Plantar fasciitis is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis.The plantar fascia is a thick fibrous band of tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes. The term fasciitis is a misnomer as studies of the tissue do not demonstrate inflammation. Plantar fasciosis is a more accurate diagnosis. It has been reported that plantar fasciitis occurs in two million Americans a year and 10% of the population over a lifetime.It is commonly associated with long periods of work-related weight bearing. Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is increased probability of knee pains, especially among runners.
The diagnosis of plantar fasciitis is usually made by clinical examination alone. Imaging studies may include radiographs, diagnostic ultrasound and MRI. An incidental finding associated with this condition is a heel spur, a small bony calcification, on the calcaneus heel bone, in which case it is the underlying condition, and not the spur itself, which produces the pain.
Treatment options for plantar fasciitis include stretching, night splints, motion control running shoes, physical therapy, orthotics, anti-inflammatory medications and surgery in refractory cases.
Orthotics, i.e., foot supports, are the only non-surgical therapy to have been supported by studies rated by the Center for Evidence-Based Medicine as being of high quality.
Some evidence shows that stretching of the calf and plantar fascia may provide up to 2–4 months of benefit.One study has shown improvement over a four-month period with stretching. In cases of chronic plantar fasciitis of at least 10 months’ duration, one study has shown high success rates with a stretch of the plantar fascia.
Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Nightsplints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking. These have many different designs.
To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.
Local injection of corticosteroids often gives temporary or permanent relief.Repeated steroid injections may result in rupture of the plantar fascia. While this may actually improve pain initially, it has deleterious long-term consequences.
There is mixed evidence regarding the effectiveness of extracorporeal shockwave therapy. A non-controlled study by Norris et al. showed positive effects. A controlled study by Buchbinder et al. showed no benefit for shockwave therapy compared to a placebo.
In refractory cases, surgery is sometimes indicated.
Traditional surgical procedures, such as plantar fascia release, are a last resort.
Coblation surgery (aka Topaz procedure) has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.
I have performed the Topaz treatment with great success, for tendinitis. TOPAZ is a quick, simple and minimally invasive medical technique now available for the treatment of tendons and fascia. The TOPAZ MicroDebrider utilizes patented Coblation® technology, designed to specifically treat tendons and fascia. To date, over 5 million Coblation procedures have been performed. The TOPAZ technique has been associated with quick return to daily activities allowing for significant improvement in patient outcomes. Since launching TOPAZ with expanded indications for tendonotomy in 2005, TOPAZ has offered a minimally invasive alternative for thousands of patients for the treatment of tendons and fascia.
The surgical removal of tissue is often necessary for treatment of the tendons found in the small joints. ArthroCare Sports Medicine TOPAZ MicroDebrider utilizes Coblation® technology and is considered an alternative to standard invasive surgical procedures. TOPAZ enables the microdebridement of soft tissue present within the tendons of the knee, shoulder, elbow, ankle and foot. The TOPAZ procedure, in conjunction with Coblation technology, preserves the anatomical structure of the tissue while delivering a precisely controlled amount of radiofrequency energy to the tissue.
While most radiofrequency-based surgical products, such as lasers and electrosurgical devices, use heat-driven processes to remove or cut tissue, Coblation-based devices operate at low temperatures. The TOPAZ Microdebrider allows for the execution of more precise procedures compared to those achieved with traditional surgical tools, which tend to destroy tissue structure under high temperatures. Coblation technology gently dissolves tissue, minimizing damage to surrounding healthy tissue.
The revolutionary benefits of Coblation technology have led to its adoption across a number of surgical specialties, including shoulder and knee arthroscopic surgery, spine, neurosurgery and ENT surgery. Considered the gold standard, Coblation technology is now employed in more than 10,000 operating rooms and has been used in the treatment of over 5 million patients worldwide.
I use a no cut no incision technique for Topaz treatment of Achilles tendonitis and Plantar Fasciitis. See below for images of my patients