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Posted by Dr. Davis (Ed Davis, DPM) on 7/16/01 at 14:10 (053368)

This is a great site. It is almost 'encyclopedic' in nature based on its richness of information.

I tried to put myself in the position of a patient searching for information which leads me to one criticism. The amount of information can be overwhelming and may be difficult for the 'uninitiated' to place in perspective.

Plantar fasciitis is very curable. About 90 to 95% of patients with this problem who see me are cured within about 2 months via concervative means.
But, it is very important that treatment modalities be applied in a logical, proper and systematic means. A 'haphazard' or 'shotgun' approach to the use of good modalities can often lead to failure or the impression that such modalities are not effective.

One suggestion: create a flow chart for the various treatments and modalities. I would be willing to help.

Regards,
Ed

Re: this site

Dr. Zuckerman on 7/16/01 at 14:44 (053369)

I believe there are preferred treatment guild lines that are in a flow chart format, put out by the American College of Foot and Ankle Surgeons. This is a very good idea.

Re: this site

Ed Davis, DPM on 7/16/01 at 15:05 (053371)

Yes, the American College of Foot and Ankle Surgeons have published several sets of guidlines. I do not beleive they have one for heel pain yet.
Ed

Re: this site

Scott R on 7/16/01 at 19:54 (053405)

Thanks Dr. Davis, and I agree about the website being overwhelming to the mild case of PF. I have thought long and hard about a flow chart, in the context of creating an interactive program that pretends to be a doctor for PF, with the obviuos legal disclaimers. I haven't figured out what the content should be. I would like to take you up on your offer of help, but I don't want you to go to a lot of effort and then me not use any of it. I would like to see whatever flow charts anyone has ever done and someday I would incorporate them into the program if I agree with what they say.

Re: this site

Dr. Zuckerman on 7/16/01 at 20:49 (053409)

I will take a look and see if there is one from the ACFAS. This is a good idea.

Re: this site

Dr. Ed Davis on 7/16/01 at hrmin (053411)

There are a number of good flow charting programs available such as 'Flow' by IMSI...
Your site has most of the info. I think you may be surprised to see that some of the real disagreement emergences when that information is prioritized in a flow chart but it is worth a try. Consider keeping it simple for starters. Lets wait to see if Dr. Zuckerman can obtain one from ACFAS, as they do good work. If not, I will come up with a rough draft for one in the next few weeks that you and Dr. Z can look at. I was thinking of doing one, anyway, for the benefit of the family doctors in my area.
Regards,
Ed

Re: this site

Dr. Zuckerman on 7/16/01 at 21:26 (053416)

You are right . I took a look at my ACFAS PPG's and there is no heel pain.

Sounds good to me. I am sure Scott and you can put something together. Good luck.

Re: Flow Chart

Glenn X on 7/16/01 at hrmin (053417)

Scott's site is super rich with information, though sometimes I feel like I'm drowning in information and starving for insight. Even so, every time I dive in I discover something of value.

That said, once past Scott's book, it takes quite a bit of work to glean the good stuff. The payoff is well worth the work, but particularly for newer people, crafting a more direct path to the information in the sight would be helpful.

I too have tried imagining a flow chart for PF. The variables seem daunting, but what a useful tool that would be.

As a simple start, how about a table? Symptoms down the left column (increasing in severity), treatments across the top (decreasing in conservatism). I don't know enough about other's experience, but some left column entries could be . . .

Discomfort (no limits on normal activity)
Pain 1-3 (some limits on normal activity)
Pain 4-7 (serious limits on normal activity)
Pain 8-10 (can't take care of self ? ?)
Morning pain worst

Inflammation

Insufficient ankle dorsiflexion

Sore ankle

Tingling on the sole of the foot
Sharp, ground-glass-like pain on sole of foot

Strained fascia
Torn fascia
Scarred fascia ? ?

And as I sink into this idea it too seems unworkable, but I'll fling it out there anyway.

On another track: Maybe this could be worked into going backwards. i.e., 'Should you ice?' with some questions that point the reader to a yes/no/possibly, followed by a link to instructions. 'Should you try OTC orthotics? Custom orthotics?' With questions. 'Should you tape, Should you increase your flexibility, Should you consider shots, anti-inflammatories, night splint, ESWT, surgery? and so forth.

Yow

Re: Flow Chart

Dr. Ed Davis on 7/16/01 at 21:33 (053419)

Thanks for your comments. We could wind up with more than one version of the flowchart.

Re: this site

Scott R on 7/16/01 at 23:55 (053434)

I considered not giving away my secret on this, but here it is: the input form for the computer doctor would also serve as the form that is filled out and presented to their real doctor so that they have a record of the relevant symptoms. It may organize the discussion. The computer's response to this info could also be printed out and presented to the doctor to let him/her tell the patient where it is in error, to let the patient know when the doctor is in error, and to teach the doctor about heel pain if not to so him/her why many doctors may well go the way of the secretary (remember those?) in the coming years.

