As mentioned before, 20% of my patients come to me seeking relief from plantar fasciitis. After I came across this TV news piece on the subject, I knew I had to address it because it’s filled with the kind of flawed, “easy fix” information I’m fighting.
(Thanks to @DrHurless for sharing this on Twitter.)
While it may appear to be a story with good information, most of it I disagree with. Not because the information presented is bad for you, but because it represents the usual incorrect, status quo rhetoric people continue to be given — whether it be from the news, the Internet, or even from their doctor. And unfortunately, these recommendations only continue to steer people away from meaningful and effective treatment.
About the only thing I agree with is the importance of daily stretching, which I can’t emphasize enough. Scientific literature has repeatedly shown how regular stretching of the calf is what will eliminate heel pain by getting to the source of the problem. Take care of your body and it will take care of you.
One of the first things I disagree with is how the doctor recommends the use of orthotics. Orthotics simply do not do anything about the cause of the pain, calf tightness. Don’t get me wrong, orthotics may in some cases give some relief from the pain of plantar fasciitis, but they don’t fix a thing.
Then there’s the idea of shockwave therapy. The anchor throws in that Dr. Kase “has [had] good success with acoustic shockwave therapy. It helps break up some of the scar tissue,” he argues.
After posting this clip on Twitter, @cathysucher asked me my opinion of this kind of therapy.
What’s being referred to here is ESWT, or Low-Energy Extracorporeal Shock Therapy. EWST is merely a flashy placebo. There’s no conclusive evidence to support its use, but it certainly helps doctors make money.
Treatments can get pricey, and insurance may not cover it. Therefore, patients who wish to have these treatments – which don’t even work in the first place – often end up paying out of pocket for them. At least it’s not an unwarranted surgery. A kissing cousin to ESWT is PRP, platelet-rich plasma, and I will have more on PRP soon.
Again, you will see better results from stretching – in combination with a little patience — than from any of the other feel good treatments.
Thank you for a great post.
I didn’t know that.
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I, like many many others, am searching for help with heel pain and found your page. I’m searching for a specific treatment plan/calendar/schedule for dealing with my problems. There are many recommendations but I can’t find a specific schedule. Sounds elementary, but this is a very involved treatment with exercises/stretching/ice/heat needed several times a day. It’s very easy to get off-track. Has anyone developed a calendar or specified daily treatment plan? Something concrete that we can sink our teeth into?! (just kidding…but not really…) Thank you!
I agree that stretching is important for heel pain, but I disagree on your thoughts regarding orthoses and shockwave therapy – and no, I dont make money from these interventions, as I work in the NHS.
I have been treating patients with plantar fasciopathy for many years. Shockwave therapy has been a god send to patients with heel pain, particularly chronic sufferers. I take validated outcome measures from all my patients and the success rate is well over 70%. There is also a wealth of good research, including systematic reviews that supports its use. There are also RCT’s which demonstrate the importance and efficacy of orthoses in the treatment of heel pain.
Try telling some of my patients that have had this debilitating condition that stretches alone will sort out their 10 year heel pain symptoms. They will laugh in your face.
Small world, I was a Barts man for 6 months in the 80’s. Loved it, the people and the training! I totally hear what you are saying. I am not saying orthotics and ESWT don’t help because they can help. What I am saying is that they are palliative and miss the underlying target, the isolated gastrocnemius contracture. I support my patients with symptomatic treatments as well. Here is my problem, most of today’s conservative treatment towards plantar fasciitis (and other foot and ankle problems) involve varied symptomatic treatments and ignore the treatment of the underlying issue, the equinus. The evidence supporting the role of equinus and its relationship with a wide variety of foot and ankle issues is very strong, yet it is generally ignored as a definitive treatment (I am not saying this includes you of course). BTW, I am about to place my stretching protocol as an AO blog. Here is a thought for you, why don’t you apply it to a few of your patients and se how it works. I think you will be surprised. Finally, there is a reason these people your refer to have “had this debilitating condition” for ten years and have “tried everything” are not better: they have tried everything, but the right thing. Ultimately that is my point. Thanks for your response, I mean it.
Stay healthy my friends,