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.

Gordon Hayward’s Long Road to Recovery

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After an ankle fracture dislocation, the ankle would be fixed and casted to allow for healing.

Opening night of the 2017 NBA season was marred by a gruesome left ankle injury to Boston Celtics’ forward Gordon Hayward only five minutes into the game. While jumping for an alley-oop, the 27 year old star player landed awkwardly on his left leg, suffering an ankle fracture-dislocation. The ankle was re-set on the court, splinted, and surgically stabilized the next day at New England Baptist Hospital. With a dedicated team of surgeons, physical therapists, and trainers, Gordon Hayward will face a long and challenging road to recovery. Along the way he will achieve milestones by re-learning to walk, run, and – hopefully – returning to play in the NBA.

Horrific ankle injuries like this are not limited to elite professional athletes and actually occur frequently to regular people performing routine daily activities like descending stairs, mowing the lawn, climbing ladders, or simply taking a misstep around the house. A displaced ankle fracture like to Gordon Hayward’s will require surgery to re-align the bones and to fix them, typically using small plates and screws to ensure that the fracture heals in proper position. Ensuring that the bones are fixed as close to normal as possible is the most important variable affecting outcome that physicians can control. Following surgery, a progressive therapy program is critical to ensuring maximal restoration of function. Even so, rehabilitation from an injury like this can take up to a year. We wish Mr. Hayward luck as he begins the long road to recovery.

Dr. Randall Marx is a board certified orthopedic surgeon, fellowship trained in conditions of the foot, ankle, and lower leg. He treats patients of all ages and is currently accepting new patients at five San Antonio area clinic locations. To schedule an appointment with Dr. Marx, please call (210) 281-9595 or visit his webpage.

Are Your Shoes Destroying Your Feet? (VIDEO)

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~Video courtesy SA Live~

TSAOG podiatrist Dr. Jessica Rutstein appeared yesterday on KSAT’s SA Live to discuss the issues that can be caused by wearing ill-fitting shoes. Watch the full interview above.

Wearing improper footwear can cause the foot and toes to be compressed and bent in ways that can be painful and, over time, can turn into deformities like bunions and hammertoes. Common foot conditions caused by improper footwear include:

  • Ingrown Toenails – when a toenail grows into the soft flesh surrounding the nail, causing pain, redness, and swelling.
  • Bunions – when the big toe is pushed against your second toe, often by narrow pointed shoes, causing a bony bump to form on the joint at the base of your big toe. 
  • Tailor’s Bunions – when the little toe is pressed against your fourth toe, often by narrow pointed shoes, causing a bony bump to form on the joint at the base of your little toe.
  • Hammertoes and Mallet Toes – abnormal bends in the joints of the toes (causing a permanently curled look), caused by wearing high heels or other shoes where the toes are forced against the front of the shoe.

To avoid these issues, here’s what you need to know:

  • Know your foot shape – choose a shoe not only the right size, but the right shape for your foot. A shoe with a rectangular toe box will fit most feet better than a triangular toe box. Avoid cramming your feet into a shoe that doesn’t fit comfortably.
  • Know your arches – if you have feet with high arches or flat feet, your feet will have a tendency to roll in or out, which can cause ankle pain. Look for shoes with stabilizers to keep your feet from rolling and consider orthotics to support your arches to avoid arch pain.
  • Know your activities – different activities (like walking vs running) require different types of foot support. Select your shoes based on what activities you plan to engage in while wearing them.
  • Know your age – as we age, the fat padding on the bottoms of our feet tends to thin out, leaving less natural support for our feet. This is why going barefoot or wearing thin soled shoes may not be as comfortable as it once was.

If you are experiencing foot or ankle pain, consider consulting a specialist to discover the cause of your pain and what you can do to correct it.

RutsteinDr. Jessica Rutstein is a podiatrist with The San Antonio Orthopaedic Group. She treats patients aged 2 years and older for conditions of the foot and toes. She has a special interest in the conservative treatment of foot problems including bunions, hammertoes, warts, and heel and arch pain. To schedule an appointment with Dr. Rutstein, please call 210.281.9595 or request an appointment online. 

Dr. Kevin Kirk Adds Clinic at Medical Center Office

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Medical Center

Beginning February 4th, 2015, Dr. Kevin Kirk will be seeing patients at our Medical Center location every first, third, and fifth Wednesday morning of the month.  This office is located at 2829 Babcock Rd, Ste 700, San Antonio, TX 78229. 

