DEAR MAYO CLINIC: Is it true that plantar fasciitis sometimes can be treated with ultrasonic energy? How does that work?
ANSWER: Yes. The treatment you are referring to is called percutaneous ultrasonic fasciotomy, which uses ultrasound technology to treat plantar fasciitis and other soft tissue problems. The treatment is showing promising results in patients who have not gotten relief from standard therapies for persistent plantar fasciitis.
Plantar fasciitis is a common foot problem that involves the thick band of tissue (plantar fascia) connecting the heel bone to the toes. The purpose of the plantar fascia is to support the arch of the foot and act as a shock absorber when you walk, run, jump or otherwise use your feet. If the strain on the plantar fascia becomes too great, small tears can develop in the tissue. Those tears can lead to inflammation and pain. In some cases, these microtears fail to heal properly, leading to degenerative changes, scarring and abnormal blood vessel growth within the tissue.
Plantar fasciitis has many possible causes, including certain types of exercise that put a lot of stress on the feet, such as jogging. Excess weight also can contribute to plantar fasciitis, particularly in overweight people who have been sedentary and then begin an exercise program. In addition, thin-soled or loose shoes, high-heeled shoes, and shoes without enough arch support or flexible padding to absorb shock can increase strain on the plantar fascia, leading to plantar fasciitis. Age also is a factor. As you age, tendons and fascia lose some flexibility and are less able to absorb impact.
To treat plantar fasciitis effectively, the extra stress on the plantar fascia must be relieved, so the tears can heal. For most people, these small tears can be treated successfully with physical therapy and special equipment that gives the foot extra support. A cortisone or other injection also may be considered.
But, for some, this isn’t enough, and finding a solution to the chronic pain and loss of function due to plantar fasciitis can be frustrating. Open surgery to remove the damaged tissue is an option, but recovery often is prolonged, and recurring pain is common.
Fortunately, a minimally invasive treatment is available for patients with plantar fasciitis who otherwise have not found relief. Percutaneous ultrasonic fasciotomy uses the Tenex Health TX tissue removal (debridement) system, which Mayo Clinic doctors helped develop. The procedure, which can be done in a doctor’s office, can be used on elbows, shoulders or other places where tendinopathy (irritation in the tendons) may develop, as well.
Here’s how it works. Before the procedure, imaging tests — such as ultrasound or MRI — are done to determine the location and extent of the degenerated tissue. Once the specially trained physician has a clear picture of what’s going on, her or she numbs the skin over the area and makes a small incision ─ just large enough to insert a needle-like probe.
The physician then inserts the probe into the opening, guided by ultrasound imaging. The probe’s oscillating tip produces ultrasonic energy, which breaks down the damaged tissue directly ahead of it. At the same time, a built-in inflow-outflow fluid system simultaneously irrigates and sucks up the broken down, or emulsified, tissue. Once all of the degenerated tissue is cleared away, the probe is removed, and the incision is closed with adhesive skin tape and a pressure bandage. The whole procedure takes only a few minutes, and complications are few.
After the procedure, patients must rest the area for several days and may need crutches or a walking boot to relieve pressure on the foot. But, they usually can get back to their regular routine within a week to 10 days, although it might take several months before returning to the activity that prompted the plantar fasciitis. Improvement continues as the tissue heals. Some people may benefit from additional physical therapy.
The procedure may not be appropriate for patients who have a complete tear in the fascia, but those with plantar fasciitis that hasn’t responded to initial treatment should talk to their doctor about all of their treatment options, including ultrasonic fasciotomy. — Jay Smith, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota