Extracorporeal Pulse Activation Technology (EPAT) for Plantar Fasciitis

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Plantar fasciitis is inflammation of the band of tissue that connects your heel bone to your toes (the plantar fascia) and a very common cause of heel pain. People suffering from plantar fasciitis generally report stabbing pain in the heel, which can be more severe in the morning. Treatment options for plantar fasciitis can range from simple stretching techniques to surgery, depending on the severity of the condition. I sat down to talk with Dr. David Hughes about EPAT, a nonsurgical treatment option for plantar fasciitis which is now available at TSAOG Orthopaedics.

What is EPAT?

EPAT stands for extracorporeal pulse activation technology, also known as shockwave therapy. The technique has been used for years in Europe and the US to treat numerous chronic inflammatory conditions.

How does it work?

EPAT uses high intensity sound waves to break up scar tissue and increase blood flow to areas where there is poor circulation, which stimulates healing.

How long does EPAT treatment take and how many treatments will I need?

Each session lasts about five minutes and patients will generally require between a minimum of 3 and a maximum of 5 treatments.

What does an EPAT treatment feel like?

EPAT treatment feels like getting snapped with a rubber band repeatedly initially, then dulls to the point where light pulses are noted.

When should I start to feel the treatment working?

It can take up to four weeks to feel pain relief, though some patients report immediate pain relief after their treatment.

Is EPAT treatment covered by insurance? How much does it cost?

Unfortunately, EPAT is not covered by insurance. Treatment cost is $495 for three treatments of one foot and $695 for three treatments on both feet. If a 4th or 5th treatment is required, there is a fee of $100 per treatment regardless of one or both feet.

What are the benefits of EPAT?

The biggest benefit is pain relief. Over 80% of EPAT patients report significantly reduced or eliminated pain. While no treatment is 100% effective, EPAT can help to heal chronic conditions that don’t respond to traditional treatment.

Additionally, since EPAT is a non-invasive therapy, there is no anesthesia required, no scarring, no risk of infection, and no recovery period after treatment. Patients don’t have to take time off work or stop their activities.

Is there anyone who shouldn’t try EPAT for plantar fasciitis?

EPAT is not recommended for people who have a pacemaker or are on blood thinners.

Dr. David Hughes is a podiatrist with TSAOG Orthopaedics. He has a special interest in the correction of foot disorders and deformities including arch disorders, hammertoes, bunions, turf toe, and charcot foot. He has appointments available at our Medical Center and Westover Hills locations.

The San Antonio Orthopaedic Group is now TSAOG Orthopaedics

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You may have noticed our redesigned logo popping up on our website, social media, and printed materials. That’s because (you guessed it – or you read the headline), The San Antonio Orthopaedic Group is now TSAOG Orthopaedics!

The San Antonio Orthopaedic Group (TSAOG) has been an institution in San Antonio since 1947. Over the years, our practice has grown exponentially – adding new physicians, specialties, and clinic locations.

As our clinical presence and our physicians’ reputations for education and research expanded beyond San Antonio, we found that our practice name The San Antonio Orthopaedic Group no longer encompassed all that we do and all that we are. (For example: Did you know that TSAOG’s physicians made 30 presentations across 8 different states and 4 different countries in 2016 alone???)

Though we recognized that our brand had to evolve with our practice, The San Antonio Orthopaedic Group (TSAOG) was how we started and will forever be a part of who we are. In 2017, our physicians voted to adopt the name TSAOG Orthopaedics to embrace who we have become and honor how we got here.

So what does TSAOG stand for now? While TSAOG will no longer officially stand for The San Antonio Orthopaedic Group, our vision, mission, and values remain unchanged. TSAOG stands for the same principles we’ve always stood for and we will continue to work to provide unparalleled patient care to our community for generations to come.

Icy Road Conditions Forecast Tuesday – TSAOG Will Be Closed

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UPDATE 1/16/18 at 4pm – TSAOG will be open normal business hours on Wednesday, January 17th.

The weather forecast for tomorrow – Tuesday, January 16th – predicts freezing rain and temperatures which will create hazardous driving conditions throughout the day. Due to safety concerns for our staff and our patients, TSAOG has decided to cancel all patient appointments scheduled tomorrow and close our offices. This includes surgical cases at the outpatient surgery center and OrthoNow appointments and walk-in hours.

We will be sending automated messages to patients cancelling their appointments and asking them to contact us to reschedule beginning today at 4:30pm. If you have an appointment scheduled tomorrow, please contact our scheduling department at (210)281-9595 to reschedule your appointment.

As of this time, we intend to reopen with normal business hours on Wednesday, January 17th, but if there is severe weather in the area, road closures affecting a wide area, or if major school districts are closed, we may be as well.

