Plantar Fasciitis-The most mismanaged diagnosis
Dr. Daniel Eichner DC, ATC, NASM-CNC
Owner at Forward Motion Chiropractic and Wellness
I have officially found the most mismanaged diagnosis-Plantar Fasciitis. You may think this is a little extreme to pick such an easy case to manage, but I have seen most issues with the management of this than any other diagnosis in my 8 years in the medical field. I may go off on a rant with this post, but we will bring itright back around and give you an answer.
The patient comes in c/o foot pain that is worse when first getting up in the morning, but relieved by movement. pain is located on the bottom of the foot, usually around a 5-8/10, described as dull achy. Sometimes the patient experiences heel pain that is worse when walking.
I have seen all kinds of treatment of this case, including 5 cortisone injections. Stop injecting cortisone into the foot. You are not solving anything. Understand the anatomy behind the issue. The plantar fascia is not a muscle, contrary to many beliefs. The plantar fascia is a long ligament extending from the base of your heel to your toes. Injecting cortisone into this is like injecting cortisone into your ACL or PCL, doesn't make any sense. Cortisone is used to paralyze a muscle essentially, but this is not a muscle. Rant over. Anyways, the second most common treatment is the plantar fascia brace placing your foot into dorsiflexion. Are you trying to stretch out the...fascia?
I have found the most effective treatment is cryotherapy with massage, Take a frozen water bottle and roll your foot on it. Also, if trained, you can perform myofascial release techniques. To prevent this from recurring, balance the gastrocnemius and the tibialis anterior, and support the medial longitudinal arch.The windlass effect is something to look into also. Contact me if you want me to review that.
The article is completely anecdotal, but I always look for evidence to support my theories. To date I have treated more than 20 plantar fascia cases successfully, many of them that were unable to be treated by there primary care physicians and even podiatrist. Sometimes we makes treatments to complex. Anyways, 5am rant over. Have a good day.
Owner at Forward Motion Chiropractic and Wellness
7 年Paralyzes maybe the wrong word to use. I was referring to the anesthetic properties of cortisone. This rant came after a Podiatrist injected one of my patients with 5 cortisone injections in 1 month. It really irked me! Completely agree with the ability of cortisone to decrease inflammation. I always try to figure out why the inflammation is there in the first place like you do. That patient that I took over within 2 weeks had symptom relief. Navicular drop test was positive. I recommended exercises to increase strength in the intrinsic muscles, in addition to plantar fascia stretch and Grade 2 1st digit mobilization. You are an awesome doc by the way! I follow your post all the time. Keep up the also work!
Doctor of Chiropractic and Educator
7 年I agree that cortisone is not typically helpful, especially long term we see it may cause more problems. But I don't agree that it "paralyses" the muscle... that would be Botox. The role of cortisone is to stop inflammation, which we know it does well. Again, not fixing the reason there is inflammation. I too find the frozen water irks to work great. Add some foot exercises in there and you have a long term fix rather than just symptomatic relief. Good early morning rant though!