Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Another way to make sure you have plantar fasciitis

Posted by Dr. Z on 9/14/02 at 16:43 (095336)

One of the important decision that a doctor has before doing ESWT is to make sure the patient has plantar fasciitis and not just something else.

As podiatrists, plantar fasciitis should be very simple to rule out by history and physical examination.

I have come to the conclusion that this is for the most part going to get the patient an exact diagnosis however I have required all of the ESWT patients that under go ESWT to have an ultrasound testing. This is done right before the procedure and in alot of cases at the initial pf evaluation

Logic should tells you that if the thickness of the plantar fascia at the insertion is abnormal and there is swelling then you have for the most part pins down the diagnosis even more.

I believe in Canada this is always done. Not sure about the USA

Re: Another way to make sure you have plantar fasciitis

Julie on 9/15/02 at 01:42 (095351)

ESWT is not the only issue. There is no more important prerequisite to ANY treatment than accurate diagnosis.

You say it should be 'simple', but clearly it isn't, judging by the number of people who think they may have PF but aren't sure, because their podiatrists aren't sure; the number of reports we have from folks whose podiatrists haven't even bothered to evaluate them but have simply offered cortisone injections or some other trial-and-error line of treatment; and the significant number of people who have had surgery for PF and have turned out to have something else, e.g. TTS, as well as or instead of PF.

In two years here I've been increasingly disturbed by these reports. Why is it 'simple' for some podiatrists but seemingly impossible for others? Of course people differ in their abilities, but the huge discrepancies thrown up by reports here seem to suggest that there may be vast differences in the quality of the professional training podiatrists receive.

Obviously this is NOT intended to be offensive to any of the excellent doctors here, who clearly know what they are doing. Their patients are the fortunate ones. It's the others who should concern us.

Re: Another way to make sure you have plantar fasciitis

Pete R on 9/15/02 at 11:16 (095367)

Julie, I totally agree with you and you will recall my thoughts on Pod's in this England.....I'm trying to be more positive about them honestly !

Even Pod's admit that their profession tends to think that any heel pain must be pf, they use it as a generic diagnosis. Quite incorrectly in many cases. It's a big worry particularly for us sufferers.

Dr Z's advise on ultrasound is a great idea and something I have thought of before given that many Dr's use it to treat accurately ESWT. The only problem is access to the equipment, there are not many pod's or UK hospitals set up to provide this.

Re: Pete

Julie on 9/15/02 at 12:05 (095369)

Yes, sure, I recall your thoughts, and my only problem with them was that you seemed to be making a blanket judgement of the UK podiatric profession, and I didn't think that was fair. The situation is no better in the States, quite obviously.

But I've always sympathised with your misfortunes with your own pods.

Re: ultrasound

Ed Davis, DPM on 9/24/02 at 00:47 (096076)

Dr. Z:

I am a big fan of diagnostic ultrasound and encourage practitioners to obtain a unit. The resolution keeps getting better as do the prices of the equipment.

Plantar fascial thickness increases with PF or with longstanding increased tension on the plantar fascia. I have noted individuals with significantly thickened fascia who are asymptomatic. On the other side, I have seen patients in which plantar fascial thickness decreases several months after ESWT. We need to study this!!!!
Ed

Re: ultrasound

john h on 9/24/02 at 09:51 (096092)

Dr. Davis: Does the fascia thicken with age? I have often wondered if my fascia was thicker than normal. The last Doc I talked with said it was not necessary to know but then again he does 100 PF surgeries a year so I can see why he does not seem to care. I am still interested in the possible delivery of cortisone (if fascia inflamation is the problem) via a tape such a cordone. After a problem with an injury that would not heal after a year I was put on the cordone tape and after about 3 weeks it is basically healed. The tape is worn 24/7 and changed at 12 hour intervals and can and does enter the blood stream. I would like to see what wearing this tape for about 30-60 days over the small painful area of the PF. If it is inflamation it seems this constant delivery would be of benefit especially if combined with reduced activity. The tape seems to adhere very well but I do not know what the effect of foot heat and prespiration would have.

Re: ultrasound

Dr. Zuckerman on 9/24/02 at 13:13 (096108)

I will start to do measurement six weeks. twelve weeks six months and one year and see what happens

Re: ultrasound

Ed Davis, DPM on 9/27/02 at 09:51 (096331)

John:

I would assume some thickening would occurr with age but we don't have studies on this.

