Nonsurgical, Surgical, and Minimally Invasive Treatment Options for Plantar Fasciitis

Doctors have developed several technologies that aim to promote healing the plantar fascia by using energy waves—radial shock waves, ultrasonic energy, or radio frequency waves.

• These therapies try to facilitate healing by stimulating blood flow to the plantar fascia.
• Some also attempt to break up scar tissue that has built up around the plantar fascia.

These are outpatient treatments. Research regarding their abilities to treat plantar fasciitis is ongoing, and doctors report different success rates. In addition, new technologies are continually being developed. Individual patients who have moderate to severe plantar fasciitis are advised to talk to their doctor to find out which of these treatments, if any, are recommended

Extracorporeal shock wave therapy (ESWT). Extracorporeal shock wave therapy is an outpatient procedure with mechanical shock waves administered with a small, hand-held device. No incisions or injections are required. Experts theorize that the shockwaves stimulate to increased blood circulation and metabolic responses that promote healing.

This treatment may require a series of outpatient appointments and potential side effects include pain, swelling, and unusual or changed sensation, including numbness.

Tenex FAST procedure. During this procedure, the doctor uses a handheld device to deliver with ultrasonic energy (sound waves) to the plantar fascia. The goal is to is break up and remove dead or contaminated tissue and stimulate healing.¹Tenex FAST procedure. Tenex website http://www.tenexfastprocedure.com/medication-adhd-tenex-houston-tx.html. Accessed November 1, 2016. This procedure requires an injection of local anesthetic and one or more small incisions.

Topaz procedure. During this procedure, the doctor injects a local anesthetic and then systematically punctures the heel multiple times with a needle-like instrument called a wand. The wand delivers radio frequency waves that break up scar tissue at the plantar fascia. This treatment increases blood flow to the injured plantar fascia area and may facilitate healing.²Topaz Procedure: minimally invasive radiofrequency treatment for tendons and fascia. University Foot & Ankle Institute website. http://www.footankleinstitute.com/topaz-procedure. Accessed November 14, 2016.

RelēF. Like the Topaz procedure, RelēF. uses radio frequency to break apart scar tissue and increase blood flow to the injured plantar fascsia.³Heel Pain Treatment Options. University of Foot & Ankle Institute website. http://www.heelpaininstitute.com/Advanced-Treatments.html. Accessed November 2, 2016. This treatment does not require injections or incisions and is usually painless.

Like injection therapies, the procedures described above are options for people who do not respond to traditional, nonsurgical treatment, such as stretching and exercises. Healing times for these treatments vary; complete results can require anywhere from 2 to 12 weeks.

Surgery: Plantar Fasciotomy

In rare cases, a doctor may advise a patient to consider surgery to treat plantar fasciitis.

Plantar fasciotomy. The most common surgery is plantar fasciotomy. A surgeon makes an approximately 1.5-inch incision in the heel and then makes precise cuts to release tension in the plantar fascia.

Endoscopic plantar fasciotomy. This surgery is quite similar to a traditional plantar fasciotomy, but the surgeon enters the foot through two smaller incisions in the heel. This surgery is less common and requires special equipment and surgical training. Some experts believe endoscopic surgery increases the risk of nerve damage.

Plantar fasciotomy surgeries are successful in the majority of cases but do have potential side effects, such as the flattening of the foot’s arch and nerve damage. Therefore, surgery is recommended only to certain patients whose symptoms have lasted for 12 months or longer and whose pain has not responded to more conservative treatments.