Recalcitrant or tough cases of plantar fasciitis are often due to a degenerative process of the plantar fascia, known as Plantar Fasciosis. Such cases may have been treated by invasive surgical techniques in the past but now there are non-invasive or minimally invasive options.
1) ESWT or extracorporeal shockwave therapy involves the use of acoustic or pressure waves applied in an office setting to induce healing the diseased plantar fascia. It is non-invasive.
2) The Topaz Procedure is a minimally invasive technique that involves use of a radiofrequency ablation "wand" which atraumatically removes the diseased tissue.
3) The Tenex TX Procedure. A relatively new procedure in which a wand which uses ultrasound energy is inserted percutaneously (through a tiny opening in the skin) and the abnormal tissue of the fascia removed under imaging, typically sonography. The Tenex TX procedure may be potentially less traumatic than even the Topaz Procedure since the diseased tissue can be more precisely targeted.