Re: the major problem with this idea

Scott R on 7/17/01 at 00:04 (053435)

The problem with our idea is that our survey of 6,000 people showed no correlation with symptoms and treatments. For example, 100 pound people who had pain with the first few steps in the morning and were sensitive to the touch and had it for 5 years rank treatments in exactly the same order as the 300 pound person who had none of the skinny person's symptoms and had had it for 6 months. I'm exaggerating a little because there were some correlations (the biggest being male verses female),but absolutely nothing I could sink my teeth into. The whole point of doing such a large survey was to uncover the most beneficial treatments for various specific symptoms. As my friend Richard Feynman once said in reference to a difficult research project: 'We stuck our foot in the swamp and pulled it up muddy.'

In other words, if I do do it, it may turn out to largely be a marketing gimick to make the website more palatable. However, it will still have value for the other reasons mentioned earlier.

Re: the major problem with this idea

Dr. Chris Reynolds on 7/17/01 at hrmin (053548)

Pardon my intrusion, but I think this biomechanical model for PF is much like sufferers' patience, it's worn very thin. I don't deny that PF can be exacerbated by being overweight and by overuse, of course it can, just like any inflammatory condition, but there are far too many inconsistencies in symptoms for them to be explained by mechanical factors alone. For instance, one would expect pain to improve with rest overnight, but as we know this is often not the case. Why do so many 'underweight' people get PF when many obese individuals don't? Why does the presence or absence of heelspurs appear to have at best an arbitrary effect?
This is why I suggest we turn our minds to the immune system and look at an auto-immune etiology for PF. The Jade trial (www.jadepage.com)has shown very clearly in just four weeks how an immunomodulatory substance (Jade 168 Balm) has been able to significantly reduce PF pain in 68% of trial participants. Admittedly, 32 % have not responded, but there is still 2 months of the trial to go. Any drug company that could achieve a result like this for any product would be over the moon about it.
If you try to think about PF from the auto-immune point of view, at least the inconsistencies of symptoms, the responses to treatments and the presence or absence of heelspurs begin (in the light of response to an immunomodulator)to make a little sense.

Re: the major problem with this idea

Dr. Ed Davis on 7/18/01 at hrmin (053575)

I think that one of the problems you will find is inconsistent application of various modalities. Very few of the modalities mentioned, in my experience work in an isolated fashion. The best treatment results seem to occur when appropriate modalities are used in combination.

Example: A patient with long term plantar fasciitis has limited ankle dorsiflexion (movement of the ankle upwards) range of motion and is overpronated. This individual may be treated simultaneously with a night splint in order to increase ankle dorsiflexion and an orthotic designed to reduce overpronation. Use of one of these modalities alone may have questionable results. This patient, in addition, will not tolerate a good orthotic until two things occur: 1)a reasonable amount of ankle dorsiflexion is achieved and 2)acute inflammation has been relieved. Acute inflammation maybe relieved via modalities such as ultrasound, iontophoresis, steroids, etc. Remember that those modalities used to relieve the acute phase generally do not lead to permanent relief; they will make the long term modalities tolerable and thus potentially effective.

A flow chart can serve to facilitate the decision making process--how and when to apply various modalities: under what circumstances to combine modalities, the sequence of modality usage (a concept which may not be sufficiently clear from the information on this site), and how to assess or measure the effects of usage of such treatments.

Re: the major problem with this idea

Dr. Ed Davis on 7/18/01 at hrmin (053579)

Dr. Reynolds,
The biomechanical model for plantar fasciitis has led to a system of treatments which cures about 95% of plantar fasciitis via conservative means and surgery cures about 70% of those who do not respond to conservative care, albeit with certain risks associated with surgery in general. With all due respects, I cannot consider this model to be 'worn very thin' as you state.

I think that the more you understand about the biomechanical model, the less 'inconsistencies' you will find in symptoms. Let me address some of the items that you are calling 'inconsistencies.'
1)POST-STATIC DYSKINESIA--This is the term applied to pain which aoccurs after rest. It is a very common and logical finding in plantar fasciitis.
The plantar fascia is a ligament, basically a bundle of fibrous tissue, forming a band which supports the bottom of the foot and provides a 'recoil' effect to enhance propulsion (windlass mechanism). The more that excess tension is applied, that is, tension which is pathologic or beyond the degree to which it has been designed to accept, the more the band of tissue becomes damaged. The greater the damage, the more contraction that occurs with rest. After rest, one steps down on a inflamed contracted fascia and that is the reason for this finding.

2)HEEL SPURS--I believe that most surgeons, that is individuals who have opened up and visualized the so-called heel spur will verify that there really is no such thing as a spur. It is actually a shelf of bone, protruding forward from the heel bone. When viewed from the side, due to the two dimensional nature of x-rays, it appears as a spur. That shelf of bone is an area to which the plantar fascia or parallel ligament attaches (some controversy here). Long term excessive pull on the plantar fascia at its attachment to the heel bone creates this 'shelf.' The presence of the shelf of bone is thus an indicator of long term tension on the plantar fascia and thus has little to do (usually) with symptoms.

3)WEIGHT--There are heavy people who have feet which are very sound biomechanically and skinny people with poor biomechanics--enough said.
Occupation and avocation needs to be considered. Individuals working in factories, on concrete or asphalt tend to place more long term strain on the plantar fascia.