Bookmark this blog entry and follow our Facebook Page for updates. If there are no postings or updates to the blog, we will be open as usual on Wednesday, January 17th.

Stay home and stay safe.


Join Team TSAOG at the 2018 Cystic Fibrosis Tower Climb and Run

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TSAOG’s Dr. Kevin Kirk has a son with Cystic Fibrosis, so this cause is very close to his heart. He has agreed to share his personal story to help raise awareness:

The day my son was born was one of the happiest days of my life. However, something was different. Two weeks later, we were informed that my son had been diagnosed with Cystic Fibrosis. I had learned about this disorder in medical school but never thought that it would affect “my” family. Cystic fibrosis (CF) is a life-threatening genetic disease that primarily affects the lungs and digestive system. An estimated 30,000 children and adults in the United States (70,000 worldwide) have CF. In people with CF, a defective gene and its protein product cause the body to produce unusually thick, sticky mucus that clogs the lungs and leads to life-threatening lung infections. It also obstructs the pancreas and stops natural enzymes from helping the body break down food and absorb vital nutrients often causing diabetes.

Every day, my son wakes up and does thirty minutes of airway clearance, which involves nebulized medicines and a vest attached to a compressor that helps clear the mucus from his lungs. With breakfast, he takes two shots of insulin and a morning pill regimen which consists of 8 different pills. After that, he proceeds with his day like a normal teenager, except that with every meal and snack he takes another shot of insulin and 4 more pills. When he comes home from school, he does another nebulizer treatment and then goes to the gym for 2 hours and does cardio and weight training to keep him from getting sick. When he gets home from the gym, he does his homework, takes nighttime pills, and does another thirty minutes of airway clearance so that he can finally go to bed.

For those counting, that is over 40 pills, 10 insulin shots, and over one hour of airway clearance every day just to stay healthy. Even with his best efforts, sometimes he has to go to the hospital for “tune-ups”. He has been hospitalized almost every year of his life for up to two weeks at a time for IV antibiotics.

In the 1950s, few children with CF lived to attend elementary school. Since then, tremendous progress in understanding and treating CF has led to dramatic improvements in the length and quality of life for those with CF. Many people with the disease can now expect to live into their 30s, 40s, and beyond.

Donations to the Cystic Fibrosis Foundation help fund the scientific research that adds tomorrows for those children and adults living with CF. Please consider participating in the 2018 Tower Climb and Run or making a small donation to help this worthy cause.

How You Can Help:
The Lone Star Chapter of the Cystic Fibrosis Foundation is TSAOG’s Charity of the Month for January. Please join us as we volunteer and participate in the 2018 Tower Climb and Run on Saturday, January 27th.

This year marks the 33rd year of the Tower Climb and Run, sponsored by the Lone Star Chapter of the Cystic Fibrosis Foundation. It aims to raise awareness and money to work toward a cure for Cystic Fibrosis.

The Tower Climb and Run is a unique athletic event which offers not only a run, but a climb up 952 steps to the top of the Tower of the Americas, a San Antonio landmark! The event will be lots of fun, culminating in a party at the base of the Tower, featuring food, music, medals, and bragging rights.

Please join us in volunteering or participating in this event!! Sign up to join Team TSAOG at the Tower Climb or Donate Now!

TSAOG is IN NETWORK with United Healthcare

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It has come to our attention that TSAOG’s providers are showing as out of network with United Healthcare as of the start of 2018.

Rest assured, TSAOG’s providers are all still IN NETWORK with United Healthcare and there has been no interruption in our network status. This is a technical difficulty that United Healthcare (UHC) is working to resolve through their website as we speak.

UHC has assured us that this should be resolved quickly and we apologize for any confusion this may have caused.

2017 Holiday Hours – TSAOG and OrthoNow Closures

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All TSAOG offices and both locations of the OrthoNow Walk-In Injury Clinic will be closed on Friday, December 22nd and Monday, December 25th to allow the members of Team TSAOG to spend Christmas with their families. We will resume normal operating hours at all TSAOG and OrthoNow locations on Tuesday, December 26th.

All TSAOG offices and both locations of the OrthoNow Walk-In Injury Clinic will also be closed on Monday, January 1st.  We will resume normal operating hours on Tuesday, January 2nd.

Please note: The OrthoNow Injury Clinic at the Orthopaedic Institute WILL be open on Saturday, December 23rd and Saturday, December 30th from 9am until 1pm.

We wish you all a safe and Merry Christmas and a Happy New Year!

SNOW DAY – What’s Happening at TSAOG

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UPDATE – 12/8 at 6am: 

Attention TSAOG Patients!

Given the improved weather and current road conditions, we are expecting an on-time start for physician visits and surgical appointments today. If you were scheduled for Physical Therapy, Hand Therapy or for an Imaging appointment (MRI/CT) between 6am-9am, we have cancelled your appointment, but will contact you shortly after 8am to get your appointments rescheduled as quickly as possible.  Thank you for your patience!

