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uh, docs, about that 90% figure

Posted by elliott on 2/07/02 at 15:40 (072932)

That PF has a 90% cure rate with conservative measures is often bandied about here and elsewhere. As one example cited in the journals, check out this link:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7834059&dopt=Abstract

(Note the great Baxter himself among the authors.)

But I'm starting to wonder things like what their mean time from onset to beginning of treatment, severity levels, etc. (I'd bet the particular study in the link would say; I don't have it in front of me though.) I mean, maybe some such studies include too many of those who typically have it for one week and quickly get better (the rest/ice/ibuprofen crowd), those who have had it for one month and then get better (the rest/ice/ibuprofen/stretching crowd), and those who have had it for one year and then get better (above plus nightsplint/orthotics). After around a year is when many journals say that surgery should be considered as an option.

So what I'm getting at is, what if you're dealing with the crowd who is not better after a year of conservative measures (as with many on the board; after all, that's why they're here)? It's now really a conditional probability, namely the probability conservative measures work, given they haven't worked for the first year. Maybe that number is nowhere near 90%. Any feel what that number would be? Please give a separate answer for both pre- and post-ESWT, preferably accurate to five decimal places. :-)

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Re: not a doc, but I see your point

Carole C in NOLA on 2/07/02 at 16:52 (072948)

You forgot those that have had it for a few months and get better (the rest/ice/painmeds/orthotics crowd), like me. :)

Elliott, I think that if most of those that are healed in less than a year had instead ignored conservative measures to a greater or lesser extent, then they'd be in the group that had it more than a year. It just gets worse and never better without fairly aggressive pursuit of the right conservative treatment regimen, IME.

As far as the conditional probability, I think it would be a lot less than 90%. Why? Because I think that if you have PF for a year, you aren't making progress in healing because you are suffering constant small re-injuries for that year. I think that a year of constant re-injuries would make it harder for a person to heal than if they just got PF yesterday.

That's why I've given myself a year to a year and a half before even considering ESWT, which I regard as the next step. (Luckily, it looks like I won't need it, knock on wood). After all I've read about the surgical probabilities, I am not eager for that unless it is the absolute last resort. Even if it works, recovery can take months, from what I understand. And then, after that, you have to rebuild your muscles.

Carole C

Re: uh, docs, about that 90% figure

Dr. Marlene Reid on 2/08/02 at 00:03 (072992)

That 90% figure most likely comes from what most of us say, that approx 90% of the patients we see for PF, will have their symptoms greatly or all together with some type(s) of conservative care. Only 5-10% of the PF patients will require more aggressive treatments (sx or esw). I have found that it is easier to get rid of heel pain when treatment is started early on. Once the pain becomes chronic (greater then 6 months by definition of 'chronic') or over a year it is harder to get rid of conservatively. There are MNY factors in heel pain/PF, so I think that 90% you all hear is in refrence to generalities.

Re: do you have a clue what the chronic % is? (nm)

elliott on 2/08/02 at 07:07 (073004)

.

Re: % of chronics who improve by conservative means, that is (nm)

elliott on 2/08/02 at 07:16 (073009)

.

Re: not a doc, but I see your point

Carole C in NOLA on 2/07/02 at 16:52 (072948)

You forgot those that have had it for a few months and get better (the rest/ice/painmeds/orthotics crowd), like me. :)

Elliott, I think that if most of those that are healed in less than a year had instead ignored conservative measures to a greater or lesser extent, then they'd be in the group that had it more than a year. It just gets worse and never better without fairly aggressive pursuit of the right conservative treatment regimen, IME.

As far as the conditional probability, I think it would be a lot less than 90%. Why? Because I think that if you have PF for a year, you aren't making progress in healing because you are suffering constant small re-injuries for that year. I think that a year of constant re-injuries would make it harder for a person to heal than if they just got PF yesterday.

That's why I've given myself a year to a year and a half before even considering ESWT, which I regard as the next step. (Luckily, it looks like I won't need it, knock on wood). After all I've read about the surgical probabilities, I am not eager for that unless it is the absolute last resort. Even if it works, recovery can take months, from what I understand. And then, after that, you have to rebuild your muscles.

Carole C

Re: uh, docs, about that 90% figure

Dr. Marlene Reid on 2/08/02 at 00:03 (072992)

That 90% figure most likely comes from what most of us say, that approx 90% of the patients we see for PF, will have their symptoms greatly or all together with some type(s) of conservative care. Only 5-10% of the PF patients will require more aggressive treatments (sx or esw). I have found that it is easier to get rid of heel pain when treatment is started early on. Once the pain becomes chronic (greater then 6 months by definition of 'chronic') or over a year it is harder to get rid of conservatively. There are MNY factors in heel pain/PF, so I think that 90% you all hear is in refrence to generalities.

Re: do you have a clue what the chronic % is? (nm)

elliott on 2/08/02 at 07:07 (073004)

.

Re: % of chronics who improve by conservative means, that is (nm)

elliott on 2/08/02 at 07:16 (073009)

.