It started as an annoying pain with each step Leon Traeger made.

But the 60-year-old avid runner never thought twice about it until two years ago.

"If you are a runner, you are used to a certain amount of pain and then it goes away," Traeger said. "But finally it gets to a point when the pain never goes away."

Massage and acupuncture had benefits, but he was still in pain.

In June 2015, Traeger sought help from St. Cloud Foot & Ankle Center, 106 Doctors Park, and learned the cause of his pain. Plantar fasciitis, also known as chronic heel pain. The often-crippling pain typically affects people between ages 18 and 65, especially runners.

Traeger's podiatrist, Dr. Walt Ellis, gave him the standard treatment for heel pain: custom orthotics and a night splint to stretch the foot.

He was even given a two cortisone injections.

Still no relief.

With the recommended three-shot limit of cortisone looming, Traeger was running out of nonsurgical options.

That was until three weeks ago.

Thanks to a 10-minute in-office procedure known as EPAT, Traeger is regaining control of his life and is one step closer to lacing up those running shoes.

What is EPAT?

Extracorporeal Pulse Activation Technology, or EPAT, is a system that uses acoustic pressure waves to initiate a healing response in specific areas.

"It's a therapy that is primarily found within regenerative medicine and used to treat sports-related injuries," said Gregory Mercure, president and chief executive of EPAT manufacturer CuraMedix.

Ellis said sound wave technology used to treat pain was first discovered by a group of urologists in the 1980s as a way to treat kidney stones.

"But those (kidney stone) patients were experiencing some positive unintended consequences," Ellis said. "Many said they had experienced back pain relief."

Ellis said further studies on the use of sound wave treatments proved the technology was able to stimulate tissue and bone regeneration.

Ellis said St. Cloud Foot & Ankle Center was an early adopter of the original technology. He said the clinic was part of a handful in the Upper Midwest rotating a large OssaTron unit around to help treat heel spur syndrome and other orthopedic injuries. However, the clunkiness of the machine, the large out-of-pocket expense on the patient ($600-$750 per session) and the infrequency of availability made the OssaTron system impractical.

Three months ago, Ellis decided to revamp the sound therapy with the use of EPAT.

How does it work?

Patients are seated with their foot elevated. The doctor applies a jelly to the affected area, much like in an ultrasound procedure, and powers on the machine.

A small, handheld applicator is pressed against the foot and pulses targeted sound waves into the body.

"It feels almost like a mini jackhammer," said Traeger.

Mercure said the acoustic energy that is generated by the machine is targeted with the use of different sized applicator tips to suit each patient's needs.

"Basically we are creating tiny stress fractures and signaling to the body that it needs to repair itself," Ellis said.

Depending on the treatment prescribed and the strength of the device, between 1,500 and 10,000 sound wave pulses can be delivered into the targeted tissue.

Each treatment lasts about 10 minutes and is completed weekly for a period of three to five weeks.

"Patients are then assessed about 12 weeks after their last treatment," said Mercure.

EPAT treatment at St. Cloud Foot & Ankle Center can cost a patient between $600 and $800 for a total of three sessions. Ellis said additional sessions will be performed as necessary on the same heel for no added charge.

The procedure is not covered by insurance.

But Ellis said it is much more cost-effective and less invasive than surgery.

Ellis said the success rate for EPAT is about 80 percent, 10 percentage points better than traditional surgery.

And the recovery time is reduced.
A small price to pay

Three sessions in and Traeger cannot argue with the results.

"I've been doing better than I was last week," said Traeger prior to his Wednesday treatment.

After the treatment, Ellis said, Traeger is able to walk out of the office and with little to no pain.

He will be heading back to Ellis' office at the beginning of August to discuss a possible continuation of EPAT for his right heel. He is also considering doing the treatment on his left heel.

For Ellis, EPAT is nice for patients running out of nonsurgical options for coping with heel pain.

"When something like this comes along I get excited," Ellis said. "Heel pain has been an issue in podiatry for a long time. So it's rewarding to fix something like this nonsurgically."

Follow Vicki Ikeogu on Twitter @VickiSCTimes or on Facebook at facebook.com/sctimesvicki. Call her at 259-3662.