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PF

Posted by Darlene on 2/28/05 at 16:24 (170165)

I found some interesting information on the http://www.myfootshop.com website. This is something I haven't heard of before.

I will paste below:

On The Horizon....

Drs. Barrett and Erredge in Texas have taken a novel approach to treating plantar fasciitis. They have put forth a hypothesis that plantar fasciitis is not the result of repetitive loading and inflammation but rather the result of degenerative change in the fascia unrelated to mechanical load. Their study, published in the November 2004 edition of Podiatry Today advocates the use of autologous platelet concentrate (APC+) injected directly into the portion of the fascia that is painful. This technique stimulates healing.

Autologous (meaning derived from the patient) platelets are obtained by drawing the patients blood and processing it to obtain a concentrated mix of platelets. Platelets are known to have 4-6 times the normal level of human growth factor. Introduction of growth factor into a wound stimulates the influx of fibrocytes and new vascular ingrowth. This technique has been used for some time in the treatment of chronic wounds but is a new way of addressing chronic inflammatory problems such as fasciitis and tendonitis.

We applaud these doctors for their innovative thinking and look forward to more studies using this technique.

Re: PF

Dr. Z on 2/28/05 at 16:45 (170166)

Hi,
It has been proven that plantar fasciitis when chronic is now in a degenerative state. This is called plantar fasciosis or tendinosis when a tendon is involved.
I have tried the use of APCplus with ESWT. Very difficult to determine if the addition of APC with ESWT made a significant difference . We need randonized double blind studies.
The use of APC and surgical wound healing hasn't been proven to be effective yet

Re: PF

Vern on 2/28/05 at 17:05 (170169)

It is nice that you are interested. My DPM never heard of it, so I brought him the article. He responded...I know those guys and they are always trying something, but I don't know if it will help, so let's move on. My thought was he should move on to retirement.

Re: PF

Dr. Z on 2/28/05 at 18:11 (170174)

I personally found the idea extremely interesting and has alot of potential. Only time will tell

Re: PF

BrianG on 3/02/05 at 08:03 (170260)

I believe this is the same Dr. Barrett, from Texas, who came up with the Endoscopic Plantar Fasciotomy (EPF). Since so many doctors are now thinking that the EPF can do more damage than good, I have to woder if Dr. Barrett is looking for another entrance to his own personal gold mine, since the EPF door may not be paying off what it used to. I would most definitely RESEARCH before trying his latest 'cure'.

Good luck,
BrianG

Re: PF

Julie on 3/02/05 at 08:43 (170267)

Brian, thanks for pointing this out. If it's indeed the same Dr Barrett, Vern's podiatrist's reaction would seem to be a pretty sensible one.
.

Re: PF

elliott on 3/02/05 at 12:46 (170282)

If PF is 'not the result of repetitive loading and inflammation but rather the result of degenerative change in the fascia unrelated to mechanical load', why do runners get PF disproportionately and probably at a younger age on average than the rest of the population?

Re: PF

John H on 3/03/05 at 10:35 (170355)

Elliott I concluded long ago (bilateral pf for 9 yrs) that I think PF is a multitude of diseases all with one thing in common--pain. I was a big time runner and when I developed PF had recently started running a lot in the hills so I do think my PF originally developed from this activity. But for most of my life I have always been active in basketball (noon time at the YMCA) softball during season and so on. I have a lifetime of abusing my feet so perhaps PF was inevitable. Several Doctors such as Dr. Baxter have their own therories about PF and I think some of these theroies can be correct because like cancer I just feel we do not all have the same problem we like to characterize as PF. No one has ever really scientifically proved what the pain generator is in PF.

Re: PF

John H on 3/03/05 at 10:37 (170356)

I am with you on this Brian. I would want to talk personally with at least 10 people who have had the procedure. Problems often do not show until a year or so later.

Re: PF

elliott on 3/03/05 at 13:33 (170367)

John H, then I guess you agree that sweeping generalities made by doctors about PF should be regarded with healthy skepticism, if not outright rejected. The problem as I see it is not they they come up with some new explanation shedding light on PF, it is that they claim it explains just about all cases. And they usually publish a journal article with a convincing study backing up their claims. Except that later it seems to be swept aside by another doctor with his own, different, sweeping generality and journal article.

I believe Baxter's 'generality' is that the reason many PF surgeries fail is that the first branch of the lateral plantar nerve is entrapped and playing a role in the PF pain, and was not released at PF surgery. My own opinion, FWIW, is that I would be very wary to accept that unless the patient can sense a nerve problem. I guess you are sort of one counterexample to Baxter's theory (in its generality form) since the surgery did not help your PF. Whether the MAN himself holds it in true generality or not, there is no doubt that such surgery at large is now performed too often and unnecessarily. Baxter did leave his mark on TTS surgery, with that branch being routinely released as part of the surgery by many docs, but I am more comfortable with that since you are already dealing with entrapped nerves.