Topaz Coblation for Planter Fasciitis & Heel Pain

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 small incision, approximately and inch long, the TOPAZ MicroDebrider is applied on and around the tendon for half-second duration treatments placed a quarter inch apart to form a grid-like pattern. With every fourth application, the device is inserted deeper into the tendon - approximately a quarter inch in depth. Small amounts of tissue are removed as a light application of radiofrequency energy is guided into the tissue. TOPAZ treatment typically takes less than 20 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), ultra sound or x-ray, is recommended

Patient Preparation

Access can be approached open or endoscopically per surgeon's preference

Post Operative Care and Rehabilitation

First 3 weeks-use crutches

• Immobilize with splint

Week 4-Week 8

• Passive and active range of motion exercises
• Night splint-Cam walker as appropriate

2-3 months

• No sports or heavy lifting
• Routine at home or work is okay at the discretion of a surgeon
  

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Click on the roll-over link to learn about Plantar Fasciitis or Heel Pain

Plantar Fasciitis

Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot.

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 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
  
• Redness
  
• Tenderness on the bottom of the heel

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

Treatment

Conservative treatment is almost always successful, given enough time. Treatment can last from several months to 2 years before symptoms get better. Most patients will be better in 9 months.

Initial treatment usually consists of:

• Anti-inflammatory medications
  
• Heel stretching exercises
  
• Night splints
  
• Shoe inserts

If these fail, putting the affected foot in a short leg cast (a cast up to but not above the knee) for 3-6 weeks is very often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.

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

In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.

Prevention

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

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Heel Pain

Causes

Most 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.

Plantar fasciitis is inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. 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

Home Care

• Rest as much as possible for at least a week.
  
• Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.
  
• Take acetaminophen for pain or ibuprofen for pain and inflammation.
  
• Wear proper-fitting shoes.
  
• A heel cup, felt pads in the heel area, or an orthotic device may help.
  
• Night splints can stretch the injured fascia and allow it to heal.
  

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 medical history questions, such as:

• Have you had this type of heel pain before? If so, what was the diagnosis and what caused the problem?
  
• When did this episode of pain begin?
  
• Do you have pain upon your first steps in the morning or after your first steps after rest?
  
• Where exactly is your pain?
  
• Is the pain dull and aching or sharp and stabbing?
  
• Is it worse after you exercise?
  
• Is it worse when you are standing?
  
• Do you have any swelling or redness of your heel?
  
• Have you had a fall or have you twisted your foot recently?
  
• Are you a runner? How far do you run? How often do you run? On what type of surface do you run?
  
• Do you walk or stand on your feet for long periods of time?
  
• What kind of shoes do you wear?
  
• Do you have any other symptoms?

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 shoe changes and the use of orthotics have not been successful, cortisone injections 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 antipronation device. If orthotics are prescribed by your provider, wear them in all of your shoes, not just while exercising.

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