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Orthopedics and Health

Plantar fasciitis, extra-corporeal shock-wave therapy (ESWT)

New treatment For Tennis Elbow and Painful Heel

By Dr. W. Gifford Jones

February 17, 2002

"Why has God done this to me?" a patient asked several months ago. She had developed tennis elbow and had been forced to stop playing her favourite sport. But to make matters worse she had also developed plantar fasciitis, commonly known as painful heel. And she having difficulty walking. But she learned that God hadn't totally deserted her. Due to a new treatment she's now back playing tennis and walking without pain.

Tennis doesn't rival skiing down the Alps to head the list of sports causing serious injuries. But it's estimated that eight million North Americans suffer from tennis elbow. Another seven million from painful heel. And doctors have needed the wisdom of Solomon plus a little luck to ease the pain.

Moreover, contrary to popular opinion, tennis elbow is not the exclusive bailiwick of tennis players. Carpenters, dentists, window cleaners, pianists and gardeners often complain of aching arms and shoulders. Tennis elbow occurs in any activity that requires gripping and continued stress. It occurs more frequently in older players, but it does not respect ability. Weekend hackers get it and so do professionals .

It's generally believed that the backhand shot is the main culprit. But studies indicate it doesn't matter whether players use wood or metal rackets, tight nylon or gut strings. Some sports medicine specialists believe it's the size of the grip that makes the difference with a small grip causing the most pain.

Continued stress also triggers Plantar fasciitis. The plantar fascia is a thick structure that runs from the heel bone to the ball of the foot. It aids in supporting the arch of the foot and, like the string on a bow, is subject to strong forces. This may cause small tears in the fascia In the process of healing a bony spur may occur causing pain. And when the feet hurt everything hurts.

Small wonder that so many people suffer from this condition. Today the typical worker walks seven miles a day. The busy housewife up to 10 miles a day. And the average person walks 70,000 miles in a lifetime, almost three times around the earth. Humans also now walk on concrete, buy tight, ill-fitting shoes and are often overweight. And in the process of evolution two legs have replaced four for supporting

My patient is happily back on the court because of extra-corporeal shock-wave therapy (ESWT) . It's been used for several years to break up kidney stones and is now helping those who suffer from both tennis elbow and painful heels.

Dr Robert Gordon, a prominent Canadian orthopedic surgeon, has been using ESWT for the last two years at Toronto's Etobicoke General Hospital. And because of ESWT players for the Texas Rangers and Boston Celtics suffering from painful heel have returned to the game.

Gordon says ESWT cures tennis elbow in 63 percent of cases and 72 percent of those suffering from painful heel.

U.S doctors and researchers treated 364 patients with chronic heel pain and found it effective in 82 percent of cases.

Dr Gordon says that ESWT works by causing miniature fractures in the tissues. This improves the circulation and increases the activity of cells called osteoblasts which help the healing process. Patients feel better in six weeks, but the healing process requires three months.

ESWT takes 20 to 30 minutes and patients can return to work the same day. Dr Gordon claims the only side-effect is some bruising and he has not encountered any serious complications.

Is there any way to prevent these injuries? We can't stop walking. But we can use better sense when playing tennis. If you begin to get mild pain during a game your elbow is delivering a message. So give your tendons a rest before they become hot and painful.

Remember to warm up before the game. Researchers warmed up the tendons of rabbits and then tested them for strength. They found the tendons endured more force without harm after they had been warmed up.

ESWT is also being used to heal small stress fractures. But what is more exciting is it's ability to heal broken bones that simply refuse to heal. Runners, jumpers and skiers often fracture the tibia, the main bone in the lower leg. In some cases the ends of the bones will not unite. It's a serious complication and normally requires the insertion of intramedullary nails to stabilize the fracture. Now ESWT is being used to stimulate the work of the osteoblasts.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod