More and more of us are suffering from heel pain (Plantar Fasciitis) and Achilles tendinitis, which comes from injury or mechanics. Twisting a foot, repetitive use causing strain, or improper shoes are common ways they occur. Both of these problems tend to become chronic, especially when left untreated from their onset.
Historically, treatments were conservative, including injection of cortisone, physical therapy, immobilization with boots or casts, and wearing orthotics. Each has varying levels of success, but when unsuccessful, the only alternative was to live with the pain or have surgery.
Several new treatments have come out: Two of these are minimally invasive procedures and one is a non-invasive office procedure.
• The Tenex procedure is done in a surgery center with very light sedation and local anesthesia. It uses ultrasound to guide a micro tip that is inserted into the foot. Ultrasonic energy is applied to breakdown and removes the damaged tissue. This allows for immediate ambulation and the patient can return to normal activity in a few short weeks.
• The Topaz procedure is performed in an outpatient facility where patient is lightly sedated and the area is numbed with local anesthetic. A small grid is drawn on the bottom or back of the heel, depending on which area is to be treated. 50-60 markings are made inside the grid and into each a shallow puncture is made. Once all of the punctures are made, the tip of the Topaz instrument is placed into each puncture and activated for a split second, allowing a burst of plasma energy that penetrates the tendon or fascia. This is repeated to make sure all punctures are adequately treated. Afterward the area is bandaged and a short boot is used for 7-14 days. The bandage is removed in 5 days and the patient is allowed to shower. In 7-14 days the patient can return to regular shoes.
• EPAT, also known as shockwave therapy, is completely non-invasive and is preformed in an office. No anesthesia is necessary, as it is a painless procedure. Contact gel is applied to the affected area and the head of the EPAT is placed against the foot. The EPAT applies low impact sound waves into the painful structure, which causes micro trauma that stimulates the structure to heal. The sensation is one of rapid tapping against the foot. The process takes about five to ten minutes. Once finished, the patient will not have any pain and can return to normal activity. The procedure is done 3-5 times a week for several weeks.
A patient will see faster results with the Topaz treatment than the EPAT. The EPAT response is much more gradual over a one to three month period.
With these newer less traumatic procedures, chronic plantar fasciitis and Achilles tendinitis can be treated and resolved with little or no down time, fewer complications, and a much better outcome.
Dr. Brian Kiel is a Podiatrist and Co-Owner of Podiatry Centers of Memphis. Call (901) 767-5620 or visit pcmdev.melloncg.net