Plantar fasciitis is one of the most common problems I see at
Powder River 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 PROS diagnoses Plantar Fasciitis
If you make an appointment with me at PROS, 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 PROS, 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 the PROS at 307.686.1413 to setup a consultation.
Dr. Robert Grunfeld is a board-certified orthopedic surgeon at
Powder River Orthopedics & Spine who specializes in foot and ankle procedures in Gillette, Wyoming. The
Board-certified physicians at PROS take an innovative and comprehensive
approach to the treatment of acute and chronic orthopedic pain. Have your
procedure in our modern
operating rooms at Campbell County Memorial Hospital or
Powder River Surgery Center. See the PROS for:
- General orthopedic surgery
- Joint replacement surgery: shoulder, hip, knee and ankle
- Shoulder, elbow, hand and wrist surgery
- Sports Medicine
- Spine surgery and injections, including minimally invasive procedures
- Bunions and great toe arthritis procedures
- Foot and ankle surgery
- Trauma and fracture care
- Workplace injuries
For a consultation, call 307.686.1413 or visit
www.cchwyo.org/PROS.
PROS is a Campbell County Medical Group Clinic with
Campbell County Health.