Dr. Kirk treats orthopedic conditions of the foot, ankle, lower leg, and knee for patients aged 6 years and older and has a special interest in total ankle replacement, ankle and knee arthroscopy, reconstruction, and trauma surgery. 

In addition to the Medical Center office, Dr. Kirk continue to see patients at TSAOG’s Downtown, Northeast, Northwest, and Southeast offices.

KirkDr. Kevin Kirk is a board certified orthopedic surgeon, fellowship trained in foot, ankle, and lower leg care, with The San Antonio Orthopaedic Group. He treats patients aged 6 years and older for all orthopedic conditions. To schedule an appointment with Dr. Kirk, please call 210.281.9595 or request an appointment online.

TSAOG Congratulates Our Texas Super Doctors® 2014

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The following five TSAOG physicians were recently featured in Texas Super Doctors® 2014, which appeared in the December 2014 issue of TexasMonthly magazine:

The Super Doctors® list identifies top physicians in over 40 specialty areas, as selected by their peers and independent research conducted by Key Professional Media.

Dr. Brad S. Tolin received additional recognition this year as part of the Texas Super Doctors® Hall of Fame since he has been listed as in Texas Super Doctors® for 10 consecutive years!   

Congratulations to all our TSAOG Texas Super Doctors® 2014!

TSAOG Customer Survey Highlights – December 2014

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When our patients have something nice to say about us, we like to brag about it! Please enjoy some of the highlights from TSAOG’s December 2014 Customer Survey:

  • “Well organized and on time. I was very pleased with Dr. Balldin’s assessment and treatment plan and his answers to my questions”
  • Dr Bell and his staff always addressed each patient by name and treated individuals with warmth and compassion. Over the last year I never waited more than 10 minutes to see Dr Bell and for most of my appointments he was right on time.”
  • “[I liked] that there are multiple docs under one roof whose specialties overlap and they can collaborate.”
  • “[Dr. Brenman] and his nursing staff are always super efficient and even though I know they see a huge amount of patients they offer me really personalized care.”
  • Dr. Brown is extremely knowledgeable and explains procedures and options well, and PA Rice has been very helpful and thorough.”
  • “I never feel like I am in an assembly line like I have when I am a patient in other practices.”
  • Dr. Burkhart gave me my life back by successfully operating on my rotator cuff injury. No more pain and can do anything I did before the surgery. Great Man Dr. Burkhart!”
  • “I don’t like coming to the SAOG only because it means I am injured or starting to fall apart due to age, BUT I like coming to SAOG because I’m cared for very well and am very satisfied with my care and the customer service. Thanks to all of the staff, keep up the great work!” (Dr. Connor)
  • “I was very impressed with how well the office was run overall. There was a calm atmosphere and everyone I encountered was very pleasant.”
  • Dr. Drukker was already my physician, but also a lady in Houston recommended him. He is great!”
  • “Very happy with Dr. Garcia. Also with his regular follow-ups”
  • “I like Dr. Gonzalez and think he is an excellent surgeon and physician.”
  • “Although Dr. Hartzler is listed as a shoulder/ elbow specialist, he agreed to see me regarding my foot/ankle problem. He was very kind and I felt well taken care of.”
  • Radiologist and Leticia (Technician) were awesome. I was nervous and scared and they made me feel at ease and explained everything.”
  • “I was actually surprised at the speed with which I was able to get a new patient appointment.”
  • “Doctors are friendly and listen carefully” (Dr. Hibberd)
  • “Keep up the great work — both the office and the practice seem to run like well-oiled machines, with great resources and availability.”
  • Dr. Hughes listens well, takes my lifestyle into consideration when making recommendations on treatment.”
  • “I have always been able to be seen promptly by my doctor and the staff has always been courteous and professional.” (Dr. Jacobs)
  • “I would like to thank Dr. Kaiser for the wonderful job he did on my knee.”
  • Dr. Kirk was very gentle, patient & explained in great detail everything I needed to know.”
  • “I loved the care I received from Dr. Marx and would highly recommend him to anyone needing surgery.”
  • “Able to get seen quickly, Dr Ochoa is a good guy. I would recommend him to anyone.”
  • “With a complete state of the art facility each and every detail was handled perfectly. An amazing staff and an equally amazing set of doctors. I was completely impressed and 100% pleased!”
  • Dr. Paul Pace and his staff are amazing and I am so thankful to each and every member of his team that were involved in any aspect of my surgery and continued treatment. Thank you thank you thank you”
  • “The doctor shows an interest in my overall well being.” (Dr. Rowland)
  • “The doctors are fully informed in the field of orthopaedics. They offer a storage of information to help me understand my condition and the plan of treatment. They are friendly and make you feel very comfortable.”
  • “It was my first visit with Dr. Rutstein and I was very impressed. She is well informed in her field and had answers to all of my concerns. She took a lot of time to explain and offer suggestions. It was a beautiful experience. Her treatment plan is making a big difference in my condition. “
  • “…chiropractic services help me a lot.” (Dr. Seidel)
  • Dr Taber has a great bedside manner, very professional. I completely trust him with my care”
  • “From the first visit, my care has been exceptional, personalized, and caring. This is the best orthopedic organization I have ever had the honor of using. You have extensively improved my daily functioning and reduced my pain significantly, improving my overall lifestyle.”
  • Dr. Tolin exhibits exceptional patient relations. He is PROFESSIONAL, focused on the patient, and educational. I have never had the superior attention he provides to me.”
  • “Very pleased with all aspects of the hip replacement process. I would and have recommended Dr. Ursone to anyone considering hip or knee replacement. Extremely pleased with the care provided by North Central Baptist Hospital.”
  • “Excellent customer service!” (Dr. Valdez)
  • “Excellent experience. Some of my favorite docs in the past have had poor staff. Not SA Orthopedic! Everyone is top notch!” (Dr. Viroslav)
  • “I know that the good Lord sent me to Dr Woodbury and his staff.”

