I have some interesting and exciting news for you,
for people who suffer from heel pain and plantar fasciitis, what is it?
Well I have a lot of videos on that but I'm gonna explain it.
This is the plantar fascia right here, there's a little band of -- well, this is the muscle,
but the plantar fascia is right about here.
When people have heel pain in the morning, they have pain right about here with
this plantar fascial band,
goes into the heel bone,
this is the heel bone right here, number 19,
well, so the plantar fascia goes into this heel bone
and why do people have pain and why do people have heel spurs?
The pain is because the plantar fascia pulls on that bone and keeps on pulling on it.
When it pulls on it by a phenomenon called Wolff's law, the bone forms more bone
to go ahead and accommodate the pressure or the pull of that plantar fascia
causing the little bone spur down at the bottom.
Now how do we treat this?
Typically you know, we do injections, physical therapy, strapping, using heel cups,
over the counter inserts or even custom inserts.
Now 85% of our patients do better with that and physical therapy
but let's say for those who just don't get better, what do we do?
Well we have endoscopic surgery
we'll go ahead and take a little 4mm camera,
go in and we cut the band.
The other way is a minimally invasive opening
but we still cut the band with the scissors,
a small opening, we're able to cut with scissors,
the other option is the traditional, we open up the bottom open it up look at it and we cut
the band, everything we do, cutting the band,
whether you do it by camera or do it by opening a small incision, big incision, cutting the band.
What does cutting the band do?
It releases the pressure so you form a little scar tissue there
it's going to fill in the gap so you essentially elongate the plantar fascia,
take the pressure off the plantar fascia, take the pressure off the bone.
Sometimes on MRI you will see swelling of the bone right about here
as well as swelling at the plantar fascia at the same time.
So the bone is active, the bone is and so is the plantar fascia,
so soft tissue and bone is. Now back in the old days before the MRIs
we think, oh that heel spur must be the problem.
We see it, it looks ugly like a little hook on the bottom the foot, right?
So we used to go ahead and take that out.
But since the MRI we found that not all the time is the bone inflamed but --
or even the heel spur is inflamed, it's not inflamed,
its really the plantar fascia and soft tissue that's inflamed.
Now we also have stem cell injections for that to help it to heal,
we also have shockwave therapy which is basically
a big hammer device we put on the bottom of the heel after we numb you up,
we use that for kidney stones, we use it for for tennis elbow, etcetera
but plantar fasciitis it works really good for it,
for people with resistant heel pain.
We're talking about resistant heel pain,
people that have done everything in the world conservatively and it doesn't work,
that is where we step in.
So for the 15% of you that have heel pain despite all conservative care
we have the shock wave therapy, we have those surgeries I recommended,
you know, recovery from the endoscopic can be two weeks off your feet
and then walking in a boot for another four weeks
but exciting technology that I want to share with you today
and I have testimonials of two patients right after that are two weeks post-op
right after this video is that something called hydro surgery. What is hydrosurgery?
Hydrosurgery is using ultrasound as well as using water to differentiate -- or saline --
to differentiate bad tissue and sucking out the bad tissue,
selectively sucking out the bad tissue from the heel.
So instead of cutting the plantar fascia
now we have technology with the use of ultrasound now
to selectively cut the inflamed bad tissue.
What happens when you have plantar fasciitis?
ITIS - inflammation, right? So, inflammation - you're gonna get inflammation, inflammatory tissue.
Inflammatory tissue has more water content
so we use this little probe right here, a little probe, a little stick, a little pen, a little needle,
water shoots out the end and bad tissue or inflamed tissue
gets sucked into this little hole right here.
So it's a constant stream of water coming out and breaks up all the other bad scar tissue
and it gets sucked in here, that's the layman's term of how that works.
So basically in this procedure you're brought into the operating room,
they give you a little anesthesia, we numb you up, make a small little poke incision
not even as big as a -- a little poke,
everything's going toward minimal invasive now, a little poke.
So under ultrasound, the low ultrasound probe down here
we can see the inflamed tissue, a lot of times we see that, we see the inflamed plantar fascia,
we see normal here and it gets hugely inflamed right here so what do you do?
Make it a little -- let's make a little stab,
we go into this plantar fascia with ultrasound guidance we go in, out a few times
with saline dripping as well as a vacuum going and
the vibration of the saline will break up some of that inflamed scar tissue
and then this tube right here will suck in all the debris, all the bad tissue that's been debrided
so what's left behind are good viable, non inflamed tissue and you can heal.
