Home Forums Marketplace Table of Contents Events Member List Site Map Register Mark Forums Read



Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

If you have any problems with the registration process or your account login, please contact contact us.


Tags: , ,

Plantar Fasciitis Discussions

Reply
Submit Thread >  Submit to Digg Submit to Reddit Submit to Furl Submit to Del.icio.us Submit to Google Submit to Yahoo! This Submit to Technorati Submit to StumbleUpon Submit to Spurl Submit to Netscape  < Submit Thread
 
Thread Tools Display Modes
  #1  
Old 8th December 2005, 06:18 PM
Admin's Avatar
Admin Admin is offline
Administrator
 
About:
Join Date: Aug 2004
Location: Cyberspace
Posts: 2,723
Join Date: Aug 2004
Marketplace reputation 45% (0)
Thanks: 104
Thanked 387 Times in 193 Posts
Default Plantar Fasciitis Discussions

Podiatry Arena members do not see these ads
Plantar Fasciitis Discussions


Is a calcaneal spur in the plantar fascia?
Extracorporeal Shock Wave Therapy:
Ultrasound therapy for plantar fasciitis
Plantar fasciitis and dorsal pain
Nutrition and plantar fasciitis
Botulinum toxin and plantar fasciitis
First-Step Pain
Foot Orthoses Effective in Plantar Fasciitis Treatment
Decompression drilling for heel pain
Plantar fasciitis is associated with functional limitation in older people
Growth Factors For Chronic Plantar Fasciitis?
Wheatgrass cream no more effective than placebo for plantar fasciitis
Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy
Plantar fasciitis treated with local steroid injection
Orthoses vs plantar fasciitis
Achilles loads and load in plantar fascia
Functions and Dysfunctions of the Plantar Fascia
Hamstring tightness and plantar fasciitis
Low-Dye taping and iontophoresis for plantar fasciitis
Heel cut-out in orthotic for plantar fasciitis
Offload midfoot for plantar fasciitis?
Plantar fasciitis in HIV positive people
ActiPatch and plantar fasciitis
Detecting plantar fasciitis on plain x-ray?
Glucosamine In Treatment Of Plantar Fasciitis
Plantar Fasciosis Neuropathy
Plantar fasciitis vs FHL tendinitis
Manual therapy for recalcitrant foot pain after fasciotomy
Routine x-rays for heel pain of no value
Clinical Trial on Low Dye Taping
Persistent heel pain
Effectiveness of Foot Orthoses to Treat Plantar Fasciitis
Night splints for plantar fasciitis
'Inflammatory' vs 'mechanical' plantar fasciitis
Pathomechanics of plantar fasciitis
Plantar Fasciitis Paradigms
Injection therapy for heel pain
Plantar fascia stretching exercise for plantar fasciitis
Foot Orthoses Effective in Plantar Fasciitis Treatment
Heel pain: Biomehanical and sensory differences
Does anyone have a problem with this heel pain article?
Counterstrain technique for plantar fasciitis
Megavoltage irradiation for heel spurs
A cure for plantar fasciitis? Dream on
NSAID's and plantar fasciitis
Work shoes and plantar fasciitis
Obesity and pronated foot type may increase the risk of chronic plantar heel pain
Plantar fascia thickness and pain
Cryosurgery and plantar fasciitis
Gastroc recession cured 93.6% of chronic plantar fasciitis
Heel Spur vs. Plantar Fasciitis: Patient Education
High heel shoes and plantar fasciitis
Diagnosis for all heel pain "plantar fasciitis"?
Plantar heel pain and Flexor Hallcis Longus dysfunction
Unresponsive Heel Spur Syndrome/ Plantar Fasciitis

Last edited by Admin : 7th January 2008 at 07:28 PM.
Reply With Quote
Sponsored Links
  #2  
Old 26th October 2006, 05:48 PM
njw podski njw podski is offline
Member
 
About:
Join Date: Jul 2006
Posts: 4
Join Date: Jul 2006
Marketplace reputation 0% (0)
Thanks: 0
Thanked 0 Times in 0 Posts
Default

Hi all,

had an interesting conversation with a group of medicos a few days ago re: Plantar Fasciitis. The approach that several of them took was that the Plantar fascia is an area of vascular compromise, similar to the rotator cough in the shoulder. Therefore, plantar heel pain is viewed as an impaired healing process, micro tears don't heal because of poor vascularity. This line of thinking is familiar to me, and appears to be an approach taken with many enthesopathies.