We encourage you to review and rate your experience with TSAOG.  The next time you visit us, please take the time to fill out our patient survey and you may see one of your comments online the next month! You can also choose to submit a testimonial online anytime

Please note: Spelling and punctuation errors may have been corrected for readability.

Integrating Orthotics and Rehabilitation to Improve Outcomes for Lower Extremity Trauma Patients

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Orthopedic surgeon and lower extremity specialist Dr. Kevin L. Kirk co-authored a study that was featured in the October 2014 issue of Clinical Orthopaedics and Related Research, a publication of The Association of Bone and Joint Surgeons.

The study investigated whether integrating orthotics with a rehabilitation program would improve outcomes for patients suffering from significant disability following lower extremity trauma and sought to find out:

  • If an 8-week integrated program would improve pain, performance, and outcomes for these patients.
  • If the level of recovery differed for those undergoing the program more than or less than 2 years after their injury.
  • Whether the program would reduce the number of patients considering late stage amputation.

The study evaluated 84 service members who underwent 4 weeks of rehabilitation without an orthotic, followed by 4 weeks of rehabilitation with an orthotic. After 8 weeks, all subjects showed improvement in patient-reported measures as well as physical performance measures and patients improved similarly regardless of the length of time out from their injury. 41 out of 50 patients who were initially considering amputation had changed their minds by the end of the program. Read the full study.

KirkDr. Kevin L Kirk is a board-certified orthopedic surgeon, fellowship trained in conditions of the foot, ankle, and lower extremity, with The San Antonio Orthopaedic Group. He treats patients aged 6 years and up for all orthopedic conditions, but has a special interest in conditions of the foot, ankle, and knee. To schedule an appointment with Dr. Kirk, please call 210.281.9595. 

Dr. Randall Marx Adds Clinic at Downtown Office

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Metropolitan Methodist Plaza

Beginning October 10th, 2014, Dr. Randall Marx will be seeing patients at our Downtown location every other Friday.  This office is located at 1200 Brooklyn Ave, Ste 320, San Antonio, TX 78212. 

Dr. Marx treats orthopedic conditions of the foot, ankle, and lower leg for patients of all ages and has a special interest in total ankle replacement, ankle arthroscopy, and tendon reconstruction. 

In addition to the Downtown office, Dr. Marx will continue to see patients at TSAOG’s Central, Medical Center, and North Central offices.

Dr. Randall Marx is a board certified orthopedic surgeon, fellowship trained in conditions of the foot, ankle, and lower leg. He has a special interest in total ankle replacement, ankle pain, and tendon reconstruction. To schedule an appointment with Dr. Marx, please call 210.281.9595.

