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EPAT or Extracorporeal Pulse Activation Technology is an FDA approved treatment for a variety of musculoskeletal disorders. In the lower extremity, it is most commonly used for plantar fasciitis, Achilles tendonitis, and other tendon pain. EPAT is a non-invasive procedure, which works by using pressure waves to increase blood flow and metabolism to the injured area in order to help accelerate the healing process.

Most patients will undergo 3 different treatment sessions over 3 consecutive weeks with each treatment lasting 5-10 minutes. Only restriction with undergoing the treatment is all non-steroidal anti-inflammatories and icing must be stopped prior to treatment because they can interfere with the positive effects promoted from the EPAT. The best results from the treatment usually begin about 6 weeks following the last treatment. There are multiple level 1, 2, and 3 studies on EPAT with an overall success rate of 80-85%. EPAT is thought to be just as effective as, if not more effective, than other modalities, such as injections and medications, with possible quicker return to activity. For additional information on EPAT, and how it can help your chronic foot and ankle pain, consult your doctor or check out some of the links below to view some of the research articles.

PubMed listed publications – Orthopedics
Foot and Ankle

Extracorporeal shockwave therapy in patients with Morton’s Neuroma Hyun Seok , MD, PhD, Sang-Hyun Kim , MD, PhD, Seung Yeol Lee , MD, Sung Won Park , MD Journal of the American Podiatric Medical Association (2016)

Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study Gollwitzer, H; Saxena, A; DiDomenico, LA; Galli, L; Bouché, RT; Caminear, DS; Fullem, B; Vester, JC; Horn, C; Banke, IJ; Burgkart, R; Gerdesmeyer, L. The Journal of Bone and Joint Surgery (2015)

Two emerging technologies for achilles tendinopathy and plantar fasciopathy. Langer PR. Clinics in Podiatric Medicine and Surgery (2015)

Ultrasonographic evaluation of low energy extracorporeal pulse activated therapy (EPAT) for chronic plantar fasciitis. Gordon R, Wong C, Crawford EJ. Foot & Ankle International (2012)
Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete. Saxena A, Fournier M, Gerdesmeyer L, Gollwitzer H. Muscles, Ligaments and Tendons Journal (2012)
Successful treatment of chronic plantar fasciitis with two sessions of radial extracorporeal shock wave therapy. Ibrahim Ibrahim M, Donatelli R, Schmitz C, Hellman M, Buxbaum F. Foot & Ankle International (2010)

Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures.Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures. Lohrer H, Nauck T, Dorn-Lange NV, Schöll J, Vester JC. Foot Ankle International (2010)

Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H. American Journal of Sports Medicine (2008)

Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Journal of Foot & Ankle Surgery (2007)

Extracorporeal Shock Wave Therapy for the Treatment of Plantar Fasciitis Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Foot & Ankle International (2004)

Effect of shock-wave therapy on patellar tendinopathy in a rabbit model. Hsu RW, Hsu WH, Tai CL, Lee KF. Journal of Orthopedic Research (2004)

Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy. Hammer DS, Adam F, Kreutz A, Rupp S, Kohn D, Seil R. Archives of Orthopaedic and Trauma Surgery (2003)

Shock wave therapy induces neovascularization at the tendon-bone junction: a study in rabbits. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, Yang LC. Journal of Orthopedic Research (2003)

Preliminary Results on the Safety and Efficacy of ESWT for Treatment of Plantar Fasciitis. Alvarez R. Foot & Ankle International (2002)

Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and a comparison of results to fasciotomy. Weil LS Jr, Roukis TS, Weil LS, Borrelli AH. Journal of Foot & Ankle Surgery (2002)

Achilles

Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy Gerdesmeyer L. Mittermayr R, Fuerst M, AI Muderis M, Theiel R, Saxena A International Journal of Surgery (2015)

Extracorporeal shock wave therapy improves the walking ability of patients with peripheral artery disease and intermittent claudication. Serizawa F, Ito K, Kawamura K, Tsuchida K, Hamada Y, Zukeran T, Shimizu T, Akamatsu D, Hashimoto M, Goto H, Watanabe T, Sato A, Shimokawa H, Satomi S. Japanese Circulation Journal (2012)

