Extracorporeal Shock Wave Lithotripsy ( ESWL )

Extracorporeal Shock Wave Lithotripsy is a technique recently developed to break the cycle of re-injury associated with plantar fasciitis. This new treatment is called called OssaTripsy. This name is to distinguish the orthopedic lithotripsy from urological lithotripsy. Lithotripsy was originally developed to treat kidney stones non-invasively. Shockwave therapy revolutionized Urology ( urinary system surgeons ) by giving surgeons the option of treating the kidney stones without:

• Invasive surgery – No cutting
• Overnight hospital stays, before stone removal surgery require multiple days in the hospital
• Less damage to the kidney area

A company called HMT ( High Medical Technology ) developed the OssaTron®. HealthTronics SSI (Nasdaq symbol: HTRN ) distributes and operates the OssaTron in the United States and Canada. The HealthTronics' OssaTron(r) was the first high-energy ESW device in the U.S. approved by the Food and Drug Administration (FDA). The OssaTron is the only device in the U.S. approved to treat two chronic orthopaedic conditions, chronic plantar fasciitis and chronic lateral epicondylitis, more commonly referred to as tennis elbow. HealthTronics currently operates approximately 60 OssaTrons throughout the country and the Company has performed approximately 15,000 procedures since receiving FDA approval for its first indication in early 2001.

OssaTripsy uses a acoustic energy wave that is focused at the area of pain. It is believed that the shock wave causes micro-trauma to the area. This micro-trauma stimulates an intense focused inflammatory response that promotes healing at the insertion point of the plantar fascia.

For Ossatripsy to be effective a high level of energy is required and can be painful. Most patients in the U.S. have the procedure performed in an outpatient setting with twilight sedation ( MAC sedation). The procedure takes about 15 minutes to perform. Patients are able to walk on the foot the same day of treatment. Complications have been minimal. Most doctors advise continued stretching and limited activity for approximately 4 weeks after surgery.

The long term success of Shock Wave therapy has yet to be seen, although short term success rates of 65% -95% have been seen. The best success rates seem to result from treatments with high-energy shock waves. The OssaTron is a high-energy treatment option. ( December 2003 )

Recently, the American College of Foot and Ankle Surgeons (ACFAS) and the American Podiatric Medical Association (APMA) have released a joint policy statement endorsing the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of plantar fasciitis, more commonly known as heel spurs or heel pain syndrome. This policy statement acknowledges ESWL as ``revolutionizing the treatment of chronic heel pain, much the same way the lithotripter did for kidney stones in 1984.''

Two articles published in Foot & Ankle International(r), a publication of the American Orthopaedic Foot & Ankle Society, support the efficacy of shock wave surgery with the OssaTron(r) to treat chronic plantar fasciitis. The articles, titled ``Symptom Duration of Plantar Fasciitis and the Effectiveness of Orthotripsy(r)'' and ``Effect of Extracorporeal Shock Waves on Calcaneal Bone Spurs,'' were published in the December 2003 edition of Foot & Ankle International, Volume 24, Number 12.