However, what I haven't come accross before is the use of nitrolingual spray, or the gel form of same, applied to the plantar heel to increase local blood flow and encourage healing of micro tears.

Greatly interested in anybodies take on this.

Nathan
Reply With Quote
  #3  
Old 13th November 2006, 12:00 PM
DrGillman DrGillman is offline
Member
 
About:
Join Date: Nov 2006
Location: Massachusetts, USA
Posts: 10
Join Date: Nov 2006
Marketplace reputation 0% (0)
Thanks: 0
Thanked 1 Time in 1 Post
Default

Take a look at Graston Technique: www.grastontechnique.com It is a means to non-surgically debride, stimulate tendons, and strip through fascia. It has been an excellent soft tissue method and has worked fairly well with plantar fascitis.

Scott
Reply With Quote
  #4  
Old 13th November 2006, 09:56 PM
Andrew van Essen Andrew van Essen is offline
Member
 
About:
Join Date: Jun 2005
Posts: 4
Join Date: Jun 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 1 Time in 1 Post
Default

Please see attached transcrit from the ABC Helath reportYesterday on Plantar Fasciitis

Regards

Andrew van Essen

13 November 2006
Heel pain treatment
Listen Now - 13112006 | Download Audio - 13112006

Proximal plantar fasciitis is the most common cause of heel pain. Researchers in the U.S. suggest that a new plantar fascia-specific stretching exercise is proving quite effective to help treat and potentially cure plantar fasciitis.

Show Transcript |
Hide Transcript

Transcript
This transcript was typed from a recording of the program. The ABC cannot guarantee its complete accuracy because of the possibility of mishearing and occasional difficulty in identifying speakers.

Norman Swan: Welcome to the program. This morning on the Health Report identifying people with whiplash injury who'll go on to have long term problems and it doesn't have much to do with compensation arguments; using stem cells to help children with brain injuries and a common problem which may be frequently misdiagnosed and ineffectively treated.


It's heel pain and if you, or someone you know has had it, you'll be well aware that it can be very painful and the treatments can be too. One cause of heel pain is a condition called plantar fasciitis and an orthopaedic surgeon in the United States has found what he thinks is a simple, non-surgical treatment which works. It's a special stretch.


Ben DiGiovanni is an Associate Professor of Orthopaedic Surgery at the University of Rochester School of Medicine in New York.


Ben DiGiovanni: The classic symptom is the first step in the morning pain, that's the key information when a patient stands in the morning and has severe heel pain, there's a high chance it's going to be plantar fasciitis.


Norman Swan: So it's not in the middle of the foot, it's actually at the heel?


Ben DiGiovanni: Exactly, right at the base of the heel pad on the bottom aspect, it's not that arch discomfort but it's that pain in the heel right at the base there.


Norman Swan: And what's causing the pain?


Ben DiGiovanni: The patient will not recall a significant injury, it's more they do something that's just a little bit more than they're used to doing. They may run hills instead of running on flat surfaces or they may do a lot of standing and walking at a Mall around holiday time because it's very, very common during the holiday season here in the States. What happens is they get a small tear, a micro tearing of the origin of that structure the planta fascia, which is a connective tissue that supports the arch. A small tear and have some discomfort but not terrible then they get off their feet and they sleep at night and the body tries to heel that in a contracted position. And then they take that first step in the morning and they cause further micro tearing and that's what the pain with the first step in the morning is.