Extra-corporeal pulsed-activated therapy (“EPAT” sound wave) for Achilles tendinopathy: a prospective study. Saxena A, Ramdath S Jr, O’Halloran P, Gerdesmeyer L, Gollwitzer H. The Journal of Foot & Ankle Surgery (2011)

Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Rompe JD, Furia J, Maffulli N. American Journal of Sports Medicine (2009)

Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy: a randomized, controlled trial. Rompe JD, Furia J, Maffulli N. The Journal of Bone and Joint Surgery (2008)

Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendon Achillis: a randomized controlled trial. Rompe JD, Nafe B, Furia JP, Maffulli N. American Journal of Sports Medicine (2007)

High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Furia JP. The American Journal of Sports Medicine (2006)

Shock wave therapy for chronic Achilles tendon pain: a randomized placebo-controlled trial. Costa ML, Shepstone L, Donell ST, Thomas TL. Clinical Orthopedics and Related Research (2005)

Lower Extremity

The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. American Journal of Sports Medicine (2014)

Vibration and pressure wave therapy for calf strains: a proposed treatment. Saxena A, St Louis M, Fournier M. Muscles, Ligaments and Tendons Journal (2013)

Ultrasonographic evaluation of low energy extracorporeal pulse activated therapy (EPAT) for chronic plantar fasciitis. Gordon R, Wong C, Crawford EJ. (Foot Ankle Int. Mar 2012)

High-energy focused extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease). Knobloch K, Vogt PM. BioMed Central Research Notes (2012)

Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study Moen MH, Rayer S, Schipper M, Schmikli S, Weir A, Tol JL, Backx FJ. British Journal of Sports Medicine (2011)

Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. Cacchio A, Rompe JD, Furia JP, Susi P, Santilli V, De Paulis F. The American Journal of Sports Medicine (2010)

Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome Rompe JD, Cacchio A, Furia JP, Maffulli N. American Journal of Sports Medicine (2009)

Extracorporeal shockwave for chronic patellar tendinopathy. Wang CJ, Ko JY, Chan YS, Weng LH, Hsu SL. The American Journal of Sports Medicine (2007)

Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. Sems A, Dimeff R, Iannotti JP. Journal of the American Academy of Orthopaedic Surgeons (2006)

Effects of shock waves on the microcirculation in critical limb ischemia (CLI) (8-week study). De Sanctis MT1, Belcaro G, Nicolaides AN, Cesarone MR, Incandela L, Marlinghaus E, Griffin M, Capodanno S, Ciccarelli R. Angiology (2000)

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Important Reminders About EPAT

November 9th, 2017 by Lindsay Lopez

EPAT is:
• Performed in your physician’s office/ clinic
• Does not require anesthesia
• Requires a minimal amount of time

Patients can:
• Bear weight (i.e. walk) immediately,
• Return to work/normal activities within 24-48 hours
• Resume strenuous activities after 4 weeks.

Interested in finding out more EPAT and if this treatment could help you? Let’s talk.

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More Questions and Answers about EPAT

November 7th, 2017 by Lindsay Lopez

What is the duration of the treatment and how many treatments will I need?
Treatment sessions take approximately 5-10 minutes depending on the disorder to be treated. Generally, at least 3-5 treatment sessions are necessary at weekly intervals.

What are the possible side effects or complications?

The non-invasive EPAT treatment has virtually no risks or side effects. In some cases, patients may experience some minor discomfort which may continue for a few days. It is normal to have some residual pain after intense exercise or a full day of work.

What if I have a special health condition?

The safety and effectiveness of the EPAT procedure has not been determined on people with the following health conditions. Your doctor will provide you with information about how these and other conditions might affect the determination to perform the EPAT procedures.

