the results speak for themselves. “I am back swimming; I walk the dog for a couple of hours every day and I am back at the gym and entertaining friends again. At the gym I have to avoid some exercises that may put undue pressure on my heels, but it doesn’t stop me from getting a full workout. I have my life back.
I will always have some pain in my feet because of the other conditions that I have, but the plantar fasciitis is under control and I hope to address my other foot problems in a few years. In the meantime I am very happy.”
The consultant's view - Dr Nagui Gendi
Plantar fasciitis is a condition manifested by heel pain, mostly on weight bearing. Typically the patient feels the pain at its worse when the foot is placed on the floor first thing in the morning or after periods of rest which then eases after taking a few steps.
The diagnosis is made mainly through imaging such as X-rays, ultrasound and MRI. Either one or a combination of these may be required to exclude other conditions such as stress fracture or to show the site of the inflammation.
Most cases are mechanical in origin, due for example to excessive running or prolonged standing especially if the patient is wearing inappropriate shoes. The condition tends to be associated with flat feet.
In the minority of patients, plantar fasciitis is part of or even the sole manifestation of an inflammatory rheumatic condition.
The treatment of plantar fasciitis is mostly conservative and includes initially rest, activity modification, footwear changes, wearing heel pads or orthotics and stretching exercises. If persistent, pain injections along with immobilisation help to resolve the problem in 80-90% of patients within a year. The remaining 10-20% remains a challenge. Surgery is rarely resorted to.
ESWT is a welcome addition to our assortment of treatment methods. Apart from temporary pain and skin redness, ESWT is a safe treatment and studies have shown proven benefit from the treatment for stubborn cases. The success of the treatment is dependent on how the treatment is carried out and careful patient selection as it is not appropriate for everyone.