Norman Swan: And the plantar fascia if I remember my second year anatomy stretches from the heel right to the front of the foot?


Ben DiGiovanni: That's correct and it inserts on all the toes so it originates at the heel bone, goes and inserts on all five toes so when you take that first step and you kind of lean forward on your toes that's stretching that structure.


Norman Swan: And it's basically keeping your foot in place?


Ben DiGiovanni: Exactly, supporting the arch.


Norman Swan: And is there any relationship to the heel spur in terms of plantar fasciitis?


Ben DiGiovanni: That's a great question and typically it gets called a heel spur syndrome, those kind of names and we used to think it was the heel spur that was causing the problem but we've learned actually that that structure, the plantar fascia in an MRI, it's really not directly associated with the heel spur. It's more superficial to that structure so it's really not the heel spur that's causing the problem, it's more that micro tearing of the plantar fascia.


Norman Swan: Now people have told me who've had plantar fasciitis that it is incredibly painful and it's not just the first step in the morning, it can go throughout the day.


Ben DiGiovanni: Right, and usually it's most commonly when they've been off their feet for a while, they've been in the car, have driven for a distance, or they've sat for lunch and they're going to take that first step. Usually it's after inactivity and then when they start to walk again they get the pain. Now when it becomes more of a chronic problem it's going on for months, typically they start to have pain when they're standing and at the end of the day it becomes worse so it's kind of a build up of symptoms that occurs.


Norman Swan: And in the past thinking it's been a heel spur people have, I mean my eyes water just thinking about, have injected it with steroids to try and sort it out.


Ben DiGiovanni: Right, steroids are one way of treating it but I've been away from steroids because there are two main problems with it. No. 1 is it can cause what's called fat pad atrophy, loss of the fat pad on the bottom of the foot, and you really need that. So I think that's a pretty significant disadvantage. And the other thing is it can weaken that structure and give you some temporary relief where you continue to walk through it, you kind of mask the symptoms. Sometimes it can lead to rupture of the plantar fascia.


Norman Swan: So where did you get the idea for stretching being the solution?


Ben DiGiovanni: Well you know it's one of those things that the Achilles tendon stretch has been a kind of tried and true way of approaching it and there's thought to be a connection between the Achilles tendon being tight and then having plantar fasciitis. And I think there is actually a connection but the problem is when I looked at things I kind of said well why are we stretching the Achilles tendon when the problem's the plantar fascia.


Norman Swan: Just to explain here people would give you an Achilles tendon stretch like standing on a step with your heels going down or angling your foot against the wall hoping to stretch the whole foot structure.


Ben DiGiovanni: Exactly right, so against the wall, or the heel hang right off the step is the classic and I found a lot of patients were having months and months of pain and it's not uncommon. I'm an orthopaedic surgeon as a foot and ankle specialist and it's one of the things that from the literature and my experience before I started doing this new stretch and you tell them well it's probably going to take nine or ten months for this to go away. And that's just way too long for something that's so painful so I wanted to get a better handle on it and I thought well, you know, let's target the plantar fascia better and based on knowing the anatomy and some other stretching protocols I'd done for different parts of the body I thought let's recreate this stretch to better target the plantar fascia by pulling up on the toes and pulling up on the ankle before you take that first step in the morning or prior to being active after inactivity.


Norman Swan: So tell us you know, I'm your patient, tell me what to do with this stretch.