The quality of the plantar fascia itself can be a factor--its elasticity or lack of, its thickness, its strength. Certainly, some means of restoring tissue quality to that ligament could be a boon. Perhaps your product can help in this area and I will give you a lot of credit if it does. But, please do not criticize information which has withstood the test of time in order to promote your product. If your product helps people, it can be promoted on its own merits.
Ed

Re: Dr Ed Davis

Julie on 7/18/01 at 11:19 (053580)

Dr Davis

Thank you for this lucid explanation, and for your other post above about the inconsistent application of treatment modalities. I very much hope you will be a frequent visitor to heelspurs.com!

Re: Jade results

Scott R on 7/18/01 at 12:46 (053586)

So far the Jade 168 doesn't appear to be doing very well. Only 7 out of 22 (32%) people at heelspurs.com have ranked it above a 5 on a scale of 1 to 10. Our independent check of the Jade is at http://heelspurs.com/jade.cgi

Re: the major problem with this idea

Glenn X on 7/18/01 at hrmin (053589)

I know nothing about auto-immune stuff, but it sounds like with PF we're suggesting that our inherent healing tools aren't up to the job. My cuts, muscle pulls, and tendon yanks continue to heal nicely elsewhere in my body, so even after 3-plus years with this major annoyance, auto-immune directions don't strike a chord with me. (While Dr. Davis's remarks feel right on).

That said, (not to sound too anthropomorphic) I sometimes wonder that my foot is trying to go off in some direction to mend itself, and I'm just not letting it do that. Sorta feels like my foot's mission is inconsistent with my body's and my mind's mission. Meaning, my foot is trying to heal itself as best it can and doesn't really care if it serves a higher-level purpose such as walking. First things first.

My lack of communication with my foot is getting in both of our ways. We're not collaborating. Our relationship needs work. I'm not listening, and in fact don't even understand the language. Foot is from Pluto, me is from Mercury.

As for Jade, I'm way skeptical, but if there were no downside, cost was reasonable, and there were some credible evidence that it could help, I'd rub chocolate pudding on my feet.

Re: the major problem with this idea

wendyn on 7/18/01 at 13:55 (053590)

I like you Glenn.

Re: Jade results

Dr. David S. Wander on 7/18/01 at 20:49 (053638)

I agree strongly with Dr. Davis and welcome him to this site. For years I've been telling patients that 'heel spurs' do not exist, and it is actually a shelf of bone, not a sharp point. Scott, as you know I do have a hand-out regarding heel pain/plantar fasciitis that I hand out to my patients, listing each treatment option availabe. I have resisted an actual flow chart, due to different symptoms, patient needs, etc, and to resist lumping all heel pain patients into one category. However, a flow sheet can be very useful as a general guideline. I would be more than happy to work on this with Dr. Davis if he is amenable to this idea.

As far as Jade goes, at the present time if you think there will be any real benefit from this product, give me a call.....I've got some land I'd like to sell you.

Re: Jade results

Dr. Ed Davis on 7/18/01 at hrmin (053646)

Dr. Wander:
Thank you. I think it can be a fun project.
By the way, are you or Dr. Z going to the APMA annual meeting in Chicago next month? If so, it may be a good time to get together on this.

Scott--We should consider you an 'honorary' podiatrist. You may be interested in attending some of our meetings. Our national meeting next month should have exhibitors for a lot of things you are interested in--orthotics, night splints, ECSWT, etc. While some of the lectures may be of interest, just walking on the convention floor to look at exhibits and talk to representatives of the various products is an education in itself.
Ed

Re: Jade results

Julie on 7/19/01 at 03:16 (053675)

Dr Wander, excuse me, but I don't think your remark about Jade at the end of your last post was called for. Dr Reynolds has impressed me and others as a sincere doctor trying to help his patients and, now, people here. He isn't a snake oil peddler trying to sell a useless product to gullible PF sufferers. Whether he is right or wrong about the causes of PF and the efficacy of Jade in its treatment, he has done nothing to deserve sarcasm.

There is room on this website for everyone, and for all contributions. I have greatly valued yours in the past, and am very glad Dr Davis has come on board.

Re: Jade results

Dr. Chris Reynolds on 7/19/01 at hrmin (053676)

Scott, as we say in Australia, 'Give us a fair go'. The facts are:-
1. On the heelspurs Jade database there are only 21 participants. We can't count you because you are not participating in the Jade trial.
2. Of those 21 participants, only 12 (not 21 as you imply) have responded with satisfaction levels. Of these, 7 (58% not 32%) have reported satisfaction levels greater than 5 on a scale of 1 to 10.
3. I don't see how you can then pronounce that 'the Jade 168 doesn't appear to be going very well'. It is in fact going extremely well when you consider that in my trial, 68% of respondents have had significant improvement in symptoms inside four weeks. Four of them have experienced a dramatic improvement in the first few days of treatment, and their life quality has improved immeasurably. Some of these participants have extolled the virtues of Jade on heelspurs.
4. We have another two months to go in the trial and now some of the non-responders are beginning to notice improvement in symptoms.

I understand the scepticism about Jade emanating from you and a number of others on this site. It's not surprising when a stranger from downunder pops out of the blue and suggests that a topical cream can actually work in PF, but it can, and, as we are now seeing, it often does.
Dr. Chris Reynolds.

Re: Jade results

Dr. Chris Reynolds on 7/19/01 at hrmin (053677)

I wonder if you would like to take a look at the PF trial results on my website. http://www.jadepage.com You may be pleasantly surprised.

Re: the major problem with this idea

Dr. Chris Reynolds on 7/19/01 at hrmin (053682)

With all due respect, Jade is not my product and the trial I am running has been entirely self-funded except for the Jade itself. This is art for art's sake not money for God's sake.
All I am suggesting is that Jade, working as I think it does as an immunomodulator, can in some cases lead to complete and permanent remission of symptoms overnight in patients who have had PF for years. If therefore, the mechanical model is correct, then how could these phenomena possibly occur. It can't be due to 'restoring tissue quality', because it is too quick. To my mind, it has to be some kind of immunological response. Therefore, it is reasonable don't you think, to postulate an auto-immune etiology in PF? Of course there is no doubt that physical and other factors exacerbate the problem, but what about the actual underlying cause? What I would be interested to see, and you can probably tell me if it exists, is a detailed study of the life events in PF patients during the several months leading up to the onset of their problem, because I have a feeling that stress, be it physical, emotional or otherwise may be a major factor in suppressing the individual's immunity at the time. Why the plantar fascia should so commonly be involved I don't know.
Once I was walking along the street, arms free, when I suddenly thought I had been shot in the elbow. The pain was exquisite. This was of course the onset of epicondylitis, but for no obvious physical reason. I was however under considerable stress at the time and had been for several months. Isn't this the kind of story you hear from PF patients all the time?
I invite you to at least have a look at my website http://www.jadepage.com
where you will find under PF Trial Results that the Jade is indeed promoting itself on its own merits.

Re: the major problem with this idea

Glenn X on 7/19/01 at hrmin (053707)

Wendy, What a terrific remark to read! Thank You.

I've only been roaming this site a couple of weeks but the practical insights, sense of community, and shared hope is amazing.

Re: Jade results

Mary Ann S on 7/19/01 at 11:12 (053720)

I agree with Julie's coment. Dr. Reynolds is giving us a chance to try what he has found to give good results in some of his patients. It has helped me. I have NO pf pain. And it has been a long time since I could say that. So what ever the cause, the medication or whatever I will continue to use it. The pain is no fun as we all know.

Re: Jade results

Scott R on 7/19/01 at 17:06 (053754)

Dr. Davis, I would love to meet with you and the rest of the doctors who know me from heelspurs.com. Dr. Weil Sr is working on getting me in for free. I haven't heard back from him yet, but my email was down earlier this week. We could all work on our preliminary flow charts before we go and then sit down before lunch or dinner and work out a completed version out.

Re: Jade results

Lisa C on 7/21/01 at 02:08 (053887)

Julie said it all. I would like to thank Dr. Reynolds for putting his money where his mouth is and giving us this opportunity to try something new for FREE!! We should be open to all new ideas, like the possibility that the earth is not flat...

Re: Jade results

Dr. Chris Reynolds on 7/21/01 at hrmin (053908)

Lisa, thank you and the many others on heelspurs.com who have lent me their moral support during the Jade Balm clinical trial. We as therapists are after all trying to help the likes of you and many others to obtain a better quality of life. If the Jade helps some people recover from PF or attain a reduction in pain, then I think that has to be a good thing.
You can check the latest results of the trial at http://www.jadepage.com
Dr. Chris.

Re: Earth not flat

Glenn X on 7/21/01 at hrmin (053917)

Good one. Totally right.

I too applaud Reynolds's efforts. I am particularly appreciative of his questions, but I am quite skeptical of his answer --- so far.

Re: Earth not flat

Dr. Chris Reynolds on 7/22/01 at hrmin (053947)

I think if you read my piece about PF on http://www.jadepage.com , you would have a better understanding of what I am trying to say. Put very simply, if the CAUSE of PF is mechanical, how could a topical substance (Jade 168 Balm, which I believe to be an immunomodulator) relieve completely the symptoms of someone who has suffered PF for many years, overnight? This has happened any number of times. There HAS to be another explanation, and I believe it is an immunological one.
I in no way doubt that physical activity, obesity, standing for long periods etc. exacerbates the problem, of course it does. In the same way the plethora of treatments available for PF all help different people in different ways and to different extents. I am just trying to take the mechanical model theoretically one step further back which, when it was mooted, knowledge of auto-immunity was in its infancy, .
The key lies in the immunomodulatory power of the Jade which is something you have to experience for yourself to believe, and when you do, you know it is working for you. Just ask some of the trial participants who have had quite dramatic and rapid responses to Jade after only a day or two of application - in miniscule amounts I might add and only once daily.
What I don't understand is why there is such a variety of responses to the Jade, but you could say that about any treatment modality.
The important thing is it's safe and easy to use and it's helping a lot of people. Does it really matter how it works so long as it does?

