March 2011

Preferred plantar fasciitis treatment changes with duration of symptoms

In the moment: Footcare

Foot and ankle surgeons favor stretching for a patient with four months of plantar fasciitis symptoms but turn to less conservative treatments if the pain continues for four months, according to survey results presented in February at the AAOS meeting.

Researchers from Bowling Green University surveyed 83 foot and ankle surgeons about their preferred response to a hypothetical case of plantar fasciitis. Presented with four months of symptoms, respondents were asked to pick one of six non-operative treatments; 43% picked plantar fascia-specific stretching, followed by physical therapy (24%) and night splinting (21%).

Presented with 10 months of symptoms, the surgeons had to pick two choices from a longer list that included surgical procedures. Only 25% selected non-operative treatment, 33% selected extracorporeal shock wave therapy, and 72% went with surgery.

The extent to which respondents said their decisions would be evidence-based also changed over time, from 75.9% at four months to 48.2% at 10 months. Nearly 40% of respondents said treatment at 10 months would be based on their personal clinical experience.

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3 Responses to Preferred plantar fasciitis treatment changes with duration of symptoms

  1. Even orthopedic surgeons who are specializing in the foot, have limited experience when compared to podiatrists. While stretching is important, calf tightness is not the prime cause of plantar fasciitis and may well be a result of a painful gait due to the plantar fasciitis. A thorough foot, ankle and lower leg podiatric medical exam is necessary to identify the root cause.

    In most case, wearing the appropriate shoes, having a functional podiatric foot orthotic created, and then stretching, cures 80% + of symptoms. It’s important to understand, the longer one has had plantar fasciitis, the longer it will take to get it under control and eliminated. Podiatrists specializing in podiatric sports medicine are the only medical specialist fully trained to treat this condition, others may only be taking a stab-in-the-dark !

  2. As a podiatrist who deals with plantar fasciitis patients on a daily basis, and involved in a large multi-disciplinary medical practice, less than 1% of our patients require surgery for this condition. And it is really not related to duration of symptoms. The 3 areas of flexibility, mechanical support/changes, and anti-inflammatory are key to helping these patients. Subtle changes in how patients ice, stretch, what activities they do, etc can make big differences. I encourage physicians/physical therapists that deal with this problem to strive toward 0% surgery. Surgery weakens an important structure and should be undergone only after extensive rehabilitation. One the the common problems I see is actually mis-diagnosis of plantar fasciitis, when it truly is a plantar fascial tear, plantar heel bursitis, plantar heel stress syndrome, Baxter’s nerve entrapment, intrinsic muscle strain, tarsal tunnel variant, etc.

  3. Dr. Michael Lax says:

    As a runner for 40 years, and a practitioner who has treated countless running injuries, I have developed a somewhat different opinion regarding plantar fasciitis.

    After many years of prescribing flexibility exercises and orthotic therapy and seeing less than satisfactory results, I started to look at strength, and specifically strength endurance deficiencies, of both the intrinsic and extrinsic foot musculature.

    What I have found to be the single most effective treatment for most cases of plantar fasciitis that I see in my office is a pretty simple exercise: frequent barefoot walks around the home on the balls of the feet, never letting the heels touch the ground. Start with 20 seconds, gradually building up to 2 minutes, 4 times daily. Try it. See if it helps your patients…

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