Ben DiGiovanni: Well the key thing is before that first step in the morning or any time you've been less active and you you're going to stand up and have that sharp ouchy pain, what you want to do is, and the way I instruct them to do it is to cross their legs kind of like a guy does. So if it's your right foot you put that right foot and ankle over your left knee and then what you want to do is with your right hand, if it's your right foot, you pull up on your toes - you grab just the toes, not the ball of the foot, grab those toes and pull it up towards your shin and towards your knee. And what that does is that you've got the toes pointed up and that ankle pointed up and with the other hand you feel the structure in the bottom of your foot in your mid arch area and that's the plantar fascia. It'll feel like a firm nice tight guitar string, typically if you have a good stretch. That left hand, the opposite hand, kind of feel that area making sure it feels nice and firm like a guitar string. And what I actually ask patients to do then is to kind of let go of the foot and the ankle and then while the leg is crossed to feel for that structure, you can't feel it anymore. And then I have them again pull up on those toes, point it towards the shin and the knee, using the other hand to make sure it feels nice and firm like a guitar string and then you hold it there for a count of 10 and then you kind of let it go, let the foot relax, pull up on it again, hold it for a count of 10 and do that ten times before you take that first step in the morning, or any time you've been less active, and you're going to take that step and have that sharp ouchy pain, do the stretch again.


Norman Swan: And how many times during a day?


Ben DiGiovanni: The study was three times a day. Most patients in clinical practice they will usually do it about 5 to 6 times a day.


Norman Swan: So you did a randomised trial comparing Achilles tendon stretches to this plantar stretch, what did you find?


Ben DiGiovanni: Well it was really some surprising and really encouraging information. We followed patients up initially at 8 weeks to see how they were doing and what you need to remember actually is we took the worst of the worst. So these patients had to have chronic heel pain of at least 9 months duration. What we wanted to do is avoid studying those people where we thought they were going to get better just with time. So these patients were the worst of the worst, had this chronic heel pain, they'd tried all kinds of other things, injections, inserts, night splints, all kinds of stuff. What we found is that at 8 weeks when you compared the plantar fascia stretch group with the Achilles tendon stretch group there was a dramatic improvement and it was significant statistically in favour of the plantar fascia group in terms of pain, resolution, decreased inactivity limitations, and satisfaction.


And then that was a study that we published in 2003 in The Journal of Bone and Joint Surgery and then what we just published in August of 2006 in The Journal of Bone and Joint Surgery we presented the two year follow up on these patients,. And the results were very encouraging and it looks like they've maintained their improvement for the two years duration, the ones that improved and 90% had improved and were very satisfied. And what was really encouraging is we found about 75% of patients had no pain, no activity limitations and the best part is is after they were taught this stretching protocol is they really didn't need to see another physician or another physical therapist. And a vast majority of them had seen multiple people before starting this stretch.


Norman Swan: I notice in your research in the paper you say there were no significant differences between the groups at 2 years. Does that mean the differences didn't change, in other words there was still a gap, or they merged because the group that had Achilles tendon stretches had got better of their own accord?


Ben DiGiovanni: Well what we did is at the 8 weeks is that we did a cross over to the study. So basically the patients who had the Achilles tendon stretch we said ah, now we're going to teach you the trick, we're going to teach you the plantar fascia test.


Norman Swan: Which is the only ethical thing to do.


Ben DiGiovanni: Exactly, and so at that point we taught them the stretch and what was really interesting is you saw the disparity between the two groups go away and the Achilles tendon stretch group, once they were called the plantar fascia stretch group they behaved like the original plantar fascia stretch group.


Norman Swan: Did you find out what happened if they stopped the stretch, because presumably not everybody stuck to the program?


Ben DiGiovanni: The did it for 8 weeks when they were instructed to do it and then they did it as needed. So if they started to feel a little bit of discomfort they would do the stretch again and it wasn't a big deal cause they got a good handle on it right off the bat. And most of them did not have a recurrence of their symptoms but if they did they did the stretch and they quickly were improved again.


Norman Swan: I mean the advantage in this is that you don't need any sort of long term physiotherapy, this is really quite cheap.


Ben DiGiovanni: You know that's what's really, really encouraging.


Norman Swan: You're doing all these colleagues of yours out of business.


Ben DiGiovanni: Well I'm an orthopaedic surgeon, I love to operate and that's what I do but you know we do learn, I've got enough grey hair now, we learn there are certain things where surgery's not the answer. And when you look at plantar fasciitis it's really only about 50% of patients after surgery who have complete resolution of pain, complete resolution of activity limitations and are satisfied. So we've come up with something we think is superior to surgery and surgery really is not the answer unless you exhaust these other things.


