ROSEMONT, IL--(Marketwire - April 08, 2009) -
This award-winning study published in the
February 2009 Foot & Ankle International
, the official journal
of the American Orthopaedic Foot & Ankle
, was the first research done on the biologic effect of
extracorporeal shock wave therapy (ESWT)
normal or pathological human tendon cells
(tenocytes), specifically in the
foot and ankle. The lead author of this study, AOFAS member Lew C. Schon,
MD, Director of Foot & Ankle Services at Union Memorial Hospital in
Baltimore, is deeply involved in research studies devoted to discovering
the causes of chronic tendinopathy
of the foot and ankle to
more effectively treat this condition non-surgically.
What happens to diseased tendons in the foot or ankle to make them become
painful and swollen? Usually, it comes after some type of over use, too
much wear and tear. If caught in its early stages, several weeks of rest in
an orthopaedic brace or boot may be all that's needed for healing. In more
advanced cases sometimes, a tendon ruptures completely and then the only
treatment is surgical repair of that tendon or moving another tendon to
take over the old one's function. In some instances, the tendon remains
swollen and painful resulting in chronic tendinopathy and the chances of it
becoming better without surgery diminish.
Dr. Schon said, "Our goal in this study was to understand how we can heal
these chronically painful tendons without surgical intervention using shock
Shock wave therapy has been used successfully as a non-surgical treatment
for many musculoskeletal diseases, such as plantar fasciitis and Achilles
tendinopathy, without knowing exactly "how" it is helping.
Studies have been done in the past on animal cells which differ, however,
from the human cell. What made this study unique was its ability to compare
healthy and diseased human tendon cells from the same group of patients. As
Dr. Schon noted, "We wanted to look at what these human tendon cells are
producing when they're healthy versus when they're diseased. With the
approval of our patients, we were able to grow these two types of tendon
cells in the lab and learn what would be required to convert a diseased
cell back to being a healthy cell. In this and other studies, we are able
to compare the response of the same patients tenocytes (healthy and
diseased) to various treatments."
He continued, "We catalogued the make-up of the diseased cells before
receiving shock wave treatment. We then calculated the appropriate dosage
of shock waves needed to make the cell proliferate and analyzed that cell
after receiving extracorporeal shock wave therapy. Our hypothesis was that
the diseased cell would have higher levels of matrix metalloprotease (MMP)
and interleukins (ILs) than the healthy cell. MMP is the enzyme which
mainly digests the collagen fibers in our body so they can be reused again
in development of new collagen. This enzyme plays a great role in tissue
breakage as well as other processes in the body. ILs are inflammatory
cytokines, which mediate the inflammatory process in the body.
"After shock wave therapy, we were able to compare the changes in the
cells. We discovered the levels of MMP decreased, which meant that the
cells were no longer digesting collagen at the same rate. When these levels
were reduced, the cell appeared to behave like a healthy cell. The shock
wave therapy has a measurable effect on human tendon cells."
This study offered a very specific cellular explanation on why shock waves
improve chronically diseased tendon cells. "Before we knew it helped, but
we didn't know why," Dr. Schon stated. "Understanding how to alleviate
damage to a cell is a very dramatic breakthrough clinically,
biomechanically and biologically. Our goal is to be able to treat diseased
tendon cells faster and better with less-invasive surgical methods. The
affect of tendinopathy on people includes pain, dysfunction, reduction in
quality of life and often loss of wages. Our study has shown that
tendinopathy and other soft tissue related disease are good candidates for
shock wave therapy."
Due to the success of this study, Dr. Schon and his co-authors have
received a grant to further study all elements of this problem. Dr. Schon
is a member of the American Orthopaedic Foot & Ankle Society.
Members of the American Orthopaedic Foot & Ankle Society are orthopaedic
surgeons (MD or DO) who have extensive training in the diagnosis,
non-surgical care and surgical treatment of the musculoskeletal system,
including bones, joints, ligaments, tendons, muscles, and nerves with a
special interest in the foot and ankle.
To find an AOFAS orthopaedic surgeon in your area, go to www.aofas.org.
The AOFAS promotes quality, ethical and cost-effective patient care through
education, research and training of orthopaedic surgeons and other health
care providers. It creates public awareness for the prevention and
treatment of foot and ankle disorders, provides leadership, and serves as a
resource for government, industry and the national and international health
About Orthopaedic Foot and Ankle Surgeons
Orthopaedic foot and ankle surgeons are medical doctors (MD and DO) who
specialize in the diagnosis, care, and treatment of patients with disorders
of the musculoskeletal system of the foot and ankle. This includes the
bones, joints, ligaments, muscles tendons, nerves, and skin. Orthopaedic
foot and ankle surgeons use medical, physical, and rehabilitative methods
as well as surgery to treat patients of all ages. They perform
reconstructive procedures, treat sports injuries, and manage and treat
trauma of the foot and ankle.
Orthopaedic foot and ankle surgeons work with physicians of many other
specialties, including internal medicine, pediatrics, vascular surgery,
endocrinology, radiology, anesthesiology, and others. Medical school
curriculum and post-graduate training provides the solid clinical
background necessary to recognize medical problems, admit patients to a
hospital when necessary, and contribute significantly to the coordination
of care appropriate for each patient.
AOFAS members have the following credentials:
-- Completed four years of medical school. The curriculum covers basic
and clinical sciences, surgery, internal medicine, pediatrics,
family medicine and all other medical specialties.
-- Completed five years of accredited graduate medical education
(residency training) in orthopaedic surgery.
-- Many orthopaedic foot and ankle surgeons also complete advanced
fellowship training in foot and ankle surgery.
-- Satisfactory completion of the national medical licensing
-- Continuing medical education credits over a specific time period.
-- Board certification: Certified by or eligible for examination and
certification by the American Board of Orthopaedic Surgery or the
American Osteopathic Board of Orthopedic Surgery.
-- Each member must hold membership in the American Academy of
Orthopaedic Surgeons (AAOS).
When selecting a medical provider to care for your feet and ankles, be sure
to ask him/her about:
-- Medical school education
-- Accredited residency training
-- Areas of practice specialization
-- Experience in your prescribed treatment (surgical and/or
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