Sunday, January 20, 2013

Plantar Fasciitis: My Experiences and My Bi-Lateral Topaz Technique + PRP Surgery

WARNING:  Lots of words ahead… mostly about feet!

Since this blog is primarily a record for myself, I want to write about my experience with plantar fasciitis in both feet for the past 1.5 years.  I talk about it a lot but hopefully putting it in writing will give me some perspective and possibly help someone else down the road.

My journey down the podiatry rabbit hole starts in Sweden... Well, sort of.  During a work trip to Sweden on December 2011, I had some free time which we spent primarily south of Sweden in Copenhagen, Denmark to be specific.  My coworkers and I were shopping on Strøget when what had been occasional pain in both of my arches and heels became non-stop.  By the end of my trip, I was tip-toeing through our office in Lund and airports in Copenhagen, London and Philadelphia because I couldn't stand to put weight on my heels at all.  (Sidebar--Reva flats may be cute but they may as well be outfitted with nails in the heels for how painful they can be for individuals with this injury--NOT the best footwear choice!)

I kept running as much as I could stand it, and bought Dansko clogs as a concession to obviously needing more supportive footwear.  In early 2012, I finally got referred to a podiatrist convenient to me who came highly recommended.  In fact, I would still recommend this office.  I was quickly diagnosed with plantar fasciitis in both feet (which an MRI would later confirm when I still wasn't getting any better.).  Here’s what happened next:  Ttwo rounds of cortisone injections in both feet (not recommended and it did nothing for me), strapping (multiple times) to help better support the fascia, various NSAID prescriptions (didn't alleviate my pain and Daypro made me nauseated and lightheaded), many different kinds of stretches, night splints, no running at all for about 8 months, prescription orthotics, supportive footwear, the aforementioned diagnostic MRI, and three months of intense physical therapy.

In other words, my podiatrist tried very hard to work with me to avoid surgery at all costs.  Here's what helped the most:  orthotics, stretching and PT.  Unfortunately, these efforts were not enough and my PT and podiatrist came to the same conclusion:  I was that rare patient who needed surgery.  Prior to going under the knife, I even had various blood panels run to rule out less common diagnoses for why I had so much pain (I.e. rheumatoid arthritis).  I am convinced my unusually high arches, high activity level and apparent poor healing response were the trifecta that placed me in Paoli Hospital in November 2012.

I was so sick of planning my life (and wardrobe—and I LOVE LOVE LOVE shoes) around literally constant foot pain.  Some days were better than others, but standing-walking heavy days like the back to back weeks I spent in New Orleans and Las Vegas were times I eventually found it nearly impossible to walk or stand.  I would have to consider social invitations very carefully-if I go this bar, will there be seating?  Can I stand a shoe with hard support today or do I have to wear a squishy sole because my pain is so intense?  Questions like this and pain were consuming my life and turning me into someone I didn't like very much--obsessed with my pain and frankly, pretty nasty a lot of the time.  Also, I've been running since I was 12, and the inability to do it at all or as much as I'd like depending on the degree of pain was making me crazy.  I avoided surgery longer than I probably should have, but eventually decided to for all the above reasons.

My podiatrist was also my surgeon, and he no longer performs the "old-school" plantar fasciitis surgery, which consisted of actually cutting the fascia in hopes of reducing the pressure/inflammation of stressed fascia tissue.  The side-effects of this surgery are often as bad as the injury itself and he felt the clinical outcomes weren't good enough to continue to perform this surgery.  The procedure I had is somewhat unusual as it combines a newer surgical technique with another one and I had it bi-laterally; most doctors will have their patients have each foot done separately if the injury is bi-lateral.  I had an outpatient “needling” type procedure done on both heels called the “
Topaz” technique which was immediately followed up by Platelet Rich Plasma (“PRP”) injections in the side of both of my heels were the fascia joins together.  Both techniques are purported to illicit a hyper-inflammatory response which in theory should force one’s body to heal itself as though the area had been acutely injured once more. 

Although the procedure was considered outpatient, I spent the better part of the day in the hospital.  I went under general plus local (knees-down) anesthesia for this procedure.  I don’t do incredibly well with anesthesia (low heart rate and extreme post-anesthesia nausea) and it was not surprising I spent a long time in recovery.  Other than feeling extremely nauseated and dizzy and weak (my heart rate was averaging around 39 bpm for awhile and required constant monitoring), I don’t remember much about that evening. 
I can attest to the hyper-inflammatory response the surgery is supposed to cause; I was on Percoset (taken simultaneously with Zofran as I vomit otherwise) for a couple of weeks after the surgery, then Vicodin and Neurontin for a week or two after that.  (Sidebar… those pain pills are the WORST.)  For awhile the pain would keep me awake at night and I was unable to walk aside from the occasional trip to the bathroom on my tippy-toes.  Putting any weight on my heel area whatsoever was an absolute no-go for a week.  I came back to work after a week but evening walking around the office proved extremely painful and difficult and I wasn’t able to come in every day the 2nd week post-op.  I would say the 3rd week is when I began to notice a significant improvement in the severity of my pain and a little after a month post-op, I started 3x/weekly physical therapy sessions again.  Tomorrow is the 10 week mark and although I feel MUCH better than I did even 4 or 5 weeks ago, it’s still too early to tell if the surgery worked.  I have days/times with significant pain and I’m still unable to stand or walk for any great length of time but I can now get around pretty normally.  Running is still a pipe-dream and as are any shoes with any type of heel that comes to a point on my heel (here’s hoping!!!).  My physical therapy session last week showed several degrees of improvement in the flexibility of both of my feet, so I am still positive.

The best advice I can give anyone is this:  Treasure the feet you have!  For example, don’t pretend flip-flops are legitimate footwear.  Baby your feet, stretch, don’t take them for granted (MAN I am jealous of a time when I could do this) and don’t ignore persistent pain that wasn’t there before.  Feel free to e-mail me if you’re going through this too and have questions.  I will be posting a brief follow up in a couple of months. Warning, foot picture below (not particularly graphic, but still!)


a couple of weeks post-op