San Antonio Podiatrist Discusses New Procedure For Tough Cases of Heel Pain

November 9, 2015 - Dr. Ed Davis, a podiatrist in San Antonio, TX states that heel pain is a leading cause of visits to the offices of podiatrists. Most heel pain is caused by plantar fasciitis, an inflammatory condition of the plantar fascia which is the ligament that attaches to the heel bone and ball of the foot.

There are many causes of heel pain. Davis states that he routinely sees patients who believe that they have longstanding and difficult to cure cases of plantar fasciitis, only to discover that their heel pain has a different cause. He emphasizes that the first step is to obtain the proper diagnosis and addresses some of the causes in his heel pain blog.

Plantar fasciitis can be divided into three distinct types:

1) Acute plantar fasciitis. This is basically a sprain or strain of the plantar fascia that occurs from overuse, overtraining or use of poorly supportive shoegear. It generally responds well to rest, massage, ice and anti-inflammatory medications and is self limiting. Acute plantar fasciitis can become chronic if one does not identify and remove the causes.

2) Chronic plantar fasciitis. Heel pain due to plantar fasciitis that persists is due to long term repetitive strain to the fascia due to unresolved issues of overuse or overtraining, poorly supportive shoegear, occupational issues and faulty biomechanics of the foot and leg. The key is a thorough exam that identifies the underlying causes. The fascia is a strong ligament that provides support to the foot. It is strong in tensile strength (pulling strength) but much weaker in torsional strength (twisting strength). A foot which rolls in to much (overpronates) or rolls out too much (oversupinates) can be a cause of twisting of the fascia in gait.

3) Plantar fasciosis or "intractable plantar fasciitis." Seemingly difficult cases of plantar fasciitis that did not seem to respond to conservative treatment were labelled "intractable" in the past and often treated surgically. The majority of such cases display no inflammation of the plantar fascia, that is no "-itis" but degeneration instead. Degeneration of the plantar fascia is termed "fasciosis" and several procedures have been developed over the last 15 years to address this diagnosis. ESWT or extracorporal shockwave therapy was the first such treatment, introduced to the US in about the year 2000. It involves application of sonic energy to induce healing of fasciosis. The Topaz procedure became avaialable about 7 years ago and involves use of a radiofrequency ablation "wand" to remove the diseased tissue from the fascia. The latest technology is is know as the TenexTX Fast procedure and utilizes an ultrasound wand to remove the bad tissue.

Davis discusses how to identify the type of plantar fasciitis here:
http://sanantoniopodiatrist.typepad.com/my-blog/2010/01/treatment-triad-for-plantar-fasciitis.html

Tenex TX provides a new minimally invasive procedure for plantar fasciosis that can be performed in the office or outpatient surgery center in less than 20 minutes via a tiny 2 mm opening on the side of the heel. The Tenex "wand" looks somewhat like a pen with a tube that attaches to it. The heel is numbed and the tip of the wand is inserted into the heel and guided with ultrasound to the area of diseased fascia. The wand releases ultrasonic energy which liquefies the diseased tissue and then extracts it via suction using the attached tube.

Patients go home immediately after the office procedure and may return to sedentary work the following day and jobs involving standing within 2 to 3 weeks. Dr. Davis is excited to offer a procedure that that is effective, minimizes patient time loss from work and activities and have a high success rate.