Can Diagnostic Ultrasound Help Us Break Free From Conservative Dogma About Plantar Fasciitis?

Stephen Barrett DPM FACFAS

Have you been thinking about the histological composition of plantar fascia lately? It haunts me every clinic day. Why? It’s because we know so much about it. Yet professionally, we have not integrated this knowledge fully, not even fractionally in the clinical arena like I know we can.

The recurrent theme I have had since the inception of my blog is education for the surgeon. Education ideally leads to better outcomes for the patient and, as I discussed last month, leads to less postoperative surgeon stress syndrome (POSSS) (see ). To that extent, I have realized that I must now reach out to all of those faithful readers of my blog (I know there at least two because one of my best friends also logs in religiously and he tells me his friend looks at it as well).

You have to agree that plantar fasciopathy is variable from patient to patient (or maybe you don’t — all the more important reason to do this). Quite frankly, I am sick to death of hearing nothing but the regurgitated dogma about how we have to treat this condition with six months of failed conservative care before you can do something definitive — like extracorporeal shockwave therapy (ESWT). This dogmatic paradigm is simply entrenching patients in a gutter of widespread empirical treatment — many times ineffective and protracted at that — when we have the ability today to really grade the condition and treat it appropriately based on the level of pathology present.

You and I are standing on a virtual intellectual powder keg of information, which can help you and your patients. (If this powder keg went off, there would be a possibility of classifying that as ESWT.) With today’s technology, there is the ability for easy collection and deciphering of this clinical data treasure trove.

This month, I want to look at the plantar fascia with diagnostic ultrasound, which has been a focus of mine for nearly a decade. More is being published on this valuable tool especially for plantar fascia. As a good example, I would direct you to the article written by Mahowald and colleagues in last month’s Journal of the American Podiatric Medical Association.1 They make the insightful conclusion that plantar fasciosis is associated with thickening when examined by high-resolution diagnostic ultrasound. We have known this for a long time and, in fact, I published our findings in Techniques of Foot of Ankle Surgery.2

How To Participate In A Comprehensive Heel Pain Study

We have an incredible opportunity. I want you to participate in the largest, randomized, prospective epidemiological study of heel pain to date. Indeed, this will help us all understand this oh so common condition even better. If we can get 200 faithful, passionate blog visitors to input the ultrasound data from their next five new patients who present to their clinic with the initial chief complaint of heel pain, we will have meaningful data of 1,000 patients. (We will take data from 500 DPMs if there are that many doctors who want to contribute. There are no limits, just the possibility of having a bigger and more robust collection of data.) It will be easy and not take too much time.

Most of you are already doing this in your initial exam. Just input the data and be part of something really big and meaningful. I wish I could promise that one lucky data contributor will win a cruise to the most exotic place on earth but I cannot. Maybe the prize could be even bigger than that. Could it be possible that we all glean a real clinical nugget from this that makes patients’ lives better? Wow, that means we all can be winners, especially the patient.

How do you participate? Easy. If you have a diagnostic ultrasound machine and you see patients with heel pain, just give us the data on the next five prospective exams. You can share this data by going to:

If just 200 of you take a few painless minutes, we will have the largest heel pain study in the history of all universes, parallel and otherwise. You know what? I will sponsor a bottle of investment-grade cult red wine to a randomly selected data hero if we make 1,000 patients.

If you dedicated professionals help me get this done, I promise to have the preliminary results back to you next month and that means more holiday karma for all. Thanks for your help on this cool academic venture.


1. Mahowald S, Legge BS, Grady JF. The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc. 2011; 101(5):385-389.
2. Barrett SL. Endoscopic plantar fasciotomy--surgical technique. Tech Foot Ankle Surg. 2011; 10(2):56-64.

Add new comment