By Dr. J. Greg Stilwell - Founder of StandStrong
Since many of us are wary of repeated steroid (cortisone) injections, there are other options for pain that won’t go away with simpler measures. Whether you visit a podiatric surgeon or foot & ankle orthopedic surgeon, you may be offered these options. Gone are the days where extensive surgical procedures are done, with grinding away of bone and removal of large amounts of the plantar fascia. Thank goodness! Those procedures often create as much pain and scar tissue as you had before the surgery.
EPAT*, TOPAZ*, and Tenex* are all relatively new on the scene and represent a more enlightened approach to treatment. Plantar heel pain can convert from an acute injury to a chronic, thickened and scarred state of gristle on the bottom of the heel that is relatively inelastic, has poor blood supply, and reduced shock absorption; this is called plantar fasciosis (as opposed to fasciitis), because of the chronic nature and low-level inflammation present ALL THE TIME. The goal of these newer treatments is to bring in new blood vessels, take away the thickened scar tissue with as minimally invasive process as possible. EPAT is a form of shockwave therapy (much like is used for kidney stones) and can bring great pain relief in as little as 3 treatments. No anesthesia is required and no incisions.
TOPAZ* does require at least a regional anesthetic and done in a sterile environment like an operating room. Multiple small holes are made into the fascia then a wand like radiofrequency device is introduced into those holes and helps take away scar tissue and stimulate regrowth of healthy blood vessels. Recovery is usually quick, meaning walking in a running shoe in about 5 days.
Tenex* is single incision surgical procedure that is also minimally invasive. This procedure uses an ultrasound probe to visualize the thickened fascia, and then a specialized probe is inserted into that area where a high-pressure water jet is utilized to break up scar tissue, which is then suctioned away.
PRP and amniotic cell injections are also a good way to stimulate healing in the chronic scar tissue domain that plantar fasciosis sufferers find themselves. PRP is platelet rich plasma; basically, a technician will draw your blood, spin it down in a centrifuge while you watch, then the doctor will inject this new hi-tech healing solution into your heel. Amniotic injections are similar, but the injection comes pre-packaged, ready for infiltration into the fascia of your heel. Both work really well after one of the aforementioned treatments.
Even after all these wonderful new high-tech procedures, you still will need something to control the cause of the chronic heel pain to begin with. So, Stand Strong and vanquish heel pain!