Cath Lab Digest

I am constantly amazed at the variety of treatment modalities that are effective for plantar fasciitis. In fact, I am amazed when a modality exists that is not effective for plantar fasciitis. Just think about all that you learn at conferences, see in exhibit halls and read in non-peer reviewed journals. You would have to be an idiot not to be able to cure plantar fasciitis.

Of course, being older, I had been under the mistaken impression that stretching, supports or orthotics, perhaps a brief course of analgesics or anti-inflammatory, and an injection or two were working. Sometimes weight loss or activity modification was necessary. This was odd. I thought my patients had generally done quite well. In fact, I seldom need to use invasive therapy for the treatment of plantar fasciitis in my patient population.

Boy, was I wrong. Turns out everything works well. We have low-energy extracorporeal shockwave therapy (ESWT), high-energy ESWT, endoscopic plantar fasciotomy, in-step plantar fasciotomy, radiofrequency Coblation (Topaz, Arthrocare), tarsal tunnel surgery, Baxter's nerve release, cryosurgical nerve ablation, drilling holes in the calcaneus, thermal nerve ablation and now platelet rich plasma injections. Do not forget botulinum (Botox, Allergan) injections, plantar fascia needling, open plantar fasciotomy, percutaneous plantar fasciotomy, subtalar joint arthroereisis, night splints and controlled ankle motion (CAM) walkers. Interesting.

Supposedly, only 10 to 15 percent of plantar fasciitis patients fail conservative care and require advanced or invasive therapy. Yet we see large numbers of patients who reportedly have responded to these advanced modalities, all with 80 to 95 percent success. Some alleged institutes or individual researchers “publish” large numbers for multiple advanced modalities. I guess they see thousands of patients with heel pain in order for them to have hundreds of patients in the 10 to 15 percent failure of conservative care group.

I have personally evaluated and reviewed many medical records of individuals who have sustained complications -- most commonly nerve injury, complex regional pain syndrome (CRPS), chronic pain and swelling, and so-called “lateral column syndrome” -- following plantar fascia surgery.

I do not believe that such injuries are rare. I similarly believe that many of the touted newer technologies lack any legitimate randomized controlled trials or level I or II evidence to justify the cost or the risk to the patient.