So basically we're just poking the inflamed plantar fascia, breaking up the scar tissue
and then sucking it out with this vacuum right here, it's all done within this one device.
So it's not much bigger than a blood drawing needle, an 18-gauge blood drawing needle
and you're under anesthesia anyway and we're able to go in with a few pokes and go ahead
and take care of this procedure without cutting the plantar fascia,
this needle's going into the plantar fascia and just breaking up all
the bad inflamed pathological tissue.
So what are you left with is a steri-strip and a little band-aid
and you're walking in a boot immediately,
there's no timeout so that's why I'm very excited about this technology,
there's no time off your feet with this
and it is covered by insurance whereas PRP we have that available,
stem cells injection as well as shock wave therapy, they're not covered by insurance.
Well this is covered by insurance
for doing this hydro surgery, minimally invasive hydro surgery
to get you back on your feet quicker, it's covered by insurance, we do it at a surgery center --
at the comfort of the surgery center,
you're walking on your feet immediately in the boots for about two weeks and
probably physical therapy for another two weeks
but patients have been very happy with this,
these are people that we've had in a study at the center,
we weeded out the worst of the worst conditions of heel pain
and even they are doing better.
So we went through our database of patients,
we asked if they want to participate in the study procedure at the company --
allowed us to do a study on a couple of patients
and they've done really well and their testimony is right after this guys.
So after this, any questions or comments please let us know,
put in the comments section on YouTube, talk to you then.
This is Dr. Lam again, this is our second patient that we did the tendon joint on
at the Family Foot and Leg Center,
so he had a lot of pain before this
as you saw with the first patient the pain is decreased significantly,
this is only one week, we used steri-strips, we didn't use the suture on this one
and how's the pain after the procedure?
"It's the first couple of days so it's sore but everyday it's getting better and better and better".
Excellent. "Yeah, feels great".
Excellent, so I'm moving the toe, I'm stretching it out,
we did a good release over there with the TenJet unit, any pain here? "No".
Any pain here? "Just right there, a little bit".
A little bit, right? "Yeah".
How does it feel let's say before the procedure till now?
"Oh yeah, it was tight, you know, I had flare-ups it would hurt"
"Now the procedure I think it's just a little sore from the actual procedure".
Good, good, good. "Much, much better".
Awesome, we'll just do a follow-up within one month and go from there my good man.
"Okay, sounds good".
This was done under ultrasound guidance and the incision is right there,
we debrided the plantar fascia utilizing the TenJet,
so far so good, everyone's done well, awesome, great job.
This is Dr. Lam, this is about one week after TenJet procedure
for the young man with chronic heel pain,
went through physical therapy, injections, and everything else. Am I correct?
"Yes".
So this is about a week out now, this is his incision and incision is really a stab incision.
He used to have a lot of pain right here, so right here.
Any pain today? "No".
We're a week out, he's been in the boot
so that's the incision chronic plantar fasciitis,
not everyone qualify for this procedure, we only do it for people who have failed conservative care.
Basically it's a little needle, we go in there,
uses the ultrasound to debride or cut out
the bad inflamed tissue versus using a knife.
The other thing we're talking about is before this we had a scope that we did using a scope,
it's a four millimeter scope we put in through through the heel, we cut it, it's called the EPF,
endoscopic plantar fasciotomy
but this is an ultrasound version and
uses fluid and sound waves to take away bad tissue.
So far for him it's one week out, he's doing really good,
one stitch is all it took but sometimes the company protocol not even requires a stitch
but I like to stitch but at the tip we put just a little steri-strip.
So right now you can put a band aid on for another week, I'll get you to physical therapy,
get it stretched out and get you back on your feet again. Sounds fair?
"Yup, I mean, I've been stretching it like just doing this, I don't know if that helps".
That's very good, keep doing your stretching exercise,
I don't feel that inflamed plantar fascia anymore because we see it on the ultrasound
when we were debriding and cutting it out.
"You'll check with the ultrasound or not?"
Not today, we don't need it,
but when we did the procedure the ultrasound was what guided the needle.
"Okay."
The ultrasound needle to break out that scar tissue,
break up the inflamed tissue so I'm very happy with your progress.
"Yeah, I am too."