Tuesday, October 13, 2015

Plantar Fasciitis and Extracorporeal Pulse Activation Technology: Part One

I first noticed the pain around May of 2014. I had been running/walking for about six months. Running/walking was new to me and I had fallen heads over heels in love with it. Well, maybe not with the running itself, but more the high I got when I ran. And when I completed a race. I figured that the pain I had in my heels was from overuse so I cut back on my mileage.

I also have a chronic illness called Sjögren's syndrome that can cause inflammation and issues with joints, tendons, and muscles. I had recently weaned off prednisone for the first time in a very long time and I thought my body just needed to adjust to functioning without it. But by July 2014, I was having major difficulties with being on my feet.

I saw a podiatrist in August and was diagnosed with bilateral plantar fasciitis with my right foot pain being worse than my left. I started with conservative treatments such as stretching and ice. If you have ever had plantar fasciitis (PF), you know that it can be a relentless, often debilitating pain that can affect all aspects of your life from work to travel to even basic personal care. By this point I had stopped running/walking all together and was lucky if I could ride a stationary bike for ten minutes without being in agony.

My podiatrist and I went through treatment after treatment: two round of physical therapy that lasted more months than I can remember; exercises, night splints, NSAIDs; alternative therapies, acupuncture, and multiple cortisone injections into both feet.

After a year and a half of all this, I had pretty much given up all hope of ever being able walk without pain again. Then at a follow-up appointment, my podiatrist presented me with three more treatment options: invasive surgery, a minor surgical procedure called TOPAZ, and an office procedure called extracorporeal pulse activation technology, or EPAT for short.

I was starting a new job and going back to work on a regular basis for the first time since 2008, so time off for invasive surgery was out of the question. I researched the other two options and while I thought the minor surgical procedure seemed like possibly the best option long-term, I did not want to risk needing time off from work if I didn't recover quickly. I was also looking at gallbladder surgery in the very near future and two surgeries in a matter of a few months did not seem like the best option for me.

So after much discussion with my husband, I elected to go with the EPAT treatments. The treatments did not require time off from work to recover, but they also are not covered by medical insurance and the average cost for the three treatments is $500.

I decided to write about my EPAT experience because I didn't know much about it going into it in terms of what to expect during the treatments or afterwards. I did my research online, and while there was plenty of technical information available, there wasn't much information in regards to actual patient experiences. The one patient experience I did read online was a horror story about how incredibly painful the procedure was, in detail. It scared me enough that I asked my husband to go to my first treatment with me!

EPAT is a non-invasive technology, invented by a company called CuraMedix, that uses pressure waves to stimulate the patient's metabolism, enhance blood circulation, and accelerate the healing process. The damaged tissue regenerates and gradually heals. Basically, using the body to heal itself which for me, was an attractive option. It treats many acute and chronic musculoskeletal conditions throughout the body and can be used in areas such as the feet, shoulders,neck, back, and other upper and lower extremities. Over 80% of patients treated report to be pain-free and/or have significant pain reduction. The procedure has virtually no side effects.

From what I read online, there are different ways to use EPAT. The doctor who did mine scheduled me for three treatments for three consecutive weeks. I also found out that because I have no office co-pay and my deductible for the year had already been met, the cost of the treatments was only going to be $50 for each office visit for a total of $150. That was definitely good news and quite a relief!

My first treatment was last week. My doctor doesn't do the treatments and so another doctor and a CuraMedix representative, along with my husband, were in the procedure room with me. The rep was there because this was the first week my doctor's office was doing the treatments, preceded by some patient trials.

I did not receive any local anesthetic. The treatment is done by using a large wand that looks similar to one they use for ultrasounds. After the doctor locates the most sensitive spots on your heel,a gel is applied and the treatment begins. She started off at the lowest setting and it feels like a very deep tissue massage. She gradually increases the setting to increase the pressure waves. The way she explained it to me was that the higher of a setting I could tolerate, the better. It would increase my chances of the therapy curing my PF.

I cannot lie. Once she started increasing the intensity, it hurt. It's not the actual device itself that hurts, but it's the pressure on the already damaged tissue that hurts. Once I got to a level where I felt like I couldn't tolerate it any higher, she left it at that setting. The entire procedure lasts about ten minutes. I have had a lot of painful procedure and I have to say, yes, it's uncomfortable, but it was nowhere near as bad as I had anticipated and I think that most people would find it very tolerable.

When I walked out of the office, I had no pain in my right heel for the first time in a year and a half and that was awesome! I was forewarned that in 24-28 hours, the pain could increase because the area would be inflammed. That is actually a good thing because it's part of the process of the tissue healing itself. And 48 hours is right when the pain came back for me. I had the procedure on a Tuesday and the pain intensified significantly from Thursday through Sunday. By Monday, it was less than my pre-procedure pain. Then I went back for treatment number two the next day, on Tuesday morning.

That was this morning. I found today's procedure more tolerable and the doctor explained to me that I should start to see more improvement as the week goes on.

The one major drawback for me, that I didn't know about until they were about to start my first treatment last week, is that while you are having this done, and for a while in the weeks that follow, you should not take NSAIDs or any other antiinflammatory medication while you are undergoing treatments. This is because the treatments are designed to initially cause inflammation and taking these kinds of medications could cause the treatments to not work as well.For me, this has been an issue because I have recently been having more autoimmune related pain issues and I had to stop taking Motrin for my pain. It also meant that I couldn't ask my doctor for a short course of steroids. Actually, I shouldn't say couldn't. I could, but I felt that it wasn't worth the risk of going through all this and then take the chance of the treatments not working optimally for me.

So that has been my EPAT experience so far. My plan is to do a follow-up blog post a few weeks after my treatments end to update you on my progress. I am hopeful though that this may be the answer to all my plantar fasciitis woes. Stay tuned!


  1. Went to this center acupuncture and the staff was great. The Mississauga acupuncturist was professional and understanding. The guy really takes his time listening to the patient. The treatment was great and I felt much better afterwards.

  2. That was this morning. I found today's procedure more tolerable and the doctor explained to me that I should start to see more improvement as the week goes on.

    1. Once I improved after the treatment, I was fine.