Achilles tendonitis and plantar fasciitis are common ailments seen in the feet. They pose a particular problem for physicians because cortisone is contraindicated around tendons, and plantar fasciitis tends to re-occur. Surgical repair of the Achilles tendon, while effective, requires up to 3 months of non-weight bearing.
Recently a new technique has been developed for the treatment of damaged tendons and fascia. This new technique is called Ultrasound Guided Percutaneous Tenotomy/Fasciotomy. It is also referred to as Focused Aspiration of Soft Tissue or FAST. This new technique can be performed through a very small incision and takes less than 10 minutes. Ultrasound guided percutaneous tenotomy/fasciotomy uses ultrasound to break up diseased tissue and then removes it through a suction tube. It is particularly effective for plantar fasciitis and Achilles tendonitis. This new procedure has revolutionized the treatment of both Achilles tenotomy and plantar fasciitis. There is no other procedure available where a patient can have an Achilles tenotomy and walk out the same day without the need of crutches or a wheelchair.
The science behind the ultrasonic procedure selectively targets diseased tissues while sparing healthy tissue. The alternative to Ultrasound Guided Percutaneous Tenotomy/Fasciotomy requires surgeons to make a large incision and expose the entire length of the tendon or fascia. The surgeon then uses a scalpel to manually cut out diseased tissue. This ‘open’ technique is much more invasive and is not an exact science. Some good tissue is usually inadvertently removed, and some bad tissue is inadvertently left in. With Ultrasound Guided Percutaneous Tenotomy/Fasciotomy or Focused Aspiration of Soft Tissue (FAST), the ultrasound is set precisely at the correct frequency (Hz) to only remove diseased tissue.
There are two companies that have come out with systems to perform this exciting procedure; Tenex Health TX has the Tenex, and HydroCision has the TenJet. Dr. Beau Willis of Gulf South Foot & Ankle has extensive experience with both machines. Dr. Willis preforms the procedure several times a week and has more experience than any other foot and ankle specialist in the greater New Orleans area.
Ultrasound Guided Percutaneous Tenotomy/Fasciotomy systems use ultrasound to break apart damaged tissues and then suction the diseased tissues away from the site. The procedure is performed using a small incision through which an ultrasonic probe is inserted. There are some differences between the two machines which are described below. Both machines are FDA approved, and both are highly effective at safely treating Achilles tendonitis and plantar fasciitis.
Tenex Health TX was the first company to develop an Ultrasound Guided Percutaneous Tenotomy/Fasciotomy system. Tenex was FDA approved in 2011 for treatment of all soft tissue. Over 75,000 patients have been treated with Tenex, and there are many studies showing its effectiveness. The Tenex machine projects ultrasonic waves into the tissues. The ultrasound is calibrated to break up damaged and diseased tissues while sparing healthy (normal) tissue. A small stream of water also shoots out the tip of the probe when the ultrasound is active to cool the tissues from the ultrasonic waves. As the diseased tissues are pulverized and mobilized by the ultrasonic waves they are suctioned out through a suction collar around the base of the probe.
HydroCision developed the TenJet for the same indications as Tenex. TenJet was FDA approved 2016 for all soft tissue. TenJet uses a supersonic jet of water traveling at 600mph through a needle -like device. The supersonic water jet is projected not outwardly into the tissues but backwards into a suction tube alongside the water needle. The TenJet system uses the principles of fluid dynamics to create an inline Venturi suction. For those of you who don’t have a PhD in fluid dynamics, this means that the high-speed water jet basically creates a whirlpool vortex. This supersonic water jet traveling at 600mph literally sucks diseased tissues into the vortex but selectively spares healthy tissues.
Both systems are effective and which machine is used generally comes down to surgeon’s preference. The procedure is performed through one or two small incisions. The entire procedure takes less than 10 minutes and can be formed under a local anesthetic. Patients can walk immediately after the procedure, and athletes can resume sports in 4 to 6 weeks, compared to 6 to 9 months with the traditional open procedure.