Sports Medicine Corner – Guest Author

Dr. Kurt Rode, of West Hartford Podiatry, and the Podiatry Center of Eastern Connecticut, has contributed the article below on a new treatment option for plantar fasciitis. Dr. Rode is a Doctor of Podiatric Medicine and has served on the medical teams at both the Boston Marathon and New York City Marathon. 

Alternative Treatment for Plantar Fasciitis

As a runner my self, I know all too well the frustration not being able to run due to plantar fasciitis or Achilles tendinitis. There is a vast number of treatment options out there. Just search the internet and you’ll find everything from home remedies to socks and surgery.

One of these treatments is Extracorporeal Pulse Activation Treatment or EPAT and one that has sparked a lot of interest of late. Some studies suggest it may be equal to surgery.

EPAT is a low frequency sound pulse wave that causes microscopic biologic responses in the soft tissue that leads to tissue regeneration in acute or chronically injured tissues.

The origin of EPAT is set in treatments used to treat kidney stones. Later treatments of calcific tendonitis of the rotator cuff lead to and attempt at dissolving heel spurs in patients with heel pain. They did not find reduction in heel spur size, but did notice that the patients experienced pain relief.

The exact mechanism of how EPAT affects tendon healing is not fully understood. There is evidence to suggest that EPAT works because cells in the connective tissue have the ability to convert EPAT stimulus into biochemical signals that increase the release of growth factors and decrease inflammatory cells.

More study is needed to understand the exact biologic effect EPAT has on tissues. All we know for certain is that in 86% of cases patients have lasting pain relief. 

Is EPAT for me?

Thorough evaluation by your doctor is recommended to determine if this treatment is appropriate for you. All tough there is minimal contraindications to this therapy, patients with a history of a deep vein thrombosis (DVT), are on blood thinners, or have a history of malignancy should not undergo this treatment.

You will need to stop all anti-inflammatory medications two weeks prior to the treatment.  You will be required refrain from taking any anti-inflammatories during the treatment and should not use ice, as all of these will impede the treatment. Tylenol is recommended for pain relief if it is needed. Activity modification is recommended during the treatment period.

EPAT is administered once a week for 4 weeks. Most patient experience some level of discomfort during the session. Local anesthetic is not needed and intensity is guided by the patient’s comfort level.

Typically you will not experience any significant improvement after the first treatment, however a slight reduction in pain for a few hours after treatment is common. Most patients experience improvement between week 2 and 3 with significant reduction in symptoms noted around 4 weeks after their last treatment. 

EPAT is an emerging, well tolerated, and effective treatment for tendon pathologies. As with all treatment options, consult your doctor to make an informed decision.