SWISS DOLORCLAST APPLICATIONS FOR PODIATRTY

1. SWISS
DOLORCLAST
APPLICATIONS
FOR PODIATRY

2. HISTORY
• EMS/Dolorclast was the first company to
develop Lithotripsy
• Extracorporeal Shockwave Therapy
• (ESWT) was first used to treat kidney stones
• Since 1990 (ESWT) has been used for a
variety of orthopaedic applications.
• More recently, it is used for treating wound
ulcers, lymphodema, burns and cellulite

3. Indications for RSWT®
Tennis elbow
(Epicondilitis
humeri radialis) Subacromial pain
syndrome
Greater trochanteric Golfer‘s elbow
pain syndrome (epicondylitis
humeri ulnaris)
Patellar tip syndrome Medial tibial stress
syndrome
Achilles
Plantar fasciopathy tendinopathy

4. MECHANISMS
• The procedure accelerates the body's own
healing mechanisms by:-
• Generating impulses of high energy, high
pressure sound waves that travel through
skin to stimulate healing.
• It is effectively changing a chronic
condition to an acute condition.

5. Radial extracorporeal shock wave therapy
RSWT®

6. 28.11.2011 Gloria Allery & Val Bryce 6
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7. RSWT®: basic physics (3) - cavitation
• Which part of shock waves mediates their biological efffects on
tissue?
• "A significant tissue effect is cavitation consequent to the
negative phase of the wave propagation."
• (Ogden et al., 2001)

8. RSWT®: see shock waves on high speed movie:
8
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9. RSWT®: basic physics - cavitation
Cavitation bubbles
Wave front
Secondary
Hydrophone shock waves
(used to trigger
a high-speed
camera)
Applicator
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10. SCIENTIFIC BACKGROUND
• ESWL can trigger a variety of effective
actions
• Release more substance P
• Inhibits the COX11 enzyme
• Activates cellular defenses
• Hyper stimulates nerve fibres

11. RSWT RANDOM CONTROL TRIALS WITH POSITIVE
OUTCOMES
Chronic plantar fasciopathy
•Gerdesmeyer et al., Am J Sports Med 2008; 36: 2100-2109
•Chow and Cheing, Clin Rehab 2007;21: 131-141
•Greve et al., Clinics 2009; 64: 97-103
Midportion Achilles tendinopathy:
•Rompe et al., Am J Sports Med 2007;35:374-381
•Rompe et al., Am J Sports Med 2009;37:463-470
Insertion Achilles tendinopathy:
•Rompe et al., Am J Bone Joint Surg 2008;90:52-61
Medial tibial stress syndrome:
•Rompe et al., Am J Sports Med 2009 [Epub Sep 23]
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12. PROBLEMS WITH DIABETIC
FOOT
• Diabetes= Worldwide= over 200million
Qld = over 200,000
• Over 1 million diabetic amputations year
worldwide
• Most common diabetic admissions
Foot ulcers = more than 15%
Amputations = more than 1-3%

13. STANDARD FOOT ULCER
MANAGEMENT
• Control infection
• Improve blood supply
• Optimise wound healing environment
• Protect wound from trauma

14. TREATMENT
ESWT in conjunction with standard
therapies for off loading foot pressure
• Padding
• Insoles
• Orthotics
• Footwear- sandals boots, casts, splints
• Walking aids, crutches, walking sticks,
wheelchairs

15. Case Study
• This patient was treated at a Hairmyres Hospital,
Scotland, and had a large diabetic foot ulcer.
This had been surgically debrided and had also
had larvae therapy. It was not responding to
treatment and there was a real chance that the
patient would need a lower leg amputation.
• The patient was treated with ESWT over a
period of six months during which there was full
healing. On average he was treated once every
2.5 weeks.

16. Large diabetic foot ulcer-
March 2010,prior to treatment

17. 24th AUGUST 2010 5 TH October 2010

18. References
[1] R. Saggini, A. Figus, A. Troccola, V. Cocco, A.
Saggini, and N. Scuderi. Extracorporeal shock wave
therapy for management of chronic ulcers in the lower
extremities. Ultrasound Med Biol, 34(8):1261– 1271,
August 2008.
[2] W. Schaden, R. Thiele, C. Kolpl, M. Pusch, A.
Nissan, C. E. Attinger, M. E. Maniscalco-Theberge, G. E.
Peoples, E. A. Elster, and A. Stojadinovic. Shock wave
therapy for acute and chronic soft tissue wounds: a
feasibility study. J Surg Res, 143(1):1–12, 2007.
[3] A. M. Larking, S. Duport, M. Clinton, M. Hardy, and K.
Andrews. Randomized control of extracorporeal shock
wave therapy versus placebo for chronic decubitus
ulceration. Clin Rehabil, Feb 2010.

19. • [4] J. Dumfarth, D. Zimpfer, M. Vögele-Kadletz,
J. Holfeld, F. Sihorsch, W. Schaden, M. Czerny,
S. Aharinejad, E. Wolner, and M. Grimm.
Prophylactic low-energy shock wave therapy
improves wound healing after vein harvesting for
coronary artery bypass graft surgery: A
prospective, randomized trial. Ann Thorac Surg,
86(6):1909–1913, December 2008.
• [5] C. Wang, Y. Kuo, R. Wu, R. Liu, C. Hsu, F.
Wang, and K. Yang. Extracorporeal shockwave
treatment for chronic diabetic foot ulcers. J Surg
Res, 152, 96–103 (2009).

20. RSWT : summary
®
→Physical mechanisms of action understood
→Wave propagation
→Cavitation
→Molecular and cellular mechanisms of action
understood
→Immediate pain relief by depletion of substance P
→Blockade of neurogenic inflammation
→Change of gene expression in adult stem cells
towards healing
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21. →Happy patients
→Efficacy and safety demonstrated in various
RCTs
→Evidence-Based Medicine Level 1
→Fast (3 x 5 min treatment) with immediate benefit
→Negligible side effects when applied properly (skin
reddening)
→No injections, no cortisone, no surgery!
→No doping!

22. A treatment modality becomes successful when...
∀ →we know how it works
∀ →we know that it works
∀ →we know why it works
→your patients become enthusiastic about it!
Enthusiastic patients – successful practice!