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Fasciitis vs. fasciosis

Posted by Tim H on 7/11/01 at hrmin (052836)

I just found out about this Web site yesterday. Scott - you are to be commended for starting and maintaining this site. I wish it was there back in 1994! I will have to fill out the survey when I get some more time. I posted the message below on the 'Ask the doctor' section and I just thought I'd stick it here to see if there will be any resulting feedback.

I'm a first-time visitor to this Web site. It contains a wealth of information and I will tell others about it. I've been living with PF in my left foot since 1994 and have tried lots of things - cortisone shots, orthotics, a cast (3 months!), rest, ice, heat, pads, insoles, and lots of stretching. Now I rely mostly on stretching and seem to do pretty well most of the time, but once in a while I get little reminders from my foot that it's not 100% cured. If I stretch ahead of time, I can do 3 mile walks with minimal or no problems. I stretch the foot in the morning before I get out of bed and don't really have any problems right after I get up My biggest problems occur when I get stuck having to stand in one place during the day for more than 10 minutes or so. I am 46 and wonder what it will be like when I get really old!

Anyway, all that is just for background. What I am wondering about is how accepted in the orthopedic MD and DPM communities is the new idea that the problem is really fasciosis and not fasciitis? One of the doctors I saw - Robert P. Nirschl (see his web note dealing with PF at http://64.35.24.189/nirschl/ankle_heelspurs.htm) seems adamant that for most people, we shouldn't be calling it plantar fasciitis since the problem isn't really an inflamation so much as unhealthy tissue. I've seen papers by other doctors on the Web which agree with this idea. If it's true, it would seem like a lot of things would need to be changed in the wording used in this web site.

Regarding surgery, Dr. Nirschl's web site has an interesting statement on his approach:

' We have found that surgical success is better if surgery focuses on only removing the unhealthy tissue and preserving the rest of the plantar fascia. It is our observation that the old surgical technique of releasing the entire fascia leaves the painful tissue behind and weakens the foot and arch and can lead to continuing problems or even harm. '

This would seem to be in opposition to what still seems to be the common surgical approch out there - i.e., cutting the whole fascia.

I'd appreciate any feedback on what I've posted here. Thanks.

Re: Fasciitis vs. fasciosis

Dr. Ed Davis on 7/16/01 at 18:32 (053400)

I have not heard the term 'fasciosis' used before but it brings up some important concepts. We tend to focus on excessive tension on the plantar fascia as the culprit without adequate consideration of the 'tissue quality' of the ligament. There is a loss of elasticity--a degenerative process occurring in the fascia which probably makes it more susceptible to injury.

Re: Fasciitis vs. fasciosis

Julie on 7/17/01 at 03:12 (053448)

Dr Davis, this is interesting. Would you say therefore that age is an important factor in the development of pf (and in the length of healing time)?

Re: Fasciitis vs. fasciosis

Ed Davis, DPM on 7/18/01 at 15:31 (053598)

Julie:

It seems logical that age should be a factor, due to loss of elasticity in tissues. Nevertheless, I am not seeing much of a correlation of plantar fasciitis symptoms with age in my own practice. Most patients I see with this problem are in their late 30's through early 50's. The reason for this may be, in part, occupational. Lots of plantar fasciitis sufferers have occupations involving standing on hard surfaces all day.
Ed

Re: Fasciitis vs. fasciosis

Julie on 7/18/01 at 15:46 (053600)

Thanks, Ed: I see what you mean. I asked because I've always wondered if my advancing age (well beyond the age range you mention) was a contributory cause!

Re: Fasciitis vs. fasciosis

Dr. Ed Davis on 7/16/01 at 18:32 (053400)

I have not heard the term 'fasciosis' used before but it brings up some important concepts. We tend to focus on excessive tension on the plantar fascia as the culprit without adequate consideration of the 'tissue quality' of the ligament. There is a loss of elasticity--a degenerative process occurring in the fascia which probably makes it more susceptible to injury.

Re: Fasciitis vs. fasciosis

Julie on 7/17/01 at 03:12 (053448)

Dr Davis, this is interesting. Would you say therefore that age is an important factor in the development of pf (and in the length of healing time)?

Re: Fasciitis vs. fasciosis

Ed Davis, DPM on 7/18/01 at 15:31 (053598)

Julie:

It seems logical that age should be a factor, due to loss of elasticity in tissues. Nevertheless, I am not seeing much of a correlation of plantar fasciitis symptoms with age in my own practice. Most patients I see with this problem are in their late 30's through early 50's. The reason for this may be, in part, occupational. Lots of plantar fasciitis sufferers have occupations involving standing on hard surfaces all day.
Ed

Re: Fasciitis vs. fasciosis

Julie on 7/18/01 at 15:46 (053600)

Thanks, Ed: I see what you mean. I asked because I've always wondered if my advancing age (well beyond the age range you mention) was a contributory cause!

Re: Fasciitis vs. Fasciosis

MarkF on 11/28/07 at 18:43 (239962)

What is the best method to determine plantar fasciitis vs. fasciosis? CT scan? MRI? Diagnostic Ultrasound? Which method is the best and why?

Re: Fasciitis vs. Fasciosis

Dr. Ed on 11/28/07 at 22:26 (239972)

Mark:

One must use a modality for soft tissue imaging: MRI or ultrasound. Ultrasound is about 1/8 to 1/10 the price of MRI and is often used in the hands of a clinician who is familiar with the diagnoses. I have not yet had a radiologist reading an MRI offer the diagnosis of fasciosis.

Dr. Ed

Re: Fasciitis vs. Fasciosis

Kathy H on 12/02/07 at 23:08 (240172)

Dr.Ed, Does fasciitis mean inflammation and fasciosis mean deterioration of the tissue?. Is there a difference from patient to patient and should there be a difference in your treatment plan? I had a MRI and they just said thickening of the plantar fascia and called it chronic plantar fasciitis. Does it matter what they call it and should I have an ultrasound?

Re: Fasciitis vs. Fasciosis

RobertCarol on 12/03/07 at 11:14 (240197)

I also would like a reply to this great question. Thanks.

Re: Fasciitis vs. Fasciosis

Dr. Ed on 12/03/07 at 11:56 (240201)

Kathy:

Your are correct in that fasciitis is inflammation of the fascia and fasciosis is degeneration of the fascia.

Inflammation can cause thickening of the fascia but that thickening is the result of edema within and around the origin of the plantar fascia. MRI often can show thickening of the fascia as well as inflammation. Few radiologists that I am aware of make the distinction between fasciitis and fasciosis.

We generally see, via sonography, a fascia that is thickened but also displays some degree of disorganization of the fibers. The fibers should be laid down in a neat orderly and parallel fasshion. I am not aware that that can be observed via MRI. Often, with fasciosis, we observe a measurable area of hypoechogenicity (decreased reflection on ultrasound indicative of an area with decreased tissue density/decreased 'health') near the area of the origin of the fascia. That area appears to correlate with the area of maximmum pain in my experience. Additonally, application of ESWT has never failed to eliminate or significantly mitigate that area in my experience.

Dr. Ed