Re: Flow Chart

Beverly on 8/27/01 at 23:14 (058193)

I'm a mere patient here crashing your site, but what about when ankle complications play in also? Along the road with PF, I developed PTT and AT.
And I've been treated out the ying yang. I have ups and downs. But when the ankle is also injured, how does that play into the projected recovery success and the flow chart?
Thanks,
Beverly

Re: this site

Dr. Zuckerman on 7/16/01 at 14:44 (053369)

I believe there are preferred treatment guild lines that are in a flow chart format, put out by the American College of Foot and Ankle Surgeons. This is a very good idea.

Re: this site

Ed Davis, DPM on 7/16/01 at 15:05 (053371)

Yes, the American College of Foot and Ankle Surgeons have published several sets of guidlines. I do not beleive they have one for heel pain yet.
Ed

Re: this site

Scott R on 7/16/01 at 19:54 (053405)

Thanks Dr. Davis, and I agree about the website being overwhelming to the mild case of PF. I have thought long and hard about a flow chart, in the context of creating an interactive program that pretends to be a doctor for PF, with the obviuos legal disclaimers. I haven't figured out what the content should be. I would like to take you up on your offer of help, but I don't want you to go to a lot of effort and then me not use any of it. I would like to see whatever flow charts anyone has ever done and someday I would incorporate them into the program if I agree with what they say.

Re: this site

Dr. Zuckerman on 7/16/01 at 20:49 (053409)

I will take a look and see if there is one from the ACFAS. This is a good idea.

Re: this site

Dr. Ed Davis on 7/16/01 at hrmin (053411)

There are a number of good flow charting programs available such as 'Flow' by IMSI...
Your site has most of the info. I think you may be surprised to see that some of the real disagreement emergences when that information is prioritized in a flow chart but it is worth a try. Consider keeping it simple for starters. Lets wait to see if Dr. Zuckerman can obtain one from ACFAS, as they do good work. If not, I will come up with a rough draft for one in the next few weeks that you and Dr. Z can look at. I was thinking of doing one, anyway, for the benefit of the family doctors in my area.
Regards,
Ed

Re: this site

Dr. Zuckerman on 7/16/01 at 21:26 (053416)

You are right . I took a look at my ACFAS PPG's and there is no heel pain.

Sounds good to me. I am sure Scott and you can put something together. Good luck.

Re: Flow Chart

Glenn X on 7/16/01 at hrmin (053417)

Scott's site is super rich with information, though sometimes I feel like I'm drowning in information and starving for insight. Even so, every time I dive in I discover something of value.

That said, once past Scott's book, it takes quite a bit of work to glean the good stuff. The payoff is well worth the work, but particularly for newer people, crafting a more direct path to the information in the sight would be helpful.

I too have tried imagining a flow chart for PF. The variables seem daunting, but what a useful tool that would be.

As a simple start, how about a table? Symptoms down the left column (increasing in severity), treatments across the top (decreasing in conservatism). I don't know enough about other's experience, but some left column entries could be . . .

Discomfort (no limits on normal activity)
Pain 1-3 (some limits on normal activity)
Pain 4-7 (serious limits on normal activity)
Pain 8-10 (can't take care of self ? ?)
Morning pain worst

Inflammation

Insufficient ankle dorsiflexion

Sore ankle

Tingling on the sole of the foot
Sharp, ground-glass-like pain on sole of foot

Strained fascia
Torn fascia
Scarred fascia ? ?

And as I sink into this idea it too seems unworkable, but I'll fling it out there anyway.

On another track: Maybe this could be worked into going backwards. i.e., 'Should you ice?' with some questions that point the reader to a yes/no/possibly, followed by a link to instructions. 'Should you try OTC orthotics? Custom orthotics?' With questions. 'Should you tape, Should you increase your flexibility, Should you consider shots, anti-inflammatories, night splint, ESWT, surgery? and so forth.

Yow

Re: Flow Chart

Dr. Ed Davis on 7/16/01 at 21:33 (053419)

Thanks for your comments. We could wind up with more than one version of the flowchart.

Re: this site

Scott R on 7/16/01 at 23:55 (053434)

I considered not giving away my secret on this, but here it is: the input form for the computer doctor would also serve as the form that is filled out and presented to their real doctor so that they have a record of the relevant symptoms. It may organize the discussion. The computer's response to this info could also be printed out and presented to the doctor to let him/her tell the patient where it is in error, to let the patient know when the doctor is in error, and to teach the doctor about heel pain if not to so him/her why many doctors may well go the way of the secretary (remember those?) in the coming years.

Re: the major problem with this idea

Scott R on 7/17/01 at 00:04 (053435)

The problem with our idea is that our survey of 6,000 people showed no correlation with symptoms and treatments. For example, 100 pound people who had pain with the first few steps in the morning and were sensitive to the touch and had it for 5 years rank treatments in exactly the same order as the 300 pound person who had none of the skinny person's symptoms and had had it for 6 months. I'm exaggerating a little because there were some correlations (the biggest being male verses female),but absolutely nothing I could sink my teeth into. The whole point of doing such a large survey was to uncover the most beneficial treatments for various specific symptoms. As my friend Richard Feynman once said in reference to a difficult research project: 'We stuck our foot in the swamp and pulled it up muddy.'

