Minimalism: An Option for Managing Plantar Fasciitis?

Minimalism: An Option for Managing Plantar Fasciitis? Blog

The recent proliferation of articles and blogs advocating minimalist running as an effective technique for managing plantar fasciitis deserves an informed response. A critical analysis is necessary to dispel the production of a popular myth about the most effective methods for dealing with this condition. Commentaries that promote minimalism or barefoot running as a solution often cite personal experience instead of scientific literature, and these articles tend to be written by people with no actual experience in a clinical environment treating this ailment. They are generally speaking from personal experience, and the reader should consider this carefully when reading such advice.

Analyzing The Evidence

Plantar fasciitis affects runners regardless of the running style. Specifically, barefoot runners and minimalists experience this condition in proportions similar to runners who wear shoes. Even the blogs posted by minimalists reveal that many are still seeking advice on how to deal with this painful inflammation, so there can be little doubt that simply running barefoot will not prove to be an adequate solution. After reviewing many of the sites that make such recommendations, it became clear that certain popular myths are the driving force behind the incorrect information. Entrenched beliefs can be difficult to displace even when there is no supporting evidence available.

Beliefs vs. Facts

Believing that simply running barefoot or practicing minimalism is sufficient as a clinical treatment is completely unfounded, and it is a position unsupported by the vast amount of scientific literature available on the subject. The credibility of such assertions should be taken seriously, however. They tend to grow into unassailable popular wisdom when they remain unchallenged for extended periods of time.


Here are a few guidelines that readers can use when examining proclamations made by people who assign to themselves the status of expert:

• What is the quality of the evidence presented to support the claim?
• Does this evidence, if it exists, actually refer to any other peer-reviewed publications, or is it being produced without any regard to the existing, established treatments for plantar fasciitis?
• Does the writer understand that muscle strength is not mentioned in any prominent scientific publications on the subject?
• Why are most clinical practitioners not treating this condition with muscle strengthening exercises?
• Why does minimalism show no signs of increasing the contractile strength of the plantar muscles involved in flexing the toes?
• If minimalism actually relieves this condition, why do so many minimalist and barefoot runners still develop it?
• Why would a non-runner want to practice barefoot running while experiencing the pain associated with this condition?

Scientific Studies Speak Volumes

The available scientific literature does not recognize muscle weakness as a significant factor, and clinicians do not use muscle strengthening protocols when treating this type of fasciitis. A recent study took up the question in response to the assertions outlined above and found no correlation between fasciitis in the plantar tissues and muscle strength. One recent clinical study did assert this connection, but it has serious flaws in the methodology. The author seems comfortable using flawed techniques to reach what appears to be a pre-determined outcome. These types of studies deserve rigorous peer-review prior to achieving a status worthy of citation.<>

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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