Advanced Regenerative Healing Options For Chronic Plantar Fasciitis

Bob Baravarian, DPM, and Rotem Ben-Ad, DPM

   Although detrimental to damaged tissues, radiofrequency does not disrupt the healthy fascia. For patient comfort, the treatment wand administers a cool mist prior to the radiofrequency treatment. Two separate procedures are usually required and occur about six weeks apart. The patient is able to ambulate immediately following the procedure with minimal restrictions.

Exploring The Potential Of Percutaneous Radiofrequency Microdebridement

A slightly more invasive procedure that occurs in the operating room is commonly known as Topaz (ArthroCare Sports Medicine) microdebridement. This procedure uses a small Coblation wand to increase vascularity and cell proliferation to promote healing. Generally, immediate weightbearing is acceptable in a controlled ankle motion (CAM) boot and patients slowly transition to a regular shoe in about two to four weeks.

   Sorensen and his colleagues performed a prospective study of 21 patients treated with bipolar radiofrequency microdebridement.4 Out of the 21 patients, 14 related excellent results, four had good results, one had fair results and two had poor results. Hormozi and coworkers found similar results with 11 out of 14 patients stating they would recommend the procedure to someone with similar symptoms.5

Redefining Minimally Invasive Surgery With Another Innovative Technique

Other innovative procedures are now emerging that are able to physically remove the offending scar tissue from the diseased area with virtually no incision or recovery time. An example of this is the Tenex procedure, also known as the FAST™ technique (Fasciotomy and Surgical Tenotomy, Tenex Health).

   Surgeons can perform the procedure with the patient under mild sedation or even with a local anesthetic alone. The technique utilizes ultrasound guidance to evaluate the fascia as well as the scar tissue within it. After making a small stab incision, one would insert the probe, which uses ultrasonic energy to break up and remove diseased tissue. Although powerful enough to break down scar tissue, the frequency is such that it does not affect normal tissue. The surgeon is again able to visualize when adequate scar removal has occurred.

   After applying a soft dressing, have the patient remain non-weightbearing for about one week with a slow transition to full weightbearing in the next two weeks. In our practice, we have found promising results with this technique for the treatment of not only plantar fasciitis but Achilles tendonitis as well.

Gauging The Impact Of PRP

Platelet rich plasma (PRP) is fractionated plasma taken from the patient that contains extremely concentrated levels of platelets. These platelets contain an abundance of growth factors that ultimately stimulate healing by recruiting stem cells and promoting collagen formation as well as angiogenesis.6

   Barrett and Erredge evaluated a small sample size of nine patients treated with a PRP injection under ultrasound guidance.7 At three weeks after injection, the average decrease in plantar fascia thickness was 2.29 mm. Signal intensity with hypoechoic changes also improved post-injection. Out of the nine patients, six patients related complete resolution of symptoms at two-month follow-up. One patient had complete resolution but was disqualified from the study due to receiving a steroid injection. One patient required a second PRP injection and eventually did have complete relief of pain. The last patient only had pain occasionally and only when the patient was ambulating barefoot. At one-year follow-up, only one patient was considered to have failed the treatment with the remaining seven still asymptomatic.

   Likewise, we have had good success in our practice with the use of PRP injections. Patients are generally non-weightbearing anywhere between two to seven days and continue with protected weightbearing in a CAM boot for another week.

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