Cath Lab Digest

Treating plantar fasciitis in this patient population can be particularly challenging. Accordingly, this author offers insights on initial conservative care, weighs in on the merits of orthotics, and reviews pertinent issues in addressing recalcitrant plantar fasciitis.

   Treating plantar fasciitis is challenging for any patient but it is much more difficult in the running population due mainly to the runner not wanting to take any time off from running. A retrospective study of 2,002 running injuries found that 157 (7.8 percent) of the injuries were plantar fasciitis.¹ Another study found there are more than 1 million patient visits per year to medical professionals for heel pain.²

   When it comes to treating heel pain, the patient history is extremely important in making a proper diagnosis. The vast majority of the time plantar fasciitis presents with post-static dyskinesia. In the early stages of this injury, a runner will be able to continue normal running as the pain will subside after the initial steps in the morning and at the start of a run. As the disease process progresses, the pain will increase as will the length of time it takes to subside. Gait compensation will begin to lead to pain in other areas of the foot and legs.

   The injury typically occurs from overuse with an insidious onset. Patients often do not seek treatment until the injury becomes more chronic in nature. The majority of the time, plantar fasciitis resolves with conservative treatment with studies showing relief of symptoms between 46 and 100 percent.^3-6 Plantar fasciitis definitely responds better to early intervention.

   Typically, athletes do not have to completely refrain from training if treatment starts early enough in the disease process. In general, if there is no limping, a runner can continue to train while treatment occurs.

   A hallmark of plantar fasciitis is pain at the plantar medial calcaneal tubercle. The plantar fascia begins in the sulcus of the foot and runs along the plantar surface of the foot with three insertions in the plantar calcaneus: medially, centrally and laterally. Bøjsen-Möllerf and Flagstadke described the structure as being triangular with the base proximal.⁷

   Always look at the running shoes the patients are currently using. Make sure patients are training in the proper shoes as running shoes are divided into neutral or cushioned. Also check for stability and motion control. It is rare that a competitive runner would need a motion control shoe. Most stability shoes will provide enough pronation control.

   For excellent running shoe recommendations, refer to the American Academy of Podiatric Sports Medicine (AAPSM) Web site at http://www.aapsm.org/runshoe.html

Pertinent Insights On Initial Treatment Measures

   Amol Saxena, DPM, treats a high volume of runners including Olympic medalists at his practice in Palo Alto, Calif.

    “The most important aspect of treatment is that people, patients and providers all have to realize plantar fasciitis is a condition that often cannot be cured but controlled,” explains Dr. Saxena. He adds that many patients are controlling their plantar fasciitis with orthoses.

    “Some runners are controlling it by running less, getting massages or injections. Even the runners I operate on still usually do something (other than nothing) to control it,” notes Dr. Saxena.

   If one initiates treatment within weeks of the onset of symptoms, then the simple conservative measures have a greater impact. There are no exact protocols of conservative treatment that universally eliminate all the symptoms.