I read the article “Extracorporeal shock wave therapy in the management of plantar fasciitis” with interest (BCMJ 2004;46[4]:174-178). I am a plastic surgeon in New Westminster and for approximately the last 25 years have been using ultrasound as my main management of plantar fasciitis. It works in a large percentage of cases and I wonder if the reason this works is somewhat similar to the extracorporeal shock wave therapy method. I have always assumed it probably increases the circulation to the area, possibly healing some tears in the plantar fascia or possibly minor stress fractures in the calcaneous. I would be interested to know if the authors have ever tried this method and if they have any comments regarding ultrasonic treatment for plantar fasciitis. To my knowledge this has not been described in the literature.

—John W.H. Legge, MBBCh
New Westminster

Authors' response

This is an interesting observation by Dr Legge on his experience with his use of ultrasound in the treatment of plantar fasciitis. The use of extracorporeal shock wave therapy (ESWT) is assumed to deliver energy to the site of pathology to stimulate and restructure the area. The analgesic properties of this therapy on the patient’s awareness of pain are thought to be related to an inhibitory effect on the sensory nerves either on a primary or secondary basis. This ESWT energy delivery in the removal of renal calculi is clear evidence of the ability to disrupt solid material. In the management of soft tissue problems ESWT is delivered in a less intense manner. It is not yet clear whether the analgesic effect is caused by direct effect on the pain mechanism or in control of the chronic inflammatory process.

— D.B. Clement, MD
J.E. Taunton, MD

John W.H. Legge, MBBCh, D.B. Clement, MD, Jack Taunton, MD. Re: ESWT. BCMJ, Vol. 46, No. 7, September, 2004, Page(s) 324 - Letters.

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