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There are a number of different treatment options available for
recalcitrant plantar fasciitis, with limited high level evidence to
guide nonoperative and operative treatment methods. The purpose of this
study was to determine the current preferred nonoperative and operative
treatment methods for recalcitrant plantar fasciitis by a group of
experienced orthopaedic foot and ankle surgeons.
Methods: A hypothetical patient with recalcitrant plantar fasciitis was developed
as the basis for a survey comprised of seven questions. The questions
related to the surgeon’s preferred treatment after 4 months of failed
nonoperative management and then after 10 months of recalcitrant
symptoms. The survey was sent to committee members of the American
Orthopaedic Foot and Ankle Society (AOFAS).
Results: Eighty-four orthopaedic surgeons completed the survey (84 out of 116; response rate
= 72%). At the 4-month visit, when questioned regarding their most
preferred next step in management, 37 (44%) respondents favored
initiation of plantar fascia-specific stretching (PFSS), 20 (24%)
supervised physical therapy, 17 (20%) night splinting, five (6%)
steroid injection, three (4%) custom orthotics, and two (2%) cast or
boot immobilization. With ongoing symptoms at 10 months, 62 (74%)
respondents chose surgery or ECSWT (extracorporeal shock wave therapy)
as their next step in management. Some form of surgery (alone or in
combination) was chosen by 46 (55%) respondents. The most popular
operative interventions were gastrocnemius recession (alone or in
combination with another procedure) and open partial plantar fascia
release with nerve decompression.
Conclusions: For shorter duration
symptoms, tissue-specific stretching and conditioning methods were
favored over anti-inflammatory or structural support modalities which
is consistent with available high-level evidence studies. Heterogeneity
of operative preferences for chronic symptoms highlighted the need for
further high-quality studies.
Re: Preferred Management of Recalcitrant Plantar Fasciitis
The study sited is interested, but I don't know of any patient that will put up with heel pain for 10 months and not seek another opinion.
Assuming the cause of the heel pain is chronic plantar fascitis, I have injected PRP and placed patient in CAM walker with heat molded 1/2 inch plastazote machined to fit into foot bed of CAM walker. I have had great success. If this fails, and again, assuming other methods of non operative treatment fails, I do an EPF. I also question why a gastrocnemius lengthening, when 90% of recalcitrant heel pain is associated with a semi rigid cavus foot type.
Re: Preferred Management of Recalcitrant Plantar Fasciitis
I-Man,
What are PRP & EPF?
Which country do you practice in?
I must say I've seen very little Plantar fasciitis in Pes cavus feet, usually normal/ low arch, but mostly in people who stand/ walk on hard surfaces.
Looking forward to other suggestions, have had a run of Plantar fasciitis in past few weeks.
Cheers,
Kara.
Re: Preferred Management of Recalcitrant Plantar Fasciitis
Quote:
Originally Posted by Kara47
I-Man,
What are PRP & EPF?
Which country do you practice in?
I must say I've seen very little Plantar fasciitis in Pes cavus feet, usually normal/ low arch, but mostly in people who stand/ walk on hard surfaces.
Looking forward to other suggestions, have had a run of Plantar fasciitis in past few weeks.
Cheers,
Kara.
Re: Preferred Management of Recalcitrant Plantar Fasciitis
Quote:
Originally Posted by Lab Guy
Google PRP for heel pain
Google EPF for heel pain
I suppose that we all fall into the trap of using abbreviations from time to time; however, in the UK (and I assume Oz and NZ also) we are encouraged to desist from so doing. The reason is the potential for misinterpretation, and confusion in law suits. It does seem reasonable to ask, as did Kara - and subtly at that - that posters should be clear on this website. I am sure that he/she is well aware of what Platelet Rich Plasma is, as well as Endoscopic Plantar Fasciotomy but was wishing to bring this out for those who were unaware.
TTFN
Bill
The Following User Says Thank You to W J Liggins For This Useful Post:
Preferred Management of Recalcitrant Plantar Fasciitis
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