Four advanced treatments for "difficult" cases of plantar fasciitis or plantar fasciosis are offered by San Antonio Podiatrist, Dr. Ed Davis.
1) The Topaz Procedure: This procedure is a minimally invasive procedure for plantar fasciitis that involves use of a small wand made by Arthrocare. It employs radiofrequency utilized by the surgeon to debride or thin the fascia at the heel, that is, remove the diseased tissue causing the heel pain. The procedure is performed via tiny "puncture" holes made in the skin at the bottom of the heel that require no sutures and leave no scarring. Patients can walk on the area the next day. http://www.topazprocedure.com/
2) ESWT or extracorporeal shockwave therapy: This procedure is a non-invasive and involves the use of a machine that generates sonic pressure waves to induce remodeling or repair of the diseased fascial tissue at the heel. It is also effective for achilles tendon problems. The procedure is performed in the office without the need for anesthesia and patients can return to activity the same day. Dr. Davis owns and uses three different ESWT technologies to obtain optimal results. The Swiss Dolorclast which is a third generation ESWT machine manufactured by EMS: https://www.ems-dolorclast.com/products/swiss-dolorclastr-classic
The Storz/Curamedix Orthopulse provides exceptional technology and versatility to ESWT treatments.
Focused ESWT can provide more targeted treatment and has demonstrated significant effectiveness in the promotion of regeneration of damaged fascia and tendons. We use the Storz/Curamedix Intelect FS-W focused unit in our office.
3) MLS Laser Therapy: MLS laser is a modality in which is supplied by Cutting Edge Lasers, https://celasers.com/medical/. The laser works by employing two synchronized wavelengths of light which treat damaged tissue at the cellular level to stimulate healing, reduce inflammation and pain. I was introduced to this modality about a year ago but had difficulty understanding and accepting the concept behind this. CE Lasers initially sold to the veterinary market in the US despite fairly widespread use of the products in Europe. There is no placebo effect with animals. I talked to several veterinarians using the CE Laser before becoming convinced of its efficacy.
4) Platelet rich plasma (PRP): Platelet rich plasma has become a popular and somewhat glamorous new treatment modality used by professional athletes for injuries. PRP is a concentrate of whole blood of the patient in which the the platelets are concentrated in a small portion. The platelet concentrate is then reinjected into the injured area. Platelets are involved in the clotting mechanism so bruising and swelling can be decreased. Platelets contain growth factors so, in concentrated form, the amount of growth factors can be increased in an injured area. Results in the press and literature have been mixed but there is a reason for this in my opinion. PRP is often used as a primary treatment or sole treatment. There may be a benefit to do so but the underlying cause of tendon and ligament pathologies must first be addressed otherwise lasting relief may not occur. I use PRP as an adjunctive treatment; for example, I will inject PRP into the plantar fascia after performing the Topaz procedure. I use the same strategy with the CE Laser, utilizing it in conjunction with ESWT.
5) Amniotic membrane injections: There is a lot of discussion about the use of stem cells to aid in the regeneration and repair of damaged tissues. Use of actual stem cells involves a minor surgical procedure to extract the cells and, as such, is not commonly performed. Stem cells contain growth factors and the primary goal is to be able to use the growth factors. PRP contains growth factors but at a lower concentration than growth factors derived from tissues with high concentrations of stem cells. A common source is amniotic fluid. A number of companies harvest donated amniotic fluid to prepare injections rich in growth factors.
For more information see our heel pain website: http://www.heelpain.pro/