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

19 comments:

  1. Thanks for sharing your experience. Very similar to mine. I'm 2 weeks post op from TOPAZ and wondering if I will ever have "normal" feet again. (I hate planning my wardrobe around athletic footwear!) Even if I can ever run again, my husband would divorce me. This is as hard on the spouses as the patients. ):
    Wondering what kinds of shoes you are able to wear... I've had no luck finding anything that doesn't look horrific. Also interested in knowing how you are doing now. (Some hope, please?)

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  2. @DGP: Thanks for your comment and I wish you the VERY best of luck. It has taken me a bit to really say the Topaz was worth it as my recovery was much slower than most patients per my surgeon.

    That being said, I am doing much better and honestly experience pretty minimal day to day pain and can comfortably do activities that used to be tough. I can even run on occasion, but not with the intensity or frequency I did pre-plantar fasciitis. Being able to run again at all is a victory for me!

    Footwear is a HUGE part of recovery and I honestly don't think I'll ever be able to wear stilettos again, which I've finally accepted. I love love love shoes and have some suggestions for you as it's a big topic of discussion for me and wearing the proper footwear is still (and probably always will be) key to feeling good for me.
    Some suggestions and brands I like:
    1. Orthaheel/Dr. Weil is hands down the BEST for people with this injury, IMO. Some of the shoes are pretty mehhhh but there are some good options out there.
    a. Love this loafer for fall: http://www.weilbeing.com/women/florence-loafer.html
    b. Good basic flip flop, loved being able to wear these in March in Aruba: http://www.orthaheelusa.com/women/sandals/tide-sandal.html
    c. I get compliments all the time on these and no one ever guesses it's orthapedic: http://www.weilbeing.com/women/renew-toe-post-sandal.html

    2. Taos brand has some comfy options, but I find I need a bit more arch support if I'm going to be wearing them for a long time
    a. Actually wearing these today in red: http://www.zappos.com/taos-footwear-carousel-graphite?zlfid=191&ref=pd_brand_page&zfcTest=fcl%3A0

    3. Cole Haan Nike Air options--I have a ton, and sometimes go up a 1/2 size so I can place my orthotic inside

    4. As crazy as it sounds, the shoe I wore most last winter was a Tory Burch boot (Daniela style) that had a very substantial lug sole and plenty of room for a full length orthotic--LOVED these

    I hope this helps you and I agree it is very hard on spouses!!

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    1. Thanks for your reply. Can't wait to go shoe shopping now! Here's to continued healing for both of us.

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  3. Hello! I am glad to read about both of your experiences on the horrid plantar fasciitis and Topaz procedure. I had the procedure done two weeks ago after trying everything to relieve my foot pain over 3 years and some change. 6 months of physical therapy, regular stretching, icing, orthotics, two types of night splints, and finally two cortisone shots earlier this year. I stopped running and really stopped walking too...even walking the dog around the block causes me grief. So finally I had the Topaz and I really believe it will work. I am wearing the boot for 4 weeks and the dr told me no ibuprofen, smoking cigarettes (not a problem) and to wear the boot all the time so that the healing will be most effective. Two weeks in I do feel better but I sense that the issue is definitely still there, which I guess is normal considering my healing is only about half way, if that.
    I am a huge fan of the orthaheel shoes, and only have a pair of flip flops, but plan on getting more types from them. I also love my Chacos. They last FOREVER. I still have a pair that is 10 years old and I've worn them all over the place, including hiking and in rivers and lakes. I just bought my 2nd pair. I get the sandals with a toe loop and also go around the heel.
    http://www.chacos.com/US/en/Women-Styles-Sandals
    My podiatrist recommends them too and also said that with the plantar fasciitis it is good to always have something around the ankle/heel for support when walking longer distances.
    I would love to run again, but I'm scared! I just want to be able to walk around and keep up with my kids! Traveling and sightseeing have been put on the back burner, so I just pray I will be able to walk. Once I get out of my boot, my podiatrist will fit me for custom orthotics which will hopefully work better than the other ones I had which did nothing.
    There is also a store here in Richmond, VA called "Good Feet" that apparently has incredible good orthotics that can fit into any shoe. Expensive - $600 for a package of 3 kinds you can wear with any shoes - but worth it according to someone I know.
    Keep me posted on both of your recoveries! Best of luck and success to you.