Norman Swan: Now in evidence-based medicine, they talk about a particular statistic called number needed to treat. In other words not everybody will benefit from a treatment even though the treatment is effective and when you're actually talking to patients about whether or not they're going to get benefit they say look 20 people have got to have this cholesterol lowering drug for one person's heart attack to be saved. Or 12 people have got to have their prostate out for one man's life to be saved from prostate cancer. Did you get any sense of how many people needed to have the plantar stretch for one to benefit?


Ben DiGiovanni: Well you know with the randomised proto study we had 50 in each group and our statisticians thought that was a good number to evaluate for a statistical difference. What we did find is that if the stretch is going to be successful it was usually going to happen within the first 6 months and this is at the 2 year follow up. So you know the patients who did not improve, if they were not improving at 6 months it wasn't go to work.


Norman Swan: And did you get a sense of what percentage it didn't have much affect on?


Ben DiGiovanni: It was less than 10%.


Norman Swan: You just mentioned earlier that you've done a fair bit of work on stretching in general. It's had a bit of a bad press stretching, it doesn't seem from randomised trial evidence to affect muscle soreness and people have questioned whether it affects injury rates and so on. What work have you done on stretching to suggest there might be benefits in other areas?


Ben DiGiovanni: Well it's more my clinical sense. Let's say someone has a hamstring injury and they've pulled their hamstring. It's pretty much agreed upon that you need to stretch out your hamstring before you walk briskly or would run, otherwise you're going to have recurrent hamstring injuries.


Norman Swan: But has that been tested?


Ben DiGiovanni: I've seen information, not the best evidence based studies, but it certainly is something that most trainers and physical therapists in this country would agree upon. I often see it in myself too as I get older, if I don't stretch and prepare myself I have injury and have problems. So I personally really very much believe in stretching protocols even though I'm a surgeon and the physical therapist who were a big part of this study have also experienced the same thing.


Norman Swan: Associate Professor Ben DiGiovanni is at the University of Rochester School of Medicine in New York. And this is the Health Report here on ABC Radio National.



References:


DiGiovanni BF et al. Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis. The Journal of Bone and Joint Surgery, 2006;88(8):1775-1781


DiGiovanni BF et al. Tissue-Specific Plantar Fascia Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain. The Journal of Bone and Joint Surgery, 2003;85(7):1270-1277

Guests
Dr Ben DiGiovanni
Associate Professor of Orthopaedic Surgery
University of Rochester
School of Medicine
Department of Orthopaedics
601 Elmwood Avenue, Box 665
Rochester, NY 14642


Presenter
Norman Swan

Producer
Brigitte Seega
Reply With Quote
The Following User Says Thank You to Andrew van Essen For This Useful Post:
AVG (23rd August 2008)
  #5  
Old 16th January 2007, 04:01 AM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Dear All

I have read wit interest Dr Swann;s talk with Dr DiGionnovani.

In one breath he says it is due to micro tears in the plantar fascia, and in the next he tells you to stretch it....?


Where is the sense.Any explainers?

Musmed.com.au
Reply With Quote
  #6  
Old 26th February 2007, 11:12 AM
Charlotte Darbyshire's Avatar
Charlotte Darbyshire Charlotte Darbyshire is offline
Senior Member
 
About:
Join Date: Jan 2006
Posts: 31
Join Date: Jan 2006
Marketplace reputation 0% (0)
Thanks: 0
Thanked 1 Time in 1 Post
Smile Re: Plantar Fasciitis Discussions

Hi
Just a quick question is there any information held advocating steriod injection therapy as a first line treatment for plantar fascial heel pain syndrome. Or is it secondary to other conservative approaches such as stretching massage strapping orthotic provision
NICE guidelines perhaps???
as many replies would be grateful
many thanks
Charlotte :)
Reply With Quote
  #7  
Old 12th March 2007, 02:25 AM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Dear Charlotte

Sorry for not replying sooner.

