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Is diabetic peripheral neuropathy / diabetic vascular insufficiency a contraindication to shockwave therapy for plantar fasciopathy?

A patient with severe bilateral insertional plantar fasciopathies presented with significant sensory loss to monofilament through the forefoot and at the site of plantar fascia insertion into the calcaneum, however, is able to determine some sensation to light touch. He also has mottling and coolness in his feet following static postures secondary to poor vascularity due to Type 2 DM. He is due to receive ESWT treatment for his insertional plantar fasciopathies and I wonder whether these co-morbidities are a contraindication to this treatment.

Alison Hill

3 months ago

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Prof Tim Watson
Prof Tim Watson

shockwave would not (in my view) be absolutely contraindicated BUT I would certainly be proceeding with caution - there is a risk of being about tissue damage (as opposed to tissue stimulation) under these circumstances. The shockwave will have a strong 'pro-inflammatory' effect - and if the local vascularity is not able to deliver the response (due to the Type2 DM) then there is the potential for an adverse response. The diminished sensation is OK - though not ideal. If all sensation was absent, then I would not be going there. Diminished - OK with caution. If this were a patient of mine, then I might be thinking of trying other options in preference - though of course, appreciate that you may have already done so???

Prof Gad Alon
Prof Gad Alon

Dear Allison, I have no research or clinical experience with ESWT so I am unable to respond directly to your question. But I have vast experience with NMES and you certainly have an option to try it on the patient's feet. (trial and error but nothing to lose). Because of the frail skin you should use water-based electrode and not self-adhesive ones. Simply place one electrode over the heel and the other over the intrinsic of the foot and set it up for few sec contraction and few second relaxation. Increase the intensity to the patient tolerance (initially do not try to get maximal contraction). Diabetic related pain is likely to begin diminishing within 1-3 treatments. Pain related to the fasciitis is likely to begin diminishing within 2-3 weeks of daily application of 30 min. If you decide to try, it will be very helpful if you share your experience (good or bad) via the forum.

Cliff Eaton
Cliff Eaton

Dear Alison As communication and feedback with the patient is important, manufacturers of Shockwave contraindicate treatment directly over areas of sensory loss. If I have read you post correctly the patient does not appear to have total sensory loss over the proposed treatment area. Therefore, administration should be acceptabe That said: If in doubt - dont, then you cannnot be wrong I hope that helps Cliff

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