OK. I scoured the internet and did everything I was supposed to. I did the icing, the stretching, the arch supports, even custom orthotics. I bought the best shoes. I bought a night splint online. I took Ibuprofen. I went to the doctor and had a cortisone shot or two. I am still miserable! Now what?
This is a question that plagues about 20 percent of plantar fasciitis sufferers. In some cases, appropriate, well accepted conservative care simply fails to provide relief. For a few months, plantar fasciitis can be considered acute. During this early phase of the condition, the previously described care is usually very effective. But once the condition has gone on for 6 months or longer, it becomes chronic rather than acute. In the chronic state, there is no longer inflammation. The ligament becomes somewhat avascular. (It loses some of its blood supply). Previously healthy collagen tissue becomes infiltrated with scar tissue from repeated microscopic fiber tears. It is no longer healthy tissue. At this point, the body can’t heal itself because it no longer “realizes” that anything is wrong. Having passed the acute inflammatory phase, the body no longer knows to bring its healing factors to the area.
At this point, other treatment options may become necessary. Surgical cutting or release of the plantar fascia should be the LAST option. There are several other treatments available at this time. All three theoretically have the same goal: To turn a chronic condition back into an acute one, so the body can once again “know” that something is wrong and heal it.
Option 1: Extra-Corporeal Shock Wave Therapy. ESWT are high energy shock waves introduced on the surface of the heel designed to repeatedly traumatize the tissue. This treatment is similar to blasting kidney stones. This treatment does not break the skin. The high energy creates tissue inflammation which can signal the body that an injury has occurred and while healing this new injury, the plantar fasciitis is often healed as well. This is performed with or without anesthesia, in an office or surgical center setting.
Option 2: Topaz Radio Frequency Ablation, also known as Coblation. Topaz is an invasive procedure performed under anesthesia in a surgical center. Holes are burned in the affected area of the fascia at different depths, with a radio wave wand through multiple skin punctures. This is to encourage the in-growth of new circulation and the creation of a “plasma field” which liberates growth factors in the area to stimulate healing.
Option 3: Platelet Rich Plasma Therapy. PRP is the most exciting new treatment. This can be performed in one office visit under local anesthesia. Approximately 20cc’s of your own blood is drawn and spun down in a centrifuge to get 3cc’s of pure platelets. Platelets have many different growth factors and proteins necessary for tissue healing. Under ultrasound guidance, this concentrate is then injected directly into the damaged area of the fascia. PRP is like “supercharged healing”!
All three of these advanced treatments can take some time to be effective. Don’t forget, we are stimulating a healing process that can take weeks to be effective. While in some cases, re-treatment may be necessary, these procedures do not violate the integrity or function of the plantar fascia as surgical cutting does. They are excellent options if traditional conservative care has failed.
I hope this post has given you some food for thought.
Dr. Neil Levin
Family Podiatry
Check us out at http://YourFootDoctor.com
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