Plantar fasciitis is one of the most common complaints that we see in our practice. 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 conditions with two different treatment requirements. Acute plantar fasciitis is an inflammatory condition and is associated with irritation and inflammation of the plantar fascia at its insertion on the heel region.
After six months this develops into chronic plantar fasciitis, the problem actually changes and and is referred to as plantar fasciopathy. Plantar fasciopathy 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 we would like to educate you on new and improved treatments for chronic plantar fasciopathy.
If plantar fasciitis is treated early and aggressively, it is often not very difficult to treat. Treatment options include stretching, night splints, oral NSAIDS, shoe modifications to a stiffer and stronger sole, added arch support or custom orthotics, physical therapy and cortisone injection therapy.
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.
Typically conservative treatments used for acute plantar fasciitis do not usually work well in these situations.
CHRONIC PLANTAR FASCIOPATHY TREATMENTS
Our common treatments in chronic plantar fasciopathy include aggressive physical therapy with additional custom arch support and shoe modifications. However, in many cases, there is a need for noninvasive and minimally invasive therapy to increase blood to the region.
Treatment options plantar Fasciopathy
Treatment options 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.
Shockwave Therapy (EPAT)
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
PRP 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 well to this treatment.
Radio Frequency Ablation (TOPAZ)
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.
The Tenjet System for Chronic Plantar Fasciopathy (Our practice is currently researching this new technology and looking at long term studies)
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.
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 six months) and those that have truly chronic plantar fascia issues.
Acute treatment for Plantar Fascia patients includes:
- Shoe modification/recommendations
- Custom Orthotics
- Physical therapy
- Oral NSAIDS
- Possible steroid injection
In conclusion, if you have been suffering from acute or chronic heel pain then please visit our Sports Podiatrist at Carolina Foot Specialists so that we can figure out the cause of your heel pain and work on solutions to resolve your pain.
Dr. Andrew Saffer-CFS Mount Pleasant 843-654-8250
Dr. Adam Brown-CFS Charleston 843-225-5575