The Problem with the Treatment of Plantar Fasciitis

The Problem with the Treatment of Plantar Fasciitis Blog

 

–Itis and –Osis: An Important Difference

Plantar fasciitis is inflammation of the ligament that runs from your heel bone to your toes. A healthy plantar fascia supports your arches and keeps your feet flexible.

When tissues in the ligament are strained, inflammation results. The weakened ligament usually swells, and the heel feels irritated or tender. There are a number of causes:
Frequently standing, walking or running on hard surfaces

  • Being overweight
  • Having especially flat feet or especially high arches
  • Having feet that roll inward
  • Wearing ill-fitting or poorly made shoes

Plantar fasciosis feels so much like fasciitis that it’s often misdiagnosed. Fasciosis, however, is due to degeneration of the ligament rather than inflammation. Degeneration may be in the form of tiny tears in the tissue or dying cells.

Inappropriate footwear that restricts blood flow to the bottom of your foot is usually to blame. When the blood supply is cut off, cells slowly die.

Avoiding Snake Oil Salesmen

Plantar fasciitis is a common and painful problem. That may account for the wild assortment of crazy remedies that permeate social media and go viral on the internet. If you read just one anecdote or testimonial about a miracle drug, you’re likely to see hundreds of ads for that product within a few days.

Rarely do legitimate podiatrists endorse unconventional remedies. Unless there is solid scientific evidence to back up the outrageous claims made by some manufacturers, you’re probably wasting your money. There will always be con artists looking to exploit people’s suffering, and nowhere are they more predatory than on the internet.

Testimonials: Sincerely Wrong?

Heel pain, especially when it is prolonged and severe, can make life miserable. Well-meaning patients are eager to share the news when a product or intervention seems to alleviate their pain. They may be entirely sincere when they swear by a remedy, but they are often sincerely wrong. The reason for that is simple.

Plantar fasciitis almost always improves on its own. Symptoms tend to appear in cycles, usually when the ligament is overworked and reinjured. Patients who take something for the problem and patients who simply rest the ligament often get well at about the same time.

In clinical trials, most patients who were not treated or were given placebos showed significant improvement over time. This seems to indicate that the condition runs its course and eventually gets better.
Patients who did receive some kind of treatment also improved. However, there was nothing striking or miraculous about their results. They didn’t heal in half the time or find themselves able to do things that they’d never done before. As of now, no treatment has proven any more effective than just waiting it out.

Patients who resort to bizarre, snake oil remedies – or even promising treatments that are still being tested – attribute healing to the new treatment. It’s far more likely that, as the saying goes, time heals all wounds.

While You Wait

You’ll have to be patient while the plantar fascia mends itself. A qualified doctor should monitor your progress. With his or her approval, you may try these helps for pain:

  • Rest your feet.
  • Avoid hard surfaces and activities that exacerbate the inflammation.
  • Buy shoes with good arch supports and cushioned soles.
  • Apply ice for a few minutes at a time.
  • Do gentle toe and calf stretches when you’re sitting or lying in bed, especially first thing in the morning when the pain is typically worse.
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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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