Your question is a good one indeed.

If you were a sports person and went to some clinics I know of, they would inject it and then tell you to jump up and down until it tore and then it does not hurt anymore. TRUE

As no-one knows what is happening why stick steroid into it. For all I know just water will work just as well.

The reason I say this is that the prolotherapy studies performed by Dr. Michael Yelland from the University of Queensland has followed up over 120 people with chronic low back pain for over 2 years.

He found that those who had the magic glucose and L/A did a teeny weenie bit better than those who had L/A and water.

It was a totally double blinded study to the extreme. I ahve spoken to him on several occassions about it all.

It seems that no matter how you treat pain at 2 years: 20% are cured: 50% are 50% better and the rest no change.

I have been collecting data on treatment of pain for many different conditions. These include treatrment for post heres zoster in the elderly, prolotherapy, recovery programmes used in rehab in the UK for chronic back patients, the use of radiofrequency to disc tears in the lumbar region.

They all have the same outcomes.

The question is. Does anything work and should we rely upon a 20% cure rate and 50% 50%better?

I am currently conducting a large study on PF. All studies show they have the bull by the horns.

Hopefully with 1 year follow up (finishes in MArch 2008) I will be able to tell you, but so far we have had 100% success rate (except for1 who does not listen) within 18 weeks. There has been one relapse so far.

The thing I can tell you is that stretching is forbidden!

Regards

Musmed

www.musmed.com.au

Quote:
Originally Posted by Charlotte Darbyshire
Hi
Just a quick question is there any information held advocating steriod injection therapy as a first line treatment for plantar fascial heel pain syndrome. Or is it secondary to other conservative approaches such as stretching massage strapping orthotic provision
NICE guidelines perhaps???
as many replies would be grateful
many thanks
Charlotte :)
Reply With Quote
  #8  
Old 12th March 2007, 05:25 AM
Charlotte Darbyshire's Avatar
Charlotte Darbyshire Charlotte Darbyshire is offline
Senior Member
 
About:
Join Date: Jan 2006
Posts: 31
Join Date: Jan 2006
Marketplace reputation 0% (0)
Thanks: 0
Thanked 1 Time in 1 Post
Default Re: Plantar Fasciitis Discussions

Thanks for your reply
Interesting reading. lots of literature seems to advocate stretching as a conservative treatment modality of choice.
do you have references against this??? my msc dissertation is based around this therapy and would be great to know your thoughts
thanks charlotte :)
Reply With Quote
  #9  
Old 12th March 2007, 01:32 PM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Dear Charlotte

I know stretching is the mainstay of therapy. It seems that it is all one has to offer.

When you read what's out there the overall cure rate is poor and it seems to take an eon at that.

Just ask your patients about strtching. Almost all will tell you it hurts and makes matters worse and they stop doing it although they will tell you they are doing it.

This is a question I am asking in my study. Interesting results I can assure you.

As I posted somewhere else on this forum. If the problem is microtears, why stretch it.

I ask you this. If you have a crack in the corner of your mouth (read microtear) do you get out and stretch it?

Remember, periosteum has more nerve fibres than any other major structure.

musmed
www.musmed.com.au

Quote:
Originally Posted by Charlotte Darbyshire
Thanks for your reply
Interesting reading. lots of literature seems to advocate stretching as a conservative treatment modality of choice.
do you have references against this??? my msc dissertation is based around this therapy and would be great to know your thoughts
thanks charlotte :)
Reply With Quote
The Following User Says Thank You to musmed For This Useful Post:
AVG (23rd August 2008)
  #10  
Old 4th February 2008, 08:19 PM
DawnPT DawnPT is offline
Member
 
About:
Join Date: Jan 2008
Posts: 20
Join Date: Jan 2008
Marketplace reputation 0% (0)
Thanks: 0
Thanked 4 Times in 2 Posts
Default Re: Plantar Fasciitis Discussions

What works in therapy? I've seen a wide variety of patients with this problem (and even got some firsthand experience). It seems like they all respond different to treatment, which must mean that the cause of the plantar fascitis is not always the same.

