In your clinical experience, what percentage of your patients with plantar fasciitis fail conservative therapy?

Less than 10 percent
59% (204 votes)
10 percent
16% (55 votes)
15 percent
11% (37 votes)
20 percent
6% (20 votes)
25 percent
4% (13 votes)
More than 25 percent
5% (18 votes)
Total votes: 347


Possibly less than 2%

I have good luck with using a heel injection of 1cc 40mg of depo-medrol plus 1cc 0.5% marcaine,injecting 1/2 medially and 1/2 plantarly around the medial condyle,but first I, Always, do an inferior calcaneal nerve block and wait until there is anesthesia of the ,soon to be ,infection sites, this can take up to 20 minutes.
While we are waiting for the heel to get numb,I heat-up JM heat-moldable orthosis and fit those to the patient's feet using my heat shield and foam pad.Advising the patient to wean themselves into these,as we would for custom-made orthosis. And see the patient back in one week for follow-up.

The problem with this poll is that many times patients recieve appliances and never go back to that doctor
The doctor thinks this is a success
The patient may have just gone to another doctor the patient thinks this was a failure
This patient may have gotten success from a minor adjustment
so it wasn't necessarily a failure other than the patient didn't have the confidence in the doctor, and that may have been from outside influences not necessarily any thing the doctor did
Therefore a poll like this is meaningless unless you poll the patients and ask detailed questions and have specific definitions for success and failure and are confident they had proper followed up before you can determine success or failure
Jan David Tepper, DPM
Upland, California

In our practice, it is probably less than 5%...

In 35+ years of practice I have seen more patients than 10% fail conservative care. But the definition is different . Failure would be described as not being able to return to previous activity following all conservative care treatments. That doesn't mean all patients go on to have surgery. Many of them change their life styles and either switch or stop certain activities.All of them stop wearing orhtotics after 1-2 years, and many switch shoe gear to something they think will help their feet.
Chronic Fasciosis of the plantar fascia is a more common diagnosis now with the use of MRI imaging.It is also reasonable to presume that if a treatment regimen of yours is not completely successful the patient is going to another practitioner.This makes it difficult to adequately assess the number of total patients that you start seeing for this diagnosis, whom either learn to live with the problem or seek other treatment.Another contributing factor to this is that in today's economic chaos,many patients are not following through with ancillary treatments such as physical therapy,custom orthotics and the like which would help them stay asmptomatic longer.
Overall I would put the number more in the %15 range than below 10. Most studies on plantar fasciiitis only cover time periods of 2-6 months and the patients have symptoms for less than 12 weeks.That is not what most practitioners see in their offices.The patients come in with 6-12 month symptoms which have been self treated and treatment to eradicate symptoms can take as long as 1-2 years.
Timothy P. Shea DPM

Of course it depends on your definition of "Failure". In my practice 90% of patients achieve 80-90% improvement with conservative care. This generally allows them to function normally with little or no discomfort. These patients are generally pleased with their results.If you define failure as not achieving 100% releif of all symptoms permanantly, then the percentage would be larger.

if pain =>5/10: injection, night splint, OTC arch supports
if pain

if this fails to relieve pain by 50% in 2-4 weeks, then aggressive PT with Graston technique

consider casting if that doesn't work.

following this protocol, i get only a handful of people that do not respond favorably. i can count on one hand, how many people have ultimately needed surgery in which i only will do a gastroc and topaz procedure. this protocol has served me well for the past 3 years.

Zeeshan Husain, DPM
Rochester, MI

Add new comment