Susan Piper’s foot always hurt worst in the morning.
Piper has been a cosmetologist for more than 30 years, so she’s on her feet all day. After she developed plantar fasciitis, her doctor’s office gave her a list of do-it-yourself treatments: stretching her foot before getting out of bed, stretching her calf muscles, rolling a frozen water bottle under her foot.
“I did everything that they recommended,” said the Brock, Nebraska, resident. “It just got to the point where there was no relief.”
Then her doctor told her that an interventional radiologist from Lincoln, Dr. Rahul Razdan, was performing a new procedure that removed patients’ diseased plantar fascia using ultrasound imaging and ultrasonic energy delivered through a needlelike device.
Piper was interested: “I was to the point where I had to do something.”
Razdan took out the offending tissue in December 2013. The hole in Piper’s heel was small enough that it didn’t need stitches. After a few weeks in a walking boot, she said, “I’ve had absolutely no problem since. It’s wonderful.”
The procedure could provide relief from a painful condition that physicians say prompts 1 million doctor’s office visits a year. Razdan and Dr. Eric Vander Woude, his partner at Lincoln’s Advanced Medical Imaging, have treated more than 100 patients with chronic plantar fasciitis since August 2013 using the Tenex Health TX treatment. They found that more than 90 percent of patients reported improvements in symptoms two weeks after their procedures, and the improvements were maintained at six months.
Early this month, Razdan presented those results to a scientific meeting of the Society of Interventional Radiology in Atlanta.
Peer-reviewed journals haven’t published research from larger studies of the procedure.
Physicians using the device are “trying to stimulate a new response to the injury, and I believe that’s sound,” said Dr. Robert Santrock, an orthopedic surgeon and assistant professor at West Virginia University. “They’re onto something. I think this is a great pathway to try to help this very difficult problem. It’s early, it’s very early, but it’s in the spectrum of the right idea, heading in the right direction.”
Doctors who have used the procedure say they’re pleased with the results. Tenex, the manufacturer of the device, says among U.S. providers, the procedure’s success rate for plantar fasciitis is closer to 85 percent.
Physicians have performed about 25,000 of the Tenex procedures over the last three years, and more than 11,000 of those cases have been performed on plantar fascia. The others targeted the shoulder, elbow, knee or ankle.
The technology was developed by Tenex Health and the Mayo Clinic, adapted from techniques that for years have been used to remove cataracts.
Plantar fasciitis is a common overuse injury that affects the sole of the foot. The plantar fascia is a tough, fibrous band of tissue connecting the heel bone to the base of the toes.
Fasciitis is inflammation of that tissue.
According to the American Orthopaedic Foot & Ankle Society, you’re more likely to develop the condition if you’re female, overweight or have a job that requires a lot of walking or standing on hard surfaces. You’re also at risk if you walk or run for exercise, the society said, especially if you have tight calf muscles that limit how far you can flex your ankles. People with flat feet or very high arches also are more prone to the condition.
Most cases of plantar fasciitis, experts say, can be resolved over three to four months with a combination of rest, stretching, anti-inflammatory medications, physical therapy and proper footwear. Sometimes, people need to wear a foot splint, usually while sleeping, or get a steroid injection.
In a small number of cases, procedures like the Tenex treatment, endoscopic surgery or open surgery are necessary.
Most of the Tenex procedures are performed using only local anesthetic. Dr. Joseph McBride and his colleagues at the Nebraska Medical Center, who have done about 20 of the procedures, give plantar fascia patients general anesthesia. “Most of our patients feel like, ‘You’re sticking a great big needle in my foot, I want to get some sedation.’ ”
McBride, an interventional radiologist, beat his own plantar fasciitis with a lot of stretching, using a splint and wearing heel cups in his shoes.
The condition developed after he increased his runs from 5 miles at a time to 10. It took him four to five months to get better. “I didn’t really start running for two months after that.”
Dr. Michael Budler, an interventional radiologist with Advanced Radiology in Lincoln, was the first doctor in Nebraska to perform the Tenex procedure and has done more than 300 of them on patients with plantar fascia, elbow, knee and Achilles tendon problems. He said he and his office colleagues have performed about 470 total.
“Interventional radiologists are really minimally invasive, image-guided-procedure experts,” Budler said. “We use ultrasound every day.”
Tenex Health representative Jared Powell said sports medicine physicians are the heaviest users of the device, followed by podiatrists, orthopedic surgeons and interventional radiologists.
Budler said the outpatient procedures take him about 20 minutes. The actual use of the ultrasonic needle, he said, takes about two minutes for an elbow and four minutes for plantar fascia.
Dr. Nicholas Bruggeman, an orthopedic surgeon at OrthoWest in Omaha, uses the Tenex device to address patients’ cases of tennis elbow.
He has performed about 40 of the procedures, he said, and has stopped doing open surgeries for the condition. “I’ve been really happy with it,” he said, “for two reasons: one, it’s a quicker recovery; two, it’s been more predictable.”
The Tenex procedure is covered by most insurance companies, the company and physicians said. Depending on where it’s performed and whether IV sedation is used, Powell said, the procedure can cost from $1,600 to $5,000.
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