In other words, if I do do it, it may turn out to largely be a marketing gimick to make the website more palatable. However, it will still have value for the other reasons mentioned earlier.

Re: the major problem with this idea

Dr. Chris Reynolds on 7/17/01 at hrmin (053548)

Pardon my intrusion, but I think this biomechanical model for PF is much like sufferers' patience, it's worn very thin. I don't deny that PF can be exacerbated by being overweight and by overuse, of course it can, just like any inflammatory condition, but there are far too many inconsistencies in symptoms for them to be explained by mechanical factors alone. For instance, one would expect pain to improve with rest overnight, but as we know this is often not the case. Why do so many 'underweight' people get PF when many obese individuals don't? Why does the presence or absence of heelspurs appear to have at best an arbitrary effect?
This is why I suggest we turn our minds to the immune system and look at an auto-immune etiology for PF. The Jade trial (www.jadepage.com)has shown very clearly in just four weeks how an immunomodulatory substance (Jade 168 Balm) has been able to significantly reduce PF pain in 68% of trial participants. Admittedly, 32 % have not responded, but there is still 2 months of the trial to go. Any drug company that could achieve a result like this for any product would be over the moon about it.
If you try to think about PF from the auto-immune point of view, at least the inconsistencies of symptoms, the responses to treatments and the presence or absence of heelspurs begin (in the light of response to an immunomodulator)to make a little sense.

Re: the major problem with this idea

Dr. Ed Davis on 7/18/01 at hrmin (053575)

I think that one of the problems you will find is inconsistent application of various modalities. Very few of the modalities mentioned, in my experience work in an isolated fashion. The best treatment results seem to occur when appropriate modalities are used in combination.

Example: A patient with long term plantar fasciitis has limited ankle dorsiflexion (movement of the ankle upwards) range of motion and is overpronated. This individual may be treated simultaneously with a night splint in order to increase ankle dorsiflexion and an orthotic designed to reduce overpronation. Use of one of these modalities alone may have questionable results. This patient, in addition, will not tolerate a good orthotic until two things occur: 1)a reasonable amount of ankle dorsiflexion is achieved and 2)acute inflammation has been relieved. Acute inflammation maybe relieved via modalities such as ultrasound, iontophoresis, steroids, etc. Remember that those modalities used to relieve the acute phase generally do not lead to permanent relief; they will make the long term modalities tolerable and thus potentially effective.

A flow chart can serve to facilitate the decision making process--how and when to apply various modalities: under what circumstances to combine modalities, the sequence of modality usage (a concept which may not be sufficiently clear from the information on this site), and how to assess or measure the effects of usage of such treatments.

Re: the major problem with this idea

Dr. Ed Davis on 7/18/01 at hrmin (053579)

Dr. Reynolds,
The biomechanical model for plantar fasciitis has led to a system of treatments which cures about 95% of plantar fasciitis via conservative means and surgery cures about 70% of those who do not respond to conservative care, albeit with certain risks associated with surgery in general. With all due respects, I cannot consider this model to be 'worn very thin' as you state.

I think that the more you understand about the biomechanical model, the less 'inconsistencies' you will find in symptoms. Let me address some of the items that you are calling 'inconsistencies.'
1)POST-STATIC DYSKINESIA--This is the term applied to pain which aoccurs after rest. It is a very common and logical finding in plantar fasciitis.
The plantar fascia is a ligament, basically a bundle of fibrous tissue, forming a band which supports the bottom of the foot and provides a 'recoil' effect to enhance propulsion (windlass mechanism). The more that excess tension is applied, that is, tension which is pathologic or beyond the degree to which it has been designed to accept, the more the band of tissue becomes damaged. The greater the damage, the more contraction that occurs with rest. After rest, one steps down on a inflamed contracted fascia and that is the reason for this finding.

2)HEEL SPURS--I believe that most surgeons, that is individuals who have opened up and visualized the so-called heel spur will verify that there really is no such thing as a spur. It is actually a shelf of bone, protruding forward from the heel bone. When viewed from the side, due to the two dimensional nature of x-rays, it appears as a spur. That shelf of bone is an area to which the plantar fascia or parallel ligament attaches (some controversy here). Long term excessive pull on the plantar fascia at its attachment to the heel bone creates this 'shelf.' The presence of the shelf of bone is thus an indicator of long term tension on the plantar fascia and thus has little to do (usually) with symptoms.

3)WEIGHT--There are heavy people who have feet which are very sound biomechanically and skinny people with poor biomechanics--enough said.
Occupation and avocation needs to be considered. Individuals working in factories, on concrete or asphalt tend to place more long term strain on the plantar fascia.

The quality of the plantar fascia itself can be a factor--its elasticity or lack of, its thickness, its strength. Certainly, some means of restoring tissue quality to that ligament could be a boon. Perhaps your product can help in this area and I will give you a lot of credit if it does. But, please do not criticize information which has withstood the test of time in order to promote your product. If your product helps people, it can be promoted on its own merits.
Ed

Re: Dr Ed Davis

Julie on 7/18/01 at 11:19 (053580)

Dr Davis

Thank you for this lucid explanation, and for your other post above about the inconsistent application of treatment modalities. I very much hope you will be a frequent visitor to heelspurs.com!

