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RENEE MONTAGNE, Host:

The excruciating pain Robin Bentz felt every time she took a step is a problem called plantar fasciitis. About two million Americans suffer from this stubborn heel pain.

NPR's Richard Knox takes a look at how some doctors are using powerful sound waves to treat it.

GEORGE THEODORE: So I'm good to start right now, okay?

TARA CASSIDY DRISCOLL: Okay.

RICHARD KNOX: Orthopedic surgeon George Theodore is about to blast a patient's foot with shock waves generated by sound.

THEODORE: Let me have you lie back now.

KNOX: Theodore shoots some Novocain into Tara Cassidy Driscoll's left ankle. Cassidy Driscoll is a 46-year-old insurance broker and mother of three. While she's waiting for her foot to go numb, she talks about the heel pain that struck her nine months ago.

CASSIDY DRISCOLL: It's an eye-opener to me how hard it is when you take a step, and every time you take that step, you're in pain. At different points, I felt like it was never going to get better.

KNOX: The pain has stopped her from running. She's tried and inflammatory drugs, ice massages, sleeping with a foot brace, orthotics, physical therapy. Finally, the therapist urged her to try something new called shock wave treatment.

THEODORE: Head over here, on your stomach.

KNOX: The high-energy sound waves that Theodore is about to beam at Cassidy Driscoll's heel is tightly focused. There is a 60 to 80 percent chance of reducing her pain by half. Maybe one in four who get the treatment will end up free of pain.

THEODORE: You're going to start to hear the shocks. These are the shocks.

(SOUNDBITE OF SHOCKS)

KNOX: Gradually, Theodore ramps up the intensity and the frequency of the shock waves, battering Cassidy Driscoll's foot with thousands of hits.

(SOUNDBITE OF SHOCKS)

THEODORE: The shocks are like a little baseball bat hitting the tissue.

(SOUNDBITE OF SHOCKS)

THEODORE: It's producing a little bit of a repair process.

KNOX: It's a kind of paradox: He's damaging her foot in order to heal it.

Theodore has been doing the shock wave therapy for plantar fasciitis for about eight years. It's beginning to catch on around the country, but most insurers won't pay for the treatment, which costs anywhere from 500 to several thousand dollars. And some doctors are skeptical about it.

NAVEN DUGGAL: Is it rock-solid science that everyone agrees on? I would say no.

KNOX: That's Naven Duggal, another Harvard orthopedic surgeon over at Boston's Beth Israel Deaconess Hospital. He says studies don't agree, and he's not impressed with reported success rates.

DUGGAL: Sixty to 80 percent for something that somebody's not going to get guaranteed pain relief. In my mind, it's not something that I would go for.

KNOX: Duggal says they don't really know what causes this pain. The plantar fascia is a tough, rubber-band-like structure on the bottom of the foot. They used to think it became inflamed, or that bony heel spurs caused the pain, but they don't think that anymore. And doctors found surgery often makes people worse, so they don't operate much anymore either.

DUGGAL: Patients have to be patient, and they have to understand that this condition, unfortunately, is not really fully understood.

KNOX: The vast majority of sufferers will get better with time, like Karen Firestone. She went to Dr. Duggal last summer for heel pain.

KAREN FIRESTONE: I walked in, and he looked at my foot and he had me step on it and he said, oh, you definitely have plantar fasciitis.

KNOX: Firestone has been religious about all the low-tech things Duggal's advised her to do, such as stretching her foot several times a day, and she's been able to resume the running she loves.

FIRESTONE: The icing, the taping - I do all of these little pieces of help for my body, and it responds. And so I think people should take that message and go with it.

KNOX: Tara Cassidy Driscoll tried these things, too, but she felt they just weren't working for her.

(SOUNDBITE OF SHOCKS)

THEODORE: Everything's going very smoothly.

KNOX: At the Mass General, Cassidy Driscoll's almost finished with a 20 minute shock wave treatment.

THEODORE: So we're all done. What do you think?

CASSIDY DRISCOLL: Oh, I think it was fine. Not the...

THEODORE: Not terrible.

CASSIDY DRISCOLL: No, no pain at all.

THEODORE: Better than surgery.

CASSIDY DRISCOLL: Oh, much better.

(SOUNDBITE OF LAUGHTER)

KNOX: She gets off the table, walks out, and drives herself home. The hope is that controlled damage from the shock waves will stimulate her body to heal her sore foot over the next few months. And maybe she'll be one of the 25 percent of patients who get totally rid of their heel pain.

Richard Knox, NPR News, Boston.

MONTAGNE: And that's Your Health on this Monday morning.

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