Modern Plantar Fasciitis Treatment Options Explained

Modern-Plantar-Fasciitis-Treatment-Options-Explained

Plantar fasciitis is one of the most common orthopedic ailments in the United States. The number of patients known to have the problem is estimated to be between six and seven million.

Many patients attempt to treat the problem at home prior to seeking treatment from a doctor which is fine unless the problem has been present for an extended period of time, usually between 3-6 months. That is when they often learn about Plantar Fasciopathy for the first time.

What’s the Difference between Plantar Fasciitis and Plantar Fasciopathy?

Plantar fasciitis is actually divided into two unique conditions with two very different treatment requirements. Acute plantar fasciitis is actually an inflammatory condition and is associated with irritation and inflammation of the plantar fascia at its insertion on the heel region.

However, after three to six months of chronic plantar fasciitis, the problem actually changes and the correct name for the problem at that point is plantar fasciopathy. The difference between plantar fasciitis and plantar fasciopathy is the latter is NON-inflammatory and there is a lack of blood supply to the region and the body thinks of the problem as being normal. This lack of blood supply results in the body not responding to the condition and therefore a lack of healing potential in the region.

Is Plantar Fasciitis and Plantar Fasciopathy treated Differently?

Treatment for these two conditions is very different and the goal of the article is to show new and improved treatments for chronic plantar fasciopathy.

If the problem of plantar fasciitis is treated early and aggressively, it is often not very difficult to treat. Often the treatment requires shoe modifications to a stiffer and stronger sole, added arch support or custom orthotics, gentle stretching and anti-inflammatory treatments such as physical therapy or cortisone injection therapy. The main treatment, as noted, is anti-inflammatory.

On the other hand, in the case of chronic plantar fasciopathy, there is NO inflammation present and there is a chronic scar tissue formation in the heel region with the body not responding to the region. The goal of treatment is to INCREASE inflammation and return the body’s blood supply to the region to help with healing.

The common physical therapy and steroid injections don’t usually work well in these situations.

Chronic Plantar Fasciopathy Treatments

Our common treatments in chronic plantar fasciopathy include aggressive physical therapy with additional arch support and shoe modifications. However, in many cases, there is a need for an adjuvant therapy to increase blood to the region.

What is Adjuvant Therapy?

Adjuvant therapy, in terms of our discussion here, is a treatment that will cause an irritation of the region of the plantar fascia that’s non-responsive and lacking the healing blood supply. This will result in a return of blood to the area and take the chronic condition and make it more acute which can then allow the body to heal the region.

Common Adjuvant therapy treatments include:

Shockwave Therapy

Shockwave therapy has been around for about 30 years and is basically a small jack hammer that is hitting the heel area and breaking up scar tissue. Much like someone hitting your shoulder over and over with a punch which causes inflammation, the concept of shockwave therapy is to cause minor damage to the region and increase blood supply. It is a treatment that can work well but is somewhat obsolete. The main benefit is that the treatment is fairly simple and does not involve injection or internal treatment.

Platelet Rich Plasma and Amniotic Injections

Platelet-rich plasma and amniotic injections are used to bring the patient’s own blood cells and healing cells to the region of chronic injury. Both treatments help recruit cells necessary to heal and have a very strong result in our hands. These treatments work well but can be somewhat painful and moderate to severe cases of scar formation may not respond full. well.

Radio Frequency Ablation

There is a group of patients who have such extensive plantar fasciopathy that the PRP and amniotic injection are not strong enough to treat. In such cases, radio frequency ablation was used to break up the scar tissue with a small needle probe. The previous treatments such as Topaz used approximately 20-30 small needle holes made through the skin on the bottom of the foot to break up the scar tissue on the sole of the foot.

This was also a very good treatment but the need for multiple holes was a problem and again the pain level was quite strong and high in these patients.

The Tenjet System for Chronic Plantar Fasciopathy

Our current favorite treatment for chronic plantar fasciopathy that does not respond to PRP and amniotic injections is called Tenjet. The Tenjet probe requires only one small needle hole made through the side of the foot which allows immediate weight bearing and showering in 2-3 days getting the foot wet.

The Tenjet system releases a high-power water jet into the region of the plantar fascia scar tissue and damage. The system is used under ultrasound guidance and the water jet which breaks up the scar tissue is connected to suction and the scar tissue is sucked out after it is broken up by the water jet.

The beauty of the procedure is that the water jet is not strong enough to break up the good fascia but strong enough to break up the poor-quality scar tissue. Patients are allowed to place weight on the foot as tolerated in a boot and they returned to shoes in about 3 weeks. Treatment is often combined with a PRP or amniotic injection at the time of the Tenjet procedure to increase the healing factors in the region.

[arve url=”https://youtu.be/B0ty_Qc2vX0″ title=”The Tenjet System for Chronic Plantar Fasciopathy” description=”About the Tenjet System and how it works for Chronic Plantar Fasciopathy” /]

What’s the Best Treatment Option for Chronic Plantar Fasciitis Treatment?

The best treatment always depends on the patient and their individual condition. So the first thing we do is separate patients into two distinct groups, those with acute plantar fascia (suffering less than four months) and those that have truly chronic plantar fascia issues.

Acute treatment for Plantar Fascia patients includes:

  • Shoe modification
  • Orthotics or insoles
  • Physical therapy
  • Rest
  • Possible steroid injection

If the problem’s been present for a prolonged period of time, treatment changes to:

foot massage for plantar fasciitis

  1. First, change shoe and insole habits to control the foot position.
  2. We then consider a short period of physical therapy to see how the patient responds.
  3. If there is no response, we suggest a PRP or amniotic injection and protection.
  4. If this does not work or if the patient prefers to proceed more rapidly to a more aggressive treatment, we use the TenJet system with a PRP or amniotic injection to break up the chronic scar and increase the healing potential to the region.

With the TenJet treatment, patients are placed in a boot, they are allowed weight immediately, but most patients will use a crutch for a short period of time until the heel pain from the acute post-surgery period begins to resolve. Most patients will begin regular shoes at 2-3 weeks and slowly increase to full healing by about 6 weeks.

In conclusion, if you have had a problem with heel pain for an extended period of time greater than 3 months, you may want to consider an adjuvant therapy that breaks up scar and increases blood supply to the region. And for that, in many cases, TenJet is the best course of treatment available today.

If you’re experiencing problems with your feet and heel pain, we’re here to help. Our nationally recognized foot and ankle specialists offer the most advanced podiatric care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

For more information or to schedule a consultation, please call (877) 736-6001 or visit us at www.footankleinstitute.com.

Dr. Bob Baravarian, DPM, FACFAS
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Dr. Bob Baravarian, DPM, FACFAS

Dr. Bob Baravarian is a Board Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital and an assistant clinical professor at the UCLA School of Medicine. He also serves as co-director of University Foot and Ankle Institute. He is Editor Emeritus of the international medical journal, Foot and Ankle Specialist.

Dr. Baravarian has been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He servers as a consultant to the ATP (Association of Tennis Professionals) tour, multiple running organizations and several shoe manufacturers. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),

Podiatrist Dr. Bob Baravarian is available for consultation at the Santa Monica, Sherman Oaks and UCLA Westwood offices.
Dr. Bob Baravarian, DPM, FACFAS
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