Re: Jade results

Scott R on 7/18/01 at 12:46 (053586)

So far the Jade 168 doesn't appear to be doing very well. Only 7 out of 22 (32%) people at heelspurs.com have ranked it above a 5 on a scale of 1 to 10. Our independent check of the Jade is at http://heelspurs.com/jade.cgi

Re: the major problem with this idea

Glenn X on 7/18/01 at hrmin (053589)

I know nothing about auto-immune stuff, but it sounds like with PF we're suggesting that our inherent healing tools aren't up to the job. My cuts, muscle pulls, and tendon yanks continue to heal nicely elsewhere in my body, so even after 3-plus years with this major annoyance, auto-immune directions don't strike a chord with me. (While Dr. Davis's remarks feel right on).

That said, (not to sound too anthropomorphic) I sometimes wonder that my foot is trying to go off in some direction to mend itself, and I'm just not letting it do that. Sorta feels like my foot's mission is inconsistent with my body's and my mind's mission. Meaning, my foot is trying to heal itself as best it can and doesn't really care if it serves a higher-level purpose such as walking. First things first.

My lack of communication with my foot is getting in both of our ways. We're not collaborating. Our relationship needs work. I'm not listening, and in fact don't even understand the language. Foot is from Pluto, me is from Mercury.

As for Jade, I'm way skeptical, but if there were no downside, cost was reasonable, and there were some credible evidence that it could help, I'd rub chocolate pudding on my feet.

Re: the major problem with this idea

wendyn on 7/18/01 at 13:55 (053590)

I like you Glenn.

Re: Jade results

Dr. David S. Wander on 7/18/01 at 20:49 (053638)

I agree strongly with Dr. Davis and welcome him to this site. For years I've been telling patients that 'heel spurs' do not exist, and it is actually a shelf of bone, not a sharp point. Scott, as you know I do have a hand-out regarding heel pain/plantar fasciitis that I hand out to my patients, listing each treatment option availabe. I have resisted an actual flow chart, due to different symptoms, patient needs, etc, and to resist lumping all heel pain patients into one category. However, a flow sheet can be very useful as a general guideline. I would be more than happy to work on this with Dr. Davis if he is amenable to this idea.

As far as Jade goes, at the present time if you think there will be any real benefit from this product, give me a call.....I've got some land I'd like to sell you.

Re: Jade results

Dr. Ed Davis on 7/18/01 at hrmin (053646)

Dr. Wander:
Thank you. I think it can be a fun project.
By the way, are you or Dr. Z going to the APMA annual meeting in Chicago next month? If so, it may be a good time to get together on this.

Scott--We should consider you an 'honorary' podiatrist. You may be interested in attending some of our meetings. Our national meeting next month should have exhibitors for a lot of things you are interested in--orthotics, night splints, ECSWT, etc. While some of the lectures may be of interest, just walking on the convention floor to look at exhibits and talk to representatives of the various products is an education in itself.
Ed

Re: Jade results

Julie on 7/19/01 at 03:16 (053675)

Dr Wander, excuse me, but I don't think your remark about Jade at the end of your last post was called for. Dr Reynolds has impressed me and others as a sincere doctor trying to help his patients and, now, people here. He isn't a snake oil peddler trying to sell a useless product to gullible PF sufferers. Whether he is right or wrong about the causes of PF and the efficacy of Jade in its treatment, he has done nothing to deserve sarcasm.

There is room on this website for everyone, and for all contributions. I have greatly valued yours in the past, and am very glad Dr Davis has come on board.

Re: Jade results

Dr. Chris Reynolds on 7/19/01 at hrmin (053676)

Scott, as we say in Australia, 'Give us a fair go'. The facts are:-
1. On the heelspurs Jade database there are only 21 participants. We can't count you because you are not participating in the Jade trial.
2. Of those 21 participants, only 12 (not 21 as you imply) have responded with satisfaction levels. Of these, 7 (58% not 32%) have reported satisfaction levels greater than 5 on a scale of 1 to 10.
3. I don't see how you can then pronounce that 'the Jade 168 doesn't appear to be going very well'. It is in fact going extremely well when you consider that in my trial, 68% of respondents have had significant improvement in symptoms inside four weeks. Four of them have experienced a dramatic improvement in the first few days of treatment, and their life quality has improved immeasurably. Some of these participants have extolled the virtues of Jade on heelspurs.
4. We have another two months to go in the trial and now some of the non-responders are beginning to notice improvement in symptoms.

I understand the scepticism about Jade emanating from you and a number of others on this site. It's not surprising when a stranger from downunder pops out of the blue and suggests that a topical cream can actually work in PF, but it can, and, as we are now seeing, it often does.
Dr. Chris Reynolds.

Re: Jade results

Dr. Chris Reynolds on 7/19/01 at hrmin (053677)

I wonder if you would like to take a look at the PF trial results on my website. http://www.jadepage.com You may be pleasantly surprised.

