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Chronic Heel Pain (Plantar Fasciitis) & Tendonitis of the Foot and Ankle |
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Heel pain represents 15% of adult foot complaints, 25% of foot injuries and 8% of injuries to runners and competitive athletes. Chronic heel pain and painful tendonitis of the foot and ankle affect countless people limiting their ability to walk, work, participate in sports and enjoy life. The Topaz™ Microdebrider is an innovative medical device developed by ArthroCare to treat both. Using a minimally invasive approach, the Topaz™ procedure uses Coblation technology to preserve and restore the normal anatomic structure of the damaged tissue while delivering a precise amount of radiofrequency energy to stimulate an immediate healing response.
What is the plantar fascia?
The plantar fascia is a very thick, inelastic ligament that attaches from the heel bone to the ball of the foot. The plantar fascia functions like a bowstring to support the arch while standing, walking and running.
What causes plantar fasciitis?
85% of people with plantar fasciitis have poorly aligned feet from arches that are either too high or too low. Poorly aligned feet allow excessive tension to develop in the plantar fascia. As the arch lowers during standing or walking, inflammation occurs as the ligament begins to tear away from the bone. Repetitive activities that stress the ligament, such as jobs that require prolonged walking or standing on hard or irregular surfaces or from sports such as running cause overuse (like tennis elbow), which leads to pain, stiffness and swelling.
In the early stages, people think it will go away because they feel pain when they get out of bed in the morning and it dissipates during the day. And for some, it resolves without treatment. For others, however, the pain increases in intensity causing them to limp.
What happened to the plantar fascia?
With chronic overuse the ligament cells become damaged and are replaced by scar tissue. This scar tissue is inelastic and hypo vascular (no blood vessels), so oxygen and nutrients necessary to heal the damaged tissue can't be absorbed properly. Additionally, production of two key growth factors has stopped, both of which are required to recruit healthy fascia cells (fibroblasts) and encourage new blood vessel formation into the damaged area. In as little as 3 months, the damaged ligament has become very thick (3-5 times normal) and now behaves like a soft-tissue mass pressing on delicate nerves causing even more pain and disability.
Professional treatment is usually required in 1-2% of the population just to be able to stand at the sink to wash dishes, let alone work, and walk or play sports. Fortunately, non-surgical treatments, including Shock-Wave therapy (ESWT) are extremely effective at curing heel pain in the majority of patients. However, for those patients who have heel pain resistant to conservative treatment, this new, FDA-approved minimally invasive surgical procedure has been shown to resolve >95% of our patients chronic heel pain over the last 21/2 years since its application in our practice. Additionally, patients with chronic Achilles tendonitis as well as other tendon disorders have also benefited from this procedure.
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