• Malignancies
• DVT (Deep Vein Thrombosis)

How is the treatment performed?
Coupling gel is applied to the treatment area of interest to enhance effectiveness. After these preparations, EPAT pressure waves are released via the applicator moved over the area of interest in a circular motion.
Why consider non-invasive EPAT?
EPAT has a proven success rate that is equal to or greater than that of traditional treatment methods (including surgery) and without the risks, complications and lengthy recovery time.

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Why Should You Consider EPAT?

November 2nd, 2017 by Lindsay Lopez

Are you tired of being in pain?

Patients, like you, who suffer from acute and chronic musculoskeletal pain now have access to an innovative,
non-invasive treatment that will get you feeling better, faster.

CuraMedix Extracorporeal Pulse Activation Technology (EPAT) is the most advanced non-invasive technology which uses energy based on unique sets of acoustic pressure waves.

EPAT helps to improve the regenerative potential, rather than further damage an area that has degenerated because of poor blood flow, tissue injury, overuse or weakness.

In as few as three weekly five to ten minute sessions, you’ll be able to return to your favorite sport or activity. And there’s no downtime.

What is EPAT?
Extracorporeal Pulse Activation Technology (EPAT), sometimes referred to as ESWT or shock wave therapy, is the most advanced and highly effective non-invasive treatment method cleared by the FDA. This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process.
What disorders can be treated?
Generally, acute or chronic musculoskeletal pain and/or pain that significantly impairs mobility or quality of life including:
• Foot and heel pain
• Achilles pain
• Tendon and/or tendon insertion pain
• Neuromas
• Trigger points

What are the expected results?
Some patients report immediate pain relief after the treatment, although it can take up to four weeks for pain relief to begin. The procedure eliminates pain and restores full mobility, thus improving your quality of life. Over 80% of patients treated report to be pain free and/or have significant pain reduction.
Is it safe?
Yes. This FDA cleared technology was developed in Europe and is currently used around the globe. A wealth of medical experience, state-of-the-art engineering and optimal quality have been built into each EPAT device, and extensive clinical studies and tests have confirmed its safety and efficacy.

Stay tuned for more information about EPAT!

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EPAT Offered at Three Locations!

October 7th, 2017 by Lindsay Lopez

What is EPAT?
Extracorporeal pulse activation treatment (EPAT®) is the most advanced and highly effective noninvasive treatment method approved by the FDA to treat acute or chronic muscle and tendon pain by stimulating blood circulation and accelerating the healing process. Damaged tissue gradually regenerates and eventually heals. Patients with heel pain (plantar fasciitis) or other tendon pain like Achilles tendonitis can benefit from this treatment.
How does EPAT work?
The treatment utilizes a unique set of acoustic pressure waves that are delivered through the body and focused on the site of pain/injury with a special applicator. These pressure waves stimulate the metabolism, enhance blood circulation and accelerate the healing process.

We offer EPAT at three of our locations-Rio Road, Abbey Road, and Fishersville!

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Use Caution when Mowing your Lawn to Prevent Injury!

September 19th, 2017 by Lindsay Lopez

Homeowners should always use caution when mowing their lawn. Take time to protect your feet and the feet of those around you, when using a mower with a rotary-blade.

25,000 Americans sustain injuries from power mowers each year according to the US Consumer Products Safety Commission. Did you know that the blade on your mower moves at 3,000 revolutions per minute? It CAN also produce more kinetic energy than a .357handgun!
Children under 14 and adults over 44 are the most likely to get injured from mowers. To prevent injury, please consider the simple precautions listed below:
• Don’t mow your lawn when its wet. You can lose control of the mower if you slip and cause a foot injury.
• Always were heavy shoes or work boots. Do not wear sneakers or sandals.
• Small children should not ride on adults lap while the adult is using a lawn tractor. This can cause serious injury to the child.
• When a mower is running, do not pull it backward.
• Children should avoid the area being mowed.
• To avoid projectile injuries, keep the clip bag attached.
• Make sure your mower has a release mechanism on that handle, so it automatically shuts off when you let go.
If you are injured while mowing, please seek immediate treatment. The wound will need to be flushed and antibiotics will need to be applied to prevent infection. More serious injuries could require surgical intervention.

