What is EPAT and How Can It Help My Nagging Heel, Foot and Ankle Pain?

November 16, 2017 Posted by Lindsay Lopez

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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