TSAOG Customer Survey Highlights – June 2014

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When our patients have something nice to say about us, we like to brag about it! Please enjoy some of the highlights from TSAOG’s June 2014 Customer Survey:

  • Dr. Seidel was very receptive and focused on my needs and had ideas that may help me recover properly from my low back pain.”
  • “The procedure was explained to me in detail by Dr. Marx. A successful surgery was done with minimal pain and discomfort and I am now able to do the things I haven’t been able to do in about 3 years.”
  • “I felt the doc handled the problem very effectively and gave me the opportunity to ask pertinent questions.” (Dr. Rowland)
  • Dr. Ochoa is fabulous. So patient and gave me a clear understanding of what my problem was as well as the choices I had.”
  • “Everyone was professional and friendly. The Dr. was gentle and very informative. His assistants were also gentle and professional. Very good experience all the way around.” (Dr. Ursone)
  • “All personnel are courteous and thorough; Dr. Bell is outstanding — warm, friendly and his information clear and straight to the point.”
  • “I’m an active person especially with the profession I have and having staff that worked with some of the local semi pro teams gave me confidence they I would be in good hands.”
  • Dr. Brenman solved my problem.”
  • Ortho Now is a real winner. Got immediate treatment.”
  • “I am so glad Dr. Balldin was available at my emergency. I could have not had a better doctor I believe that because of him I am walking normally today. I am very grateful.”
  • Dr. Drukker is an awesome physician and takes his job to the highest level there is. Great manners and caring.”
  • Ronald Connor is a great doctor.”
  • “I felt that someone finally understood my concerns and knew what steps to take to address them.”
  • “Very satisfied with Dr. Kaiser and his aide. My wife had her right hip replaced by Dr. Kaiser five years ago and it has made her life much better.”
  • “The after hours clinic option was much needed and allowed me to be seen the same day.”
  • “[I liked] The ability to go from one specialist to another (when this is necessary) and remain in the same office. I also appreciate the computerized history, treatment, care, etc. which any one of the doctors, PA’s or other medical personnel can access. It is an efficient way to practice medicine.”
  • Dr. Rahal and his assistant were very compassionate, courteous, thoughtful, patient, and wonderful!”
  • “I had seen two doctors previously about my condition, with no relief. Within 5-10 minutes, Dr. Viroslav pinpointed the problem. His care, compassion, knowledge, and thoroughness are exceptional, and I feel very secure with him handling my condition.”
  • Dr. Tolin has been guiding my treatment to my knee, much to my satisfaction and appreciation.”
  • “Thanks for being right on top of latest procedures and offering patient pain relief” (Dr. Pace)
  • Dr. Brown is awesome!”
  • “[I liked] the sincerity I feel I am given each time I go in. They are always professional and I am given their full attention.” (Dr. Gonzalez)
  • “[I liked] Timeliness of doctor keeping the appointment time valid and very close to what was set up.” (Dr. Hibberd)
  • Dr. Woodbury took the extra step just to make sure there wasn’t anything else going on with my hand. Thank You Dr. Woodbury for taking that extra step.”
  • “Very professional Dr Jacobs came highly recommended by friends that are PT’s and Dr. DeLee.”
  • “Physicians take the time to explain results of X-rays and treatment options.” (Dr. Garcia)
  • “The care I’ve received from the doctors in The San Antonio Orthopaedic Group has been excellent.”
  • “I feel very comfortable and confident of success with Dr Taber.”
  • Dr Valdez was very courteous and very competent.”
  • “[I liked] The attention Dr. Burkhart gave me.”
  • “Each physician we have seen over the years has been top notch and each has helped us to lead healthy lives.”

We encourage you to review and rate your experience with TSAOG.  The next time you visit us, please take the time to fill out our customer survey and you may see one of your comments online the next month! You can also choose to submit a testimonial online anytime!

Please note: Spelling and punctuation errors may have been corrected for readability.

Dr. Marvin Brown on Total Ankle Replacement (VIDEO)

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***Video Courtesy KSAT News and Aircheck Studios***

Dr. Marvin R. Brown, board certified orthopedic surgeon and foot & ankle specialist with The San Antonio Orthopaedic Group, was featured last night on KSAT News in a story about total ankle replacement.

He discusses the procedure for INBONE total ankle replacement along with ankle replacement patient Bettye Dube.

Ankle replacement is an option for patients with severe osteoarthritis of the ankle, which usually develops following injury to the ankle joint. If you have persistent ankle pain that is interfering with your daily life, the foot & ankle specialists at TSAOG can help. Not everyone will be a candidate for total ankle replacement, but there are a multitude of options available to alleviate joint pain

To learn more about total ankle replacement, visit our Ankle Replacement Webpage.

Dr. Marvin R. Brown is a board certified orthopedic surgeon, fellowship trained in conditions of the foot, ankle, & lower leg, with The San Antonio Orthopaedic Group. He treats patients of all ages and has a special interest in total ankle replacement and deformity correction. To schedule an appointment with Dr. Brown, please call 210.281.9595.


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