The treatment for Plantar Fasciitis: TOPAZ micro-tenotomy

Plantar fasciitis is one of the most common problems seen at Wyoming Orthopedics & Spine. It’s one of the most common causes of heel pain.

What is Plantar Fasciitis?
The plantar fascia is a tendon-like structure on the bottom of our foot—from the heel and extending toward the toes. It contributes to and supports the arch in each foot. Your plantar fascia is a shock-absorbing support system in the arch of your foot. Think of it like a bowstring. If the tension becomes too great, small tears can form in the string—and the more that tension is repeated, the more likely the string will become irritated or inflamed.

Plantar fasciitis is the painful inflammation of the thick band of tissue that runs across the bottom of your foot and connects your heel bone (calcaneus) to your toes (metatarsals). It often causes a stabbing pain that begins when you first step out of bed in the morning. Pain may decrease the more you walk, but it may return after long periods or standing or sitting. Pain can also be worse after exercise, not during it.

Those who stand a lot while they work know that this kind of heel pain becomes an unfortunate part of the job. It’s also common in runners, people who are overweight, and those who wear shoes with improper support. Plantar fasciitis affects women and men equally, and can occur in athletes and non-athletes.

Dealing with the pain of plantar fasciitis can cause chronic heel pain that prevents you from enjoying your regular activities. And, altering the way that you walk to minimize the pain from plantar fasciitis can lead to foot, knee, hip or back problems down the road.

How to diagnoses Plantar Fasciitis
If you make an appointment with me at WYOS, the first thing I will do is order x-rays in the office. After looking those over, I will likely also order an MRI. There are other causes of heel pain, and I’ll need to rule those out. These include: calcaneus stress fracture, tarsal tunnel syndrome, neuropathy, and Achilles tendinitis.

The first line of treatment is typically physical therapy, paired with non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, Aleve, and Advil, for example). In therapy, I’ll encourage Achilles stretching as well as heel cushions or shoe inserts.

The majority of patients will improve without surgery, but the recovery can take up to 12 months. For patients who have not improved after six months of nonsurgical treatment, I often will discuss a minimally-invasive procedure called a partial plantar fasciotomy with Topaz micro-tenotomy.

Topaz micro-tenotomy procedure breakdown
This procedure involves a partial release of the plantar fascia (partial plantar fasciotomy). Patients are asleep for this procedure in the operating room. I take the Topaz wand, which looks like a sewing needle, and place the wand into the affected fascia for a second. This action is repeated until a grid-like pattern forms around the heel. The Topaz wand is a specialized device that uses radio frequency waves stimulate or release the plantar fascia. This procedure brings blood to the affected area and restarts the healing process by stimulating the damaged tissue.

This is an outpatient procedure that takes approximately 45 minutes to complete. Patients are able to be discharged within an hour after the procedure with a post-op boot—patients walk on their feet right away. Most patients do not use the boot for more than a few days—use depends on your comfort. A few days later, patients are asked to come back to the office to change the dressing; however, there are no sutures or staples to remove.

Plantar Fasciitis recovery after the Topaz micro-tenotomy procedure
Recovery can take around two weeks to two months, although some patients feel better within the first few days. Physical therapy can often be beneficial and speed up recovery.

At WYOS, the success rate from the Topaz procedure is roughly 90% of the time. It’s important that patients know that the pain relief is not instantaneous—it could get worse before it gets better. But when recovery is complete, the pain is relieved and the tendon is back to normal. Patients are encouraged to stretch the tendon and wear supportive shoes and/or orthotics so the condition doesn’t recur.

Roughly 5-10% of patients may not improve from this procedure, and may have to undergo a different procedure to reduce the pain.

If you are not getting adequate relief from your plantar fasciitis or heel pain, please call WYOS at 307.686.1413 to setup a consultation or visit www.wyomingorthospine.com.