ORIGINAL POST: Attention TSAOG Patients!  
Your safety and that of our staff is of utmost importance to us. Given the weather conditions tonight and what is forecasted for the morning, our offices may need to make alternate plans for patient appointments scheduled tomorrow morning. Should we determine it is necessary to delay our opening, you will be notified via phone, text and/or email of any changes to your appointment time beginning at 6:30am. We will also post a message on this page notifying you of any delayed opening in our clinics.
If you would like to voluntarily reschedule your schedule appointment, you may do so by contacting our answering service any time at 210-804-5400. As an alternative, if you would like to test drive our new on-line self-scheduling service we offer, please go to, click on the patient portal link at the top of the page, from there follow the prompts to access your account and reschedule your own appointment!
As always, thank you for the trust and confidence you have placed in us to care for your orthopaedic needs. We look forward to serving you.

All TSAOG and OrthoNow Locations Closing Early Today – Friday, December 1st

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a man sitting in his desk with a santa hat holding a signboard with the text office christmas party written in it

Please note: All clinic locations for The San Antonio Orthopaedic Group and the OrthoNow Injury Clinic will close today, December 1st, at 4PM to allow Team TSAOG to celebrate at our annual Holiday Party!

The OrthoNow Injury Clinic at Concord Plaza will be open tomorrow, December 2nd, from 9am-1pm and all other locations will resume normal business hours on Monday, December 4th.

We apologize for any inconvenience this may cause. Thanks and have a fun and safe weekend!

Thanksgiving Hours 2017

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Harvest cornucopia close up with Happy Thanksgiving gift tag on dark wood background

All locations for TSAOG Orthopaedics and the OrthoNow Injury Clinic will be closed on Thursday and Friday, November 23rd and 24th, to allow our employees to celebrate Thanksgiving with their families.

The OrthoNow Injury Clinic at 400 Concord Plaza Dr, Ste 300, San Antonio, TX 78216 will resume normal operating hours on Saturday, November 25th from 9am-1pm.

All other locations will resume normal business hours on Monday, November 27th.

We wish you all a safe and Happy Thanksgiving!

THIS SATURDAY – Join TSAOG As We Take One Small Step for Prader-Willi Research

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TSAOG’s Dr. Sergio Viroslav has a daughter with Prader-Willi Syndrome, so this cause is very close to his heart. He has agreed to share his personal story to help raise awareness:

We always felt something was amiss. This pregnancy was different than Alice’s prior one; fetal movement was sporadic and with less vigor. The ultrasound showed excessive amniotic fluid. At least the amniocentesis revealed the normal number of chromosomes.

One month to go, Alice was admitted to the hospital with a baby that wasn’t moving much; the OB had done all she could do in 1996. All we could do was wait for the lungs to mature and hope for the best.

Olivia was born 1/11/96. She weighed less than 6 lbs, her tone was low, but at least she was alive and eating.

She didn’t walk until she was three. Then this small infant who we were told had some sort of muscle or energy producing disorder began to gain weight. She didn’t particularly eat more than her siblings, though she did seem to care more about food then her older sister and younger brother.

In 2001 a visit to a childhood obesity clinic prompted the endocrinologist to check for Prader Willi Syndrome (PWS). The doctor told us not to worry. Olivia was engaging and bright. She was performing well at school, and the chromosome test was standard in working up obesity in children. We were cautiously optimistic.

As the Twin Towers were falling on September 11th we received the news. Olivia’s 15th paternal chromosome had a deletion – Prader Willi Syndrome.

Olivia is now a junior in high school. She plans to attend college when she graduates. She has friends and is active in her Temple youth group. But every day is a challenge. The pantry is locked in our home. She takes a daily shot of growth hormone to help her muscles and metabolism. She takes medicine to help her when she becomes fatigued and medicine to help her cells use insulin more efficiently. She is at the gym every day, she eats less than 1500Kcal and she can barely lose a pound. Her hunger never ceases.

That’s why we do this. We do this to help kids with Prader Willi . We do this because it’s the only way to fight. It’s the only way to find a cure. 

“ The greatest of all mistakes is to do nothing because you can only do a little – do what you can.”-  Sydney Smith

TSAOG will be collecting donations in our clinics (where you can purchase a pair of One Small Step cut-out feet for $2) and online to help the Foundation for Prader-Willi Research work towards a cure for Prader-Willi Syndrome. All donations will go to the Foundation for Prader-Willi Research (FPWR)

The fundraising for FPWR will culminate with a family friendly walk at the Tobin Center
 on Saturday, November 11th from 9am-11:30am.  Please join us at this fun, family friendly event to help raise awareness of this disease and contribute what you can to help work towards a cure. Register or donate here.




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