Foot Specialists of Birmingham

Where Your Feet
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Relief for Plantar Fasciitis & Heel Pain with Topaz Coblation

TOPAZ Coblation Procedure

TOPAZ is a quick, simple and minimally invasive medical technique now available for the treatment of tendons and fascia. The TOPAZ MicroDebrider utilizes patented Coblation® technology, designed to specifically treat tendons and fascia. To date, over 5 million Coblation procedures have been performed. The TOPAZ technique has been associated with quick return to daily activities allowing for significant improvement in patient outcomes.

How TOPAZ Works

Through a minimal port site, the TOPAZ MicroDebrider is applied on and around the plantar fascia or tendon, for half-second duration treatments placed a quarter inch apart to form a grid-like pattern. Small amounts of tissue are removed as a light application of radiofrequency energy is guided into the tissue. TOPAZ treatment typically takes less than 10 minutes to administer. Patients are ready to leave the clinic once recovered from local or light sedation.

Patient Selection

  • Fascia with partial tears may be at an increased risk of rupture
  • Patients with acute trauma, neurogenic disease, ligamentous disruption, bone and joint abnormalities are not considered appropriate candidates for TOPAZ and should not be treated
  • A preoperative Magnetic Resonance Imaging (MRI), ultrasound or x-ray, is recommended

Patient Preparation

Access can be approached via a minimally invasive approach or by surgeons choice.  For plantar fasciitis it is usually performed via a minimally invasive procedure with no incision.

Postoperative Care and Rehabilitation

First 2 weeks in a walking boot followed by use of a stable running shoe utilizing a custom made orthotic.
Return to normal activities in 2 – 4 weeks.

Plantar Fasciitis

Heel Pain

Plantar Fasciitis

Plantar fasciitis is irritation and swelling of a ligament that attaches to the heel on the bottom of the foot. It is important that the correct diagnosis be made as other pathologies that mimic heel pain or plantar fasciitis can be excluded.

Causes

The plantar fascia is a very thick band of tissue that holds up the bones on the bottom of the foot. This fascia can become inflamed and painful in some people making walking, standing, exercising, or daily activities more difficult.

Risk factors for plantar fasciitis include:

  • Foot arch problems (both flat foot and high arches)
  • Obesity
  • Running
  • Sudden weight gain
  • Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
  • A change in activity type or level
  • A change in type of shoes
  • Trauma

This condition is one of the most common orthopedic complaints relating to the foot.

Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On X-Ray, heel spurs are seen in people with and without plantar fasciitis.

Symptoms

The most common complaint is pain in the bottom of the heel. It is usually worst in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

Most people complain of increased heel pain after walking for a long period of time.

Exams and Tests

Typical physical exam findings include:

  • Mild swelling
  • Tenderness on the bottom of the heel extending into the arch

X-Rays may be taken to rule out other problems, but having a heel spur is not significant.

Treatment

Conservative treatment is usually successful, given enough time. Treatment can usually reduce the severe discomfort quickly, but overall resolution can take a couple of months with proper compliance and support.  In most cases we do not immobilize or try to interrupt your daily walking or exercise activities.

Initial treatment usually consists of:

  • Anti-inflammatory medications
  • Proper stretching routines
  • Night splints
  • Custom orthotics / Biomechanical control of the plantar fascia and influential joints of the foot

In severe cases, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.

In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.  Additionally, the TOPAZ Coblation procedure may be a good minimally invasive treatment.

Some physicians will offer steroid injections, which can provide lasting relief in many people.

Prevention

Maintaining good flexibility around the ankle, particularly the Achilles tendon and calf muscles, is probably the best way to prevent plantar fasciitis.

Heel Pain

Causes

Frequently heel pain is not the result of any single injury, such as a fall or twist, but rather the result of repetitive or excessive heel pounding.

Heel pain can be associated with plantar fasciits. The pain is usually felt at the bottom of your heel and is often worse in the morning because of stiffness that occurs overnight. The following increase your risk of developing this painful problem:

  • Shoes with poor arch support or soft soles
  • Quick turns that put stress on your foot
  • Tight calf muscles
  • Repetitive pounding on your feet from long-distance running, especially running downhill or on uneven surfaces
  • Pronation -- landing on the outside of your foot and rolling inward when walking or running; to know if you pronate, check the soles of your shoes to see if they are worn along the outer edge

Bone spurs in the heel can accompany plantar fasciitis, but are generally not the source of the pain. If you treat the plantar fasciitis appropriately, the bone spur is likely to no longer bother you.

Heel bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendonitis is inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by:

  • Running, especially on hard surfaces like concrete
  • Tightness and lack of flexibility in your calf muscles
  • Shoes with inadequate stability or shock absorption
  • Sudden inward or outward turning of your heel when hitting the ground

What to Expect at Your Office Visit

Your doctor will take your medical history and perform a physical examination, including a full exam of your feet and legs.

To help diagnose the cause of the problem, your doctor will ask your medical history and questions related to your specific conditions as well as x-rays and possible a diagnostic ultrasound evaluation.

Diagnostic tests that may be performed include a foot x-ray, or diagnostic ultrasound focusing on the heel.

If either plantar fasciitis or bursitis is diagnosed and if a change in shoes and the use of orthotics have not been successful, a cortisone injection may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendonitis is diagnosed, anti-inflammatory medicine may be prescribed. Heel lifts may be used. Stretching can be helpful. In particularly unresponsive cases, a walking cast or boot may be helpful. Surgery is usually not necessary.

Prevention

To prevent plantar fasciitis and Achilles tendonitis, maintain flexible and strong muscles in your calves, ankles, and feet. Always stretch and warm-up prior to athletic activities.

Wear comfortable, properly fitting shoes with good arch support and cushioning. If you pronate, look for athletic shoes with an anti-pronation device. If orthotics are prescribed by your provider, wear them in all of your shoes, not just while exercising.

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