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January 28, 2013
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Heel pain is a common presenting complaint causing patients to seek a foot and ankle surgeon or doctor. One of the most common etiologies of heel pain is mechanical and/or repetitive overuse injury causing inflammation of the plantar fascia, termed Plantar Fasciitis.

Symptoms of Plantar Fasciitis can include:
• Pain on the bottom of the heel
• Pain in the arch of the foot
• Pain that is usually worse upon arising
• Pain that increases over a period of months
• Swelling around heel

Causes for Plantar Fasciitis Include:
• Repetitive loading or exercise
• Change in activity level, duration, or training surfaces
• Recent activity/long walking in un-supportive shoes or sandals
• Faulty structure of the foot.
• Recent weight gain or obesity
• Acute trauma or injury

Conservative treatment options for Plantar fasciitis include:
• Stretching of the Achilles tendon and plantar fascia complexes
• Avoid going barefoot.
• Ice.
• Limit activities.
• Custom orthotics or over-the-counter orthotics
• Supportive and comfortable shoes
• Oral anti-inflammatories
• Physical therapy modalities
• Heel injections
• Night splints

Plantar fasciitis generally resolves with conservative management, however, certain cases can fail 6 months of conservative treatment, therefore, require surgical intervention to help alleviate the symptoms. Podiatry Research has demonstrated that chronic injury and inflammation to the plantar fascia leads to micro-tears and degeneration of the plantar fascia, termed plantar fasciosis. Plantar fasciosis lacks acute inflammatory tissue, accordingly, rendering conservative options unsuccessful at times.

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Surgical options for Recalcitrant Plantar Fasciitis and Plantar Fasciosis can include:
•Topaz (ArthroCare) Microdebrider
•Platelet Rich Plasma injection
•Shockwave therapy
•Open and Endoscpoic Realease

Topaz Coblation Microdebrider procedure is a minimally invasive surgical technique utilizing small holes to break up the scar tissue and attempt revascularization of the plantar fascia. By "burning holes" into the ligament, the Topaz will turn a chronic process into an acute inflammatory process to cause an influx of inflammatory healing cells directly into the ligament.

The procedure is performed in the operating room. The anesthesia team will administer sedation medications and then a local nerve block is performed by the foot surgeon. The surgeon will then mark the area of the plantar fascia and make holes in the skin. The topaz probe is then placed through these holes into the plantar fascia. The patient is then placed into a walking boot for a period of 2 to 3weeks during the healing process.

The procedure only requires small holes compared to a larger open incision and surgery. This lends to quicker healing and less pain and scar tissue and faster recovery.

Think the Topaz procedure might help you? For help with your heel pain, please contact our office, to set-up a consultation.