Mow safely!

 

Check out the Spring edition of Foot Prints!!!

September 14th, 2017 by Lindsay Lopez

The Spring Edition of Foot Prints, which is published by the American Podiatric Medical Association, is below. We hope you enjoy reading it! There is a lot of great information included.

 

APMA_Footprints_April17_FINAL

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I Have an Ingrown Toenail, so What Can Be Done?

August 2nd, 2017 by Lindsay Lopez

Ingrown toenails can become a painful nuisance that can affect us throughout the day. An ingrown nail is when a side of the nail starts to grow into and irritate the skin. This can cause pain and redness. There are a variety of reasons that they can develop, like cutting your nails improperly opposed to straight across, after nail trauma, or some people naturally have more curved nails than others. These can be especially painful in shoes and eventually become infected if left untreated. So what can be done?

If the ingrown toenail is minor, than your doctor may be able to trim the offending edge to give you some relief; however, by the time most people come in with an ingrown toenail it is past the point of a simple trim. The next option is what is called a partial nail avulsion. What this normally entails is your doctor numbing up your toe to help take away discomfort, so that the portion of the side of the nail that is ingrown can be removed all the way back to where the nail starts under the skin. If you are someone who has had recurrent ingrown nails on the same toe, than a chemical can also be used to help prevent that portion of the nail to grow back ingrown. After the procedure you may have some mild discomfort once the numbing medicine wears off, which can be controlled with Tylenol or anti-inflammatories. Your doctor will usually have you soak your toe over the next couple days and cover the area with a Band-Aid. Sometimes, especially if the toe is infected, your doctor may put you on a course of oral antibiotics.

 

–Dr. Colleen Law

What is Plantar Fasciitis?

July 26th, 2017 by Lindsay Lopez

One of the most common causes of heel pain on the bottom of your foot is plantar fasciitis. Plantar fasciitis is pain along your heel and arch due to inflammation of the plantar fascia. The plantar fascia is a large band on the bottom of your foot that goes from the heel bone and attaches to each of the toes. This band helps support your arch as you walk. Plantar fasciitis can affect a variety of people including athletes or those who spend a lot of time on their feet at work. The pain is typically described as severe with the first couple of steps out of bed in the morning or with the first couple of steps after sitting for a long period of time. The pain generally starts to feel better as you start to take more steps, but some people also develop worsening pain or feeling of fatigue in their foot as the day goes on.

There are several different types of treatments for plantar fasciitis. One of the most important things when dealing with plantar fasciitis is supportive shoe gear. Flip-flops and flexible shoes without much support can exacerbate the condition. Also calf stretches, anti-inflammatories, and ice at the end of the day or after activities are helpful to try and calm down the inflammation. Freezing a water bottle and rolling it along your arch is a good option when it comes to icing. If these basic measures fail than steroid injections, arch supports, or night splints can also be utilized.

–Dr. Colleen Law

The posterior tibial tendon is located on the inside of your ankle and plays a major role in supporting and maintaining the arch on the bottom of the foot. Due to the high demands of the tendon with every day life, it can result in overuse of the tendon. This overuse is referred to as posterior tibial tendon dysfunction. When this occurs, patients will eventually develop a flat foot deformity and loss of arch height due to the weakened tendon no longer being able to support the arch. This condition is commonly seen in middle-aged women. Those with diabetes also have an increased risk.

The major problem with posterior tibial dysfunction is that it is a progressive disorder. This means that it will get worse overtime. The initial symptoms of the condition are pain and tendonitis; however there is normally no decrease in strength of the tendon or loss of arch at this stage. As it worsens, the tendon will develop tears and the patient will eventually end up with a decrease in the arch height and a flat foot. With early diagnosis, the progression can normally be slowed, or halted, through the use of orthotics, bracing, immobilization and physical therapy. If the dysfunction is left untreated, or progresses, then it may eventually have to be treated with surgical intervention.

 

–Dr. Colleen Law

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