If you are suffering from heel pain caused by plantar fasciitis, your podiatrist may recommend extracorporeal pulse activation therapy, more commonly known by the acronym EPAT. Developed in Europe, EPAT is effective for heel pain—over 80 percent of patients report improvement in their symptoms.
Why the EPAT Procedure is Performed
The most common condition for which EPAT therapy is prescribed is plantar fasciitis, a condition affecting the plantar fascia.
The plantar fascia is a ligament that supports the arch and acts as a shock absorber. Overuse of the plantar fascia via excessive activity or athletics can cause tearing, scarring, and inflammation—i.e., plantar fasciitis.
While EPAT has been demonstrated to be most effective for treatment of plantar fasciitis, it is also used in the treatment of other foot conditions involving soft tissue, such as Achilles tendonitis. EPAT is also helpful for treating chronic muscle pain.
How Does EPAT Work?
Extracorporeal Pulse Activation Treatment is a type of shockwave therapy, and it works by delivering pulses of sound waves that cause what is known as microtrauma, which is essentially what it sounds like—a microscopic “injury” to the soft tissue.
This in turn stimulates and improves blood circulation in the affected area, which facilitates healing. EPAT also breaks up tissue that is calcified or fibrotic.
What to Expect During Your EPAT Procedure
When you arrive at the doctor’s office for your appointment, a special gel will be applied to the skin on the bottom of your foot, particularly around your heel.
The purpose of this gel is to improve conductivity for the sound waves produced during the course of the EPAT procedure. The doctor will then apply the EPAT applicator to your skin and move it in a circular motion around the affected area. The entire treatment takes no more than fifteen minutes.
Most patients will require three weekly treatments, and it may be as long as three months before you see the maximum benefit from your EPAT, although most patients experience some pain relief within less than a month, and many experience some degree of pain relief immediately.
It is generally recommended that patients refrain from using over-the-counter anti-inflammatory medication and ice two weeks prior to the EPAT procedure, and for four weeks afterward. Tylenol is acceptable, however.
Are There Any Side-Effects or Complications Associated with EPAT?
EPAT is non-invasive, but in some cases patients have reported discomfort, redness, or bruising immediately following treatment.
Am I a Candidate For EPAT?
Because of the cost of EPAT (see below), among other considerations, your doctor will most likely want to address your heel pain with conservative treatment methods first.
These treatments may include stretching exercises, anti-inflammatory medications, orthotics, physical therapy, new shoes, and injections. EPAT is more effective for chronic plantar fasciitis.
You should not have EPAT for heel pain if you are taking blood-thinning medication, or if you have deep vein thrombosis or peripheral vascular disease.
EPAT vs ESWT – What To Know
Extracorporeal Pulse Activation Treatment (EPAT) should not be confused with Extracorporeal Shockwave Therapy (ESWT), an older type of shockwave therapy.
ESWT equipment takes up much more space, and many doctors found it cost prohibitive to have in the office. The two treatments are similar, but use slightly different technology to achieve the same end.
One important difference is that for ESWT you need to anesthetize the foot, and for EPAT you do not. ESWT usually involves only one treatment, whereas EPAT, as noted above, usually requires three.
How Much Does an EPAT for Heel Pain Cost?
Unfortunately, EPAT is seldom covered by health insurance. The cost of each treatment is generally in the neighborhood of $200, so the necessary series of three treatments usually come to around $600.