I actually never thought about it- if it was caused by micro-tears, why do we do major stretches? I have seen some people not tolerating that, so there may be an answer in itself.

I've found the most effective stretches are just done with a tennis ball rolled under your foot. You can put as much pressure as you want through the ball, so it's done to pain tolerance. Plus you don't have to worry about the exact position of your calcaneus during the stretch.

I have used kinesiotaping to help support the posterior tibialis tendon- that seems to help with pain relief while the tape is on. Taking it off is a different story. They make a special plantar fascitis "brace" that can assist with support. I like getting a good shoe orthotic (plastic base, foam on top, highly supportive arch) if there is overpronation.

I've also used ultrasound and even phonophoresis....is this proven to help?

And why does it take up to 6 months before you are "cured"?

Does anyone know if Anodyne therapy would work if it was caused by vascular compromise? Are there any research studies based on that?

Now I'm going to doubt what I've been taught, which is probably a good thing, but I seem to have more questions than when I started.
Reply With Quote
  #11  
Old 5th February 2008, 04:54 AM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by DawnPT View Post
What works in therapy? I've seen a wide variety of patients with this problem (and even got some firsthand experience). It seems like they all respond different to treatment, which must mean that the cause of the plantar fascitis is not always the same.

I actually never thought about it- if it was caused by micro-tears, why do we do major stretches? I have seen some people not tolerating that, so there may be an answer in itself.

I've found the most effective stretches are just done with a tennis ball rolled under your foot. You can put as much pressure as you want through the ball, so it's done to pain tolerance. Plus you don't have to worry about the exact position of your calcaneus during the stretch.

I have used kinesiotaping to help support the posterior tibialis tendon- that seems to help with pain relief while the tape is on. Taking it off is a different story. They make a special plantar fascitis "brace" that can assist with support. I like getting a good shoe orthotic (plastic base, foam on top, highly supportive arch) if there is overpronation.

I've also used ultrasound and even phonophoresis....is this proven to help?

And why does it take up to 6 months before you are "cured"?

Does anyone know if Anodyne therapy would work if it was caused by vascular compromise? Are there any research studies based on that?

Now I'm going to doubt what I've been taught, which is probably a good thing, but I seem to have more questions than when I started.
Dear Dawn

Maybe your name is the light in this issue.

I like in general what you have written, but I await the 'heavies' to put you down.

Then I will come to your rescue.

Hold tight

Paul C.
PS.is rolling a ball under one's foot stretching anything outside of ones imagination?
pps.I am on your side
Reply With Quote
  #12  
Old 5th February 2008, 10:35 AM
christian00 christian00 is offline
A Welcome New Poster
 
About:
Join Date: Feb 2007
Posts: 1
Join Date: Feb 2007
Marketplace reputation 0% (0)
Thanks: 0
Thanked 0 Times in 0 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Maybe your name is the light in this issue.
Agreed

Quote:
but I await the 'heavies' to put you down
Looking forward to this.
Reply With Quote
  #13  
Old 5th February 2008, 04:31 PM
Craig Payne's Avatar
Craig Payne Craig Payne is offline
Moderator
Professor of Life, The Universe and Everything
 
About:
Join Date: Aug 2004
Location: Melbourne, Australia
Posts: 4,789
Join Date: Aug 2004
Marketplace reputation 0% (0)
Thanks: 88
Thanked 808 Times in 558 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by DawnPT View Post
I actually never thought about it- if it was caused by micro-tears, why do we do major stretches? I have seen some people not tolerating that, so there may be an answer in itself.
Quote:
Originally Posted by musmed View Post
I like in general what you have written, but I await the 'heavies' to put you down.
Quote:
Originally Posted by christian00 View Post
Looking forward to this.
Stretching works, thats why