Re: the major problem with this idea

Dr. Chris Reynolds on 7/19/01 at hrmin (053682)

With all due respect, Jade is not my product and the trial I am running has been entirely self-funded except for the Jade itself. This is art for art's sake not money for God's sake.
All I am suggesting is that Jade, working as I think it does as an immunomodulator, can in some cases lead to complete and permanent remission of symptoms overnight in patients who have had PF for years. If therefore, the mechanical model is correct, then how could these phenomena possibly occur. It can't be due to 'restoring tissue quality', because it is too quick. To my mind, it has to be some kind of immunological response. Therefore, it is reasonable don't you think, to postulate an auto-immune etiology in PF? Of course there is no doubt that physical and other factors exacerbate the problem, but what about the actual underlying cause? What I would be interested to see, and you can probably tell me if it exists, is a detailed study of the life events in PF patients during the several months leading up to the onset of their problem, because I have a feeling that stress, be it physical, emotional or otherwise may be a major factor in suppressing the individual's immunity at the time. Why the plantar fascia should so commonly be involved I don't know.
Once I was walking along the street, arms free, when I suddenly thought I had been shot in the elbow. The pain was exquisite. This was of course the onset of epicondylitis, but for no obvious physical reason. I was however under considerable stress at the time and had been for several months. Isn't this the kind of story you hear from PF patients all the time?
I invite you to at least have a look at my website http://www.jadepage.com
where you will find under PF Trial Results that the Jade is indeed promoting itself on its own merits.

Re: the major problem with this idea

Glenn X on 7/19/01 at hrmin (053707)

Wendy, What a terrific remark to read! Thank You.

I've only been roaming this site a couple of weeks but the practical insights, sense of community, and shared hope is amazing.

Re: Jade results

Mary Ann S on 7/19/01 at 11:12 (053720)

I agree with Julie's coment. Dr. Reynolds is giving us a chance to try what he has found to give good results in some of his patients. It has helped me. I have NO pf pain. And it has been a long time since I could say that. So what ever the cause, the medication or whatever I will continue to use it. The pain is no fun as we all know.

Re: Jade results

Scott R on 7/19/01 at 17:06 (053754)

Dr. Davis, I would love to meet with you and the rest of the doctors who know me from heelspurs.com. Dr. Weil Sr is working on getting me in for free. I haven't heard back from him yet, but my email was down earlier this week. We could all work on our preliminary flow charts before we go and then sit down before lunch or dinner and work out a completed version out.

Re: Jade results

Lisa C on 7/21/01 at 02:08 (053887)

Julie said it all. I would like to thank Dr. Reynolds for putting his money where his mouth is and giving us this opportunity to try something new for FREE!! We should be open to all new ideas, like the possibility that the earth is not flat...

Re: Jade results

Dr. Chris Reynolds on 7/21/01 at hrmin (053908)

Lisa, thank you and the many others on heelspurs.com who have lent me their moral support during the Jade Balm clinical trial. We as therapists are after all trying to help the likes of you and many others to obtain a better quality of life. If the Jade helps some people recover from PF or attain a reduction in pain, then I think that has to be a good thing.
You can check the latest results of the trial at http://www.jadepage.com
Dr. Chris.

Re: Earth not flat

Glenn X on 7/21/01 at hrmin (053917)

Good one. Totally right.

I too applaud Reynolds's efforts. I am particularly appreciative of his questions, but I am quite skeptical of his answer --- so far.

Re: Earth not flat

Dr. Chris Reynolds on 7/22/01 at hrmin (053947)

I think if you read my piece about PF on http://www.jadepage.com , you would have a better understanding of what I am trying to say. Put very simply, if the CAUSE of PF is mechanical, how could a topical substance (Jade 168 Balm, which I believe to be an immunomodulator) relieve completely the symptoms of someone who has suffered PF for many years, overnight? This has happened any number of times. There HAS to be another explanation, and I believe it is an immunological one.
I in no way doubt that physical activity, obesity, standing for long periods etc. exacerbates the problem, of course it does. In the same way the plethora of treatments available for PF all help different people in different ways and to different extents. I am just trying to take the mechanical model theoretically one step further back which, when it was mooted, knowledge of auto-immunity was in its infancy, .
The key lies in the immunomodulatory power of the Jade which is something you have to experience for yourself to believe, and when you do, you know it is working for you. Just ask some of the trial participants who have had quite dramatic and rapid responses to Jade after only a day or two of application - in miniscule amounts I might add and only once daily.
What I don't understand is why there is such a variety of responses to the Jade, but you could say that about any treatment modality.
The important thing is it's safe and easy to use and it's helping a lot of people. Does it really matter how it works so long as it does?

Re: Flow Chart

Beverly on 8/27/01 at 23:14 (058193)

I'm a mere patient here crashing your site, but what about when ankle complications play in also? Along the road with PF, I developed PTT and AT.
And I've been treated out the ying yang. I have ups and downs. But when the ankle is also injured, how does that play into the projected recovery success and the flow chart?
Thanks,
Beverly