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Treatment of Plantar Fasciitis

Posted by KevinH on 3/29/04 at 14:17 (148072)

About 1 yr ago, I started having pain in my left foot after the weekly night of playing volleyball. This summer, it was apparent when I was taking tennis lessons, also. But in these cases, it would be painful for a day (where I couldn't walk on it in the morning at all) and then be better. This last fall, I ran on it briefly at an impromptu parents' participation in an Under6yrold soccer practice. I couldn't walk for several days on the heel without extreme pain, and it has gotten more sensitive (less activity and less contact causing greater pain and more extended layoffs).

I had already tried typical OTC anti inflammatory drugs and the Naprosyn had initially helped some in the begginning.Across last fall, the pain become both acute and chronic!! It never seemed to go away. It had been getting steadily worse, to where I sought the care of a podiatrist about 3 months ago.

The podiatrist diagnosed it as plantar fasciitis and I have heel spurs also, as indicated by the Xrays. He gave me a shot in the heel- VERY Painful! and which only seemed to cause it to flare up worse for a couple of days.

I work in a lab and so do a fair bit of standing and walking each day, up and down from a desk/computer too. He prescribed orthotics, which, while they are not a solution, allow me to get through a day. They don't make it pain free, but at least tolerable.

He had precribed Vioxx. The Vioxx did not sit well with my cholesterol medication, didn't seem to effect the left heel much if any. I'm also somewhat hesistant to use any of the high strength anti inflammatories for any length of time as I'm swimming 5-6 days a week, for 1.5-2 miles a day, for last 2.5 yrs, and beating up my muscles pretty good. I am worried about the medication effecting my recovery from the present excercise.

He has precribed physical therapy, 3x3 weeks. This gave about a 10-20% improvement with the combination of ionotophoresis (dextromethosone), electrical stimulation, massage, ultrasound, and stretching. The PTist commented that I have good range of motion and am not tight (I stretch each morning before and after swimming, so the calves are OK). They tried taping it (but not in the pattern used on the site) and it did not help. During massage, the PTist can find a very specific painful spot in the heel area (front of the ball area).

I have little to no pain in the arch and it is very painful in the heel area. I can run on it for a short distance with the pain and the twinging, but then cannot literally walk on it for 2-3 days afterwards (as evidenced in a recent soccer coaching clinic I attended when the coaches were expected to participate in drills).

I ice it occasionally at night, as it seems not to correlate much/make a difference in my first step pain in the morning.

On the last visit he gave me Bextra, which along with another steroid shot seemed to help in the most recent flareup in my heel. But I also was feeling something strange in my arms (where I beat up the muscles swimming.) and so quit taking it after a couple of days. He has asked me what else I want him to do..... (I sense he is frustrated, too).

He is scheduling me for ESWT this Thursday. I have had no MRI or ultrasound (as some of the messages seem to suggest), and I am on low dose aspirin therapy for high cholesterol and he has not asked, nor suggested I not take it(and I would've been on his last prescription of Bextra, if I hadn't quit taking IT.)

I am a male, 5'8', ~170, and fairly physically fit. I do stand a lot at work, but wear decent shoes at work and running shoes all the time at home. I use to run a fair bit in HS and into college, but had knee problems, and have not run in a while. And so I have been biking, blading and swimming since.

Because I have 3 children under 7, and am active, and need to stand at work, I am reluctant to pursue surgery. I am even more reluctant after reading the boards here. How does one pick a successful surgeon for this procedure ????(I am in Chicago/ NW Indiana).

Reading the Blue Cross/Blue Shield evaluation and the meta-analytical work on the ESWT studies, it appears that the shockwave therapy has not been shown to be very successful. (much less covered by insurance).

United ShockWave Therapies is who would be coming in to do the procedure, and it appears they use the Dornier device.

He has not talked about night splints at all. I sleep on my stomach with the foot extended (and the typical swimming position is also with the toes pointed). I have a rather long commute and so am sitting in a car with my left foot in a limited position for 2-3 hrs/day.

I am looking advice, suggestions, things we may have missed...... Others things I should ask him about.

Thanks in advance.

Re: Treatment of Plantar Fasciitis

Marianne on 3/30/04 at 13:57 (148138)

I have read that the shock wave therapy is as about effective (82%) as the plantar fascia release (83%), and with less complications. I am scheduled for plantar fascia release on Friday, and I am having my doubts. I have to have tendon repaired anyhow, so he was goingt o do 2 things at once. My doctor no helpful any time I ask questions, so I have to find things out on my own. My history is similar to yours. I also have a long commute each day to work. I will be out of work for 4 weeks. It sounds like the shock wave treatment is best for you. My impression is that Bue Cross should cover it, if you have already used up conservative measures.

Re: Treatment of Plantar Fasciitis

Ed Davis, DPM on 3/31/04 at 23:34 (148230)

Please read Scott's Heel pain Book on this site. I have a high opinion of ESWT but it is a modality to be performed in conjunction with a comprehensive treatment program for PF.