I was intrigued by the literature review of Drs Clement and Taunton in the recent BCMJ (“Extracorporeal shock wave therapy in the management of plantar fasciitis,” 2004;46[4]:174-178 [10]).

While appreciating the complexity of this type of therapy, I would find it difficult to persuade someone to pay the required $895. Painful heels are not limited to those who are “well-heeled.”

Fortunately, in our 25 years of practice, I have yet to find a patient who failed to respond to conservative therapy (exercise, orthotics, NSAIDs) or, as a last resort, one or two injections of cortisone into the heel.

The high-tech aspects of shock wave therapy are appealing, but is this just another machine in search of diseases to treat?

—Bernhard Toews, MD
Coquitlam