Bunion Shockwave Protocol

Hallux Valgus and Bunion Correction- Shockwave Protocol

Outline and Summary of Treatment for Bunion Patients

Introduction

Bunions have been long regarded by modern medicine as a normal part of aging, much like other forms of osteoarthritis.  However, through advances in fields of research such as biomechanics, physiology, and neuromuscular anatomy, it is now understood that Bunions (and osteoarthritis in general) is as much to do with ‘wear and tear’ on the body than it is a result of genetics, or aging.  Studies analyzing human locomotion (the mechanics, physical forces, and muscles/tendons/joints involved in walking/running) demonstrate that there exists optimal foot types and walking patterns, and the further we deviate from this optimal, the more prone we are to injury and damage.  Tires on a car wear with time, but any mechanic will tell you that they certainly wear quicker and unevenly if your wheel alignment is off.  As with tires, the same goes for your feet.  Check the bottom of your shoes for wear patters to see if it is uneven. 

As with a car, our bodies accumulate mileage- the average person takes approximately 10,000 steps per day (each foot absorbing all of our body weight, the ground reaction forces of which are much higher than our body weight due to the need to absorb the impact of our weight). Ten thousand steps a day results in 3,650,000 steps per year, or 30 million in ten years!  That is a tremendous amount of steps, and results in considerable physical force on your body (especially your feet).  That adds up to about 115,000 miles in a lifetime or more than four times the circumference of the globe. That is a lot of walking with, and with ill-fitting shoes or suboptimal foot mechanics (too much arch, flat feet, etc), even seemingly small and at first irrelevant issues can become major problems.If some of these steps are done with ill-fitting or improper foot wear (especially high-heels or ‘flip-flops’), the forces on the feet and subsequent damage exponentially increases.

Assessment

The first and most important aspect of the Bunion Shockwave Protocol is thorough physical and orthopedic assessment of your toes, feet and ankles.  This includes a biomechanical gait analysis (analysis of the way you walk).  This helps determine the causes and the secondary effects of your bunion(s).  It determines any other foot abnormalities that may have contributed to the formation of the bunion.  Your foot type (pronator, supinator), foot behavior (rearfoot valgus/varus, forefoot valgus/varus), and any joint dysfunctions and muscular imbalances will also be determined.  Strength testing, balance testing, and a battery of other tests are performed.  Radiographs (X-rays) may also be required to visualize the extent of any degeneration, should there be any suspected.  Thus a complete picture of the condition is developed.  This is part of the reason why this treatment protocol is so successful- it is very comprehensive.

Treatment  

Treatment type(s), durations, frequency will vary considerably from person to person, depending on several variables, including: the severity of the condition, length of time (chronicity), foot type, secondary conditions, etc.  The protocol can be of very short duration and frequency (1-3 weeks with one visit per week), or can be longer with increased frequency.  Most people experience results immediately, or at least very quickly (within 2-3 visits).  

Most people with bunions have some other type of foot abnormality, such as flat feet (pes planus) or over-supination (too high of an arch).  This therapy starts by addressing the causes of the bunion, and corrects them through stretching, strengthening, and manual therapy of the appropriate muscles, tendons and ligaments.  This takes pressure off the big toe, allowing it to move properly, thus eliminating the ‘causes’ of the bunion.  In some cases, custom foot orthotics are ordered to correct major contributing issues. This is a major advantage over surgery, which simply addresses the outcome of these factors- the bunion itself- without correcting ‘why’ it occurred. Also, surgery further damages the joint, leading to increased stresses through the foot during walking, and leads to more foot, knee and hip problems in the future.  

As noted, treatment type varies, but typically consists of a combination of the following:

    • Extra Corporeal Shockwave Therapy (ESWT)
      • Break-up calcium collection on side of the toe
      • Stretch relevant muscles, ligaments, tendons
      • Break up fibrosis/scar tissue
    • Active Release Techniques (ART) 
      • Stretch relevant muscles, ligaments, tendons
    • Joint mobilizations and manipulations 
      • Restore optimal joint position, movement (biomechanics), and proprioception
    • Bracing of the foot/toe
      • Supportive device to straighten the toe and maintain treatment gains
    • Taping of the foot/toe
      • Supportive device to straighten the toe and maintain treatment gains
    • Toe Spacer
      • Supportive device to straighten the toe and maintain treatment gains
    • Custom Foot Orthotics
      • Corrective shoe inserts to eliminate any biomechanical deficit of the foot
      • Optimizes gait pattern (kinetic chain)
    • Footwear education
      • Ensuring the proper footwear is worn
      • How to buy good shoes (several easy to do tests to exclude poor quality footwear)
    • Physical Therapy
      • In clinic and home personalized rehabilitation exercise and stretching program

This is the most Effective Treatment Available 

This treatment protocol is the the most comprehensive type of care available.  It is the result of years of research and clinical experience, combining many forms of therapy aimed at addressing the causes of Bunions- this is why it is so successful.  It addresses causes and effects of bunions, and analyzes the entire lower body in relation to your feet.  Our success rate is second to none!

 How long does the treatment last?

Approximately 2000-6000 shocks are administered per session, which last approximately 5 minutes per 2000 hits. Some patients and/or conditions require more shocks and duration, depending on severity and chronicity (how long the condition or injury has existed). Active Release Techniques, Stretching, Massage, Joint Mobilizations and Manipulations are then performed, followed by taping or bracing methods.  Thus, in total the treatment can last anywhere from 5 minutes to 35 minutes.

Treatment Costs

Typical treatments cost $120. However, a treatment may cost more, depending on the number of shocks required and delivered. Again, this depends on the severity and chronicity of the condition. Any necessary increases will be discussed with you beforehand.

How many treatments will I need?

Normally three to five treatments are necessary at weekly intervals; there is a small possibility that 2 or more additional treatments may be necessary if your condition is very chronic.

Does the treatment hurt?

It is a short treatment that may be fairly uncomfortable. However, most people are able to easily tolerate it. However, if you cannot tolerate it, adjustments on the machine can decrease the pressure you feel.

 Will it hurt after the treatment?

There may or may not be immediate pain, but some discomfort may be experienced 2-4 hours after the treatment. In some cases it can last up to 48 hours and in very rare cases, the pain lasted up to 5 days.  Some bruising and swelling can occur.


Are there contraindications and/or precautions? 

Contraindications include:

■ Coagulation disorders, thrombosis, heart or circulatory patients

■ Use of anticoagulants, especially Marcumar, Heparin, Coumadin

■ Tumour diseases, carcinoma, cancer patients

■ Pregnancy

■ Polyneuropathy in case of diabetes mellitus

■ Acute inflammations / pus focus in the target area

■ Children in growth

■ Cortisone therapy up to 6 weeks before first treatment

 Side effects include: (These side effects generally abate after 5 to 10 days.)

■ Swelling, reddening, haematomas

■ Petechiae, bruising

■ Pain

■ Skin lesions (especially after previous cortisone therapy)


If you have any further questions, please contact Dr. Kirk Andrew at 613-731-5775 or drkandrew@gmail.com



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