Should You Change Your Approach To Plantar Fasciosis?

By Stephen L. Barrett, DPM, MBA, CWS

    It is universally accepted that the most common cause of heel pain is plantar fasciitis.1 In this same vein, there is a widespread perception that plantar fasciitis is often easily treated with whatever eclectic “recipe” an individual has developed.     Interestingly, even our present use of the term “fasciitis” is erroneous, not to mention that there is a huge gap between our general understanding and what basic medical science demonstrates in regard to our clinical understanding and treatment of plantar fasciitis. There have been recent and significant advancements in the treatment of recalcitrant plantar fasciitis over the last two decades during our profession’s push for “outcomes-based” or “evidence-based” medicine. However, there is still a large abyss between our comprehensive understanding of heel pain and what is the most ideal, efficacious and cost-effective treatment protocol for heel pain syndrome.     Accordingly, let us take a closer look at some of the salient current basic medical science of plantar fasciitis and how these scientific facts either support or refute the current therapeutic modalities and paradigms clinicians currently utilize for the treatment of heel pain. Hopefully, the insights offered here will help to further elucidate the diagnosis of this very common pedal malady, and facilitate improved treatment paradigms and patient outcomes.     Unfortunately, many specialists within the universe of podiatric medicine as well as other practitioners with a primary focus of foot and ankle pathology generally believe that inflammation is the most common cause of plantar fascial heel pain. Accordingly, they also believe the mainstay of clinical treatment for plantar fasciitis should be antiinflammatory in nature. Many clinicians also mistakenly believe that the etiology of pain in most musculoskeletal conditions is due to inflammation, which various researchers have shown is not the case as evidenced by microscopic histological examination.2-7     Yet corticosteroid injections and nonsteroidal antiinflammatory drugs (NSAIDs) for the treatment of plantar fasciosis are well accepted, widespread, and are considered keystones of an effective conservative care regimen.

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