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  4. I will be having the Topaz on Dec 31st on my left foot. I have had all of the same symptoms & did all the same management as you. You mentioned general anesthesia My Dr. said a conscious sedation & local will be used for mine.Do you know why it was general for you? Dr also said more then 90% of his patients have deemed it successful. Any advice for this newbie prior to surgery? Are you able to walk at all immediately following? I have a house full of stairs, do I need just to set up shop in one place. Will I need someone to care for me after the 1st day? Pian level the first week? Thank you so much for your blog & the patience to answer all my questions.
    Wishing you a continued success in healing,

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  5. Anita - I am not sure why I went under general anesthesia, actually. Afterwards, my mother in law brought me home and I had to keep my foot elevated, and iced it (even through the wrap, which prevented me from really feeling any coldness) ever hour or so. I rested all weekend, and then had my post op on Monday where the dr. removed the bandaging and then got me into the boot. It won't be necessary for you to set up shop in one spot. I did the stairs in the morning and at bedtime during the first two nights and it was fine. I hopped and held onto things. Once I got the boot, I had to keep an ace bandage on under it, and he even wanted me to sleep with the boot on. Needless to say, I tried that the first night and in a Frankenstein-like fashion awoke in the middle of the night ripping the boot off, because it was ridiculously uncomfortable. I did not do that again and went to bed with just the wrap on for about two weeks. I started thinking I should follow the dr's orders and realized that I probably need to keep the bottom of my foot somewhat stretched while sleeping so I began wearing my night splint again. Although my dr said that I could "climb a mountain" if I wanted to, as long as I was wearing the boot, I found that I was still in a good amount of pain on my feet. This really bummed me out and discouraged me, because he made it seem like I would be pain free practically right after the procedure. Here I am now....2.5 months after the procedure and I still have arch/heel pain! I have been wearing custom orthotics for about 3 weeks and while I thought they were helping, and maybe they are, I feel like the Topaz was not successful for me. I hate to say that, and I'm confident it will work for you...maybe I'm just in that less than 10% :(
    I am still having faith though, and will try acupuncture, which my primary care dr recommended, in the new year. I don't know what else to do.
    Good luck, and keep us posted :)

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  7. Regarding all aspects the blog was perfectly nice. Orthotic Shoes

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  8. nice blog........Plantar Fascitis is very common cause of heel pain and felt more on the inside of the feet. And as
    mr.bhargava is specialist in Plantar Fascitis treatment, and can instruct in for various exercise, massage to recruit it
    and also surgery for major cases.

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  9. Thanks for the information on your journey. I'd LOVE an update two years out as I am within a month of having the Topaz procedure myself. Pretty much tried everything you mention above. My chiropractor once mentioned PRP to me, but it is costly and not covered by insurance, however, I had not heard of doing them together. Intriguing! I'd be willing to give up "running" if I could still play basketball. And your sentiments about taking your feet for granted... Oh, how I hear you. I often say, "I want my foot back". Thankfully my problem is only in one foot. Peace.

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  10. I typed in Topaz surgery in New Orleans and it led me here. Are you in New Orelans? If so, who was your doctor? I'm desperately trying to find someone in this area who does the Topaz surgery and have had no luck. Thank you.
    ~A former Jersey girl living in the south!

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  11. Whether working or exercising, we all spend an enormous amount of time on our feet. According to a recent study, three out of four people experience a serious foot problem at least once in their lifetime. We treat in Foot pain, Foot problems, Plantar Fasciitis, Plantar fasciitis treatment, Achilles heel, Bunion, Foot conditions and Heel Pain.

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  12. Checkout the FX 635 low level laser and NeuroKinetic Therapy for PF. As a chiropractor I've had great success with this combo. Northbaylaserdoc. Com

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  13. Get well soon. This is really very much harsh and painful surgery and need much time to get recover to health.


    Foot Surgery Northwest Indiana

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  14. Adelyn, would you say 3 years later that Topaz relieved your plantar fasciitis?

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  15. Adelyn, would you say 3 years later that Topaz relieved your plantar fasciitis?

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  16. I had the Topaz procedure done Friday and it's Monday night and still painful. As of right now I would never do this again.

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  17. Podiatrist Crown Point
    advice that if you wish to get rid of the calluses, you need to soak your feet in lukewarm water for nearly 30 minutes before you use a pumice stone.

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  18. Came across your blog in preparation for my topaz on friday. a little nervous and hoping it works. I was searching for length of pain following procedure. my dr made it sound like I would be virtually pain free in a week, but from everything I have read...I doubt that. However, for now I will be out of work (off my feet) for 3 weeks. here's hoping....and thanks for the blog! I hope you are doing better now! how did acupuncture go?

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