Cordran tape is primarily for dermatologic problems. i have not seen it used for musculoskeletal conditions.
Ed

Re: ultrasound

Ed Davis, DPM on 9/27/02 at 09:52 (096332)

Dr. Z:

I am looking forward to hearing about your observations!
Ed

Re: Another way to make sure you have plantar fasciitis

Julie on 9/15/02 at 01:42 (095351)

ESWT is not the only issue. There is no more important prerequisite to ANY treatment than accurate diagnosis.

You say it should be 'simple', but clearly it isn't, judging by the number of people who think they may have PF but aren't sure, because their podiatrists aren't sure; the number of reports we have from folks whose podiatrists haven't even bothered to evaluate them but have simply offered cortisone injections or some other trial-and-error line of treatment; and the significant number of people who have had surgery for PF and have turned out to have something else, e.g. TTS, as well as or instead of PF.

In two years here I've been increasingly disturbed by these reports. Why is it 'simple' for some podiatrists but seemingly impossible for others? Of course people differ in their abilities, but the huge discrepancies thrown up by reports here seem to suggest that there may be vast differences in the quality of the professional training podiatrists receive.

Obviously this is NOT intended to be offensive to any of the excellent doctors here, who clearly know what they are doing. Their patients are the fortunate ones. It's the others who should concern us.

Re: Another way to make sure you have plantar fasciitis

Pete R on 9/15/02 at 11:16 (095367)

Julie, I totally agree with you and you will recall my thoughts on Pod's in this England.....I'm trying to be more positive about them honestly !

Even Pod's admit that their profession tends to think that any heel pain must be pf, they use it as a generic diagnosis. Quite incorrectly in many cases. It's a big worry particularly for us sufferers.

Dr Z's advise on ultrasound is a great idea and something I have thought of before given that many Dr's use it to treat accurately ESWT. The only problem is access to the equipment, there are not many pod's or UK hospitals set up to provide this.

Re: Pete

Julie on 9/15/02 at 12:05 (095369)

Yes, sure, I recall your thoughts, and my only problem with them was that you seemed to be making a blanket judgement of the UK podiatric profession, and I didn't think that was fair. The situation is no better in the States, quite obviously.

But I've always sympathised with your misfortunes with your own pods.

Re: ultrasound

Ed Davis, DPM on 9/24/02 at 00:47 (096076)

Dr. Z:

I am a big fan of diagnostic ultrasound and encourage practitioners to obtain a unit. The resolution keeps getting better as do the prices of the equipment.

Plantar fascial thickness increases with PF or with longstanding increased tension on the plantar fascia. I have noted individuals with significantly thickened fascia who are asymptomatic. On the other side, I have seen patients in which plantar fascial thickness decreases several months after ESWT. We need to study this!!!!
Ed

Re: ultrasound

john h on 9/24/02 at 09:51 (096092)

Dr. Davis: Does the fascia thicken with age? I have often wondered if my fascia was thicker than normal. The last Doc I talked with said it was not necessary to know but then again he does 100 PF surgeries a year so I can see why he does not seem to care. I am still interested in the possible delivery of cortisone (if fascia inflamation is the problem) via a tape such a cordone. After a problem with an injury that would not heal after a year I was put on the cordone tape and after about 3 weeks it is basically healed. The tape is worn 24/7 and changed at 12 hour intervals and can and does enter the blood stream. I would like to see what wearing this tape for about 30-60 days over the small painful area of the PF. If it is inflamation it seems this constant delivery would be of benefit especially if combined with reduced activity. The tape seems to adhere very well but I do not know what the effect of foot heat and prespiration would have.

Re: ultrasound

Dr. Zuckerman on 9/24/02 at 13:13 (096108)

I will start to do measurement six weeks. twelve weeks six months and one year and see what happens

Re: ultrasound

Ed Davis, DPM on 9/27/02 at 09:51 (096331)

John:

I would assume some thickening would occurr with age but we don't have studies on this.

Cordran tape is primarily for dermatologic problems. i have not seen it used for musculoskeletal conditions.
Ed

Re: ultrasound

Ed Davis, DPM on 9/27/02 at 09:52 (096332)

Dr. Z:

I am looking forward to hearing about your observations!
Ed