What is the EPAT Protocol for Diabetic Neuropathy?

September 19, 2019  |  By Elise Hamann

You asked. We have answers!

diabetic neuropathyRecently, we published a Q&A blog with Dr. Kleis, DPM about how he’s using EPAT (Extracorporeal Pulse Activation Technology) to treat diabetic neuropathy. It’s a topic in which many physicians expressed interest, particularly because there are so few treatment options available to help diabetics with foot numbness, tingling, burning and severe pain.

We heard from several physicians who wanted to know more about Dr. Jeffrey Kleis' protocol. We followed up with him, and here’s the information he provided:

Q: What nerves are you treating with EPAT?

A: It depends primarily on where the neuropathic symptoms are. Most often, diabetics have neuropathy on the plantar surface of the foot and toes. In these situations, I treat the posterior tibial nerve. If they present with symptoms on the dorsum of the foot, I treat the dorsal nerves. The peroneal nerve is another good option that can bring patients relief. 

Q: What is your treatment protocol for this issue?

A: The approach is similar no matter which nerves are being treated. While the protocol may vary depending on the patient, here’s what I most commonly do:

  • Pulses: 1500 - 1800 per side per visit
  • Tip: R15 or C15
  • Frequency: 11 Hz
  • Energy level: Start at 1.6 - 1.8 bar. Usually no higher than 2.2 - 2.4 bar

Q: How often do patients receive treatment?

A: Initially, patients come in once a week for 3 to 4 weeks. Once they experience relief from their symptoms, we go to one treatment per month. From there, patients often find it convenient to combine EPAT with their routine foot care visit. Most of my diabetic patients come in every 6 to 8 weeks. If the patient is doing well, sometimes we move to a maintenance program of treatment every 3 to 4 months. 

Q: Does EPAT provide permanent relief?

A: I wish it did. Unfortunately, if patients stop treatment completely, pain will often recur. However, when they resume treatment, I’ve found that they almost always get relief once again from their symptoms.

Q: What do you charge for treatment?

A: Our fee is $150 for treatment for one foot per visit. If we’re treating both feet, we charge $225.

Interested in Learning More About EPAT/ESWT?

Diabetic neuropathy is just one condition that medical professionals are successfully treating with EPAT. In study after study, there is clinical evidence that EPAT relieves pain. Want to find out more about this technology? Download our white paper, The Art of Shockwave.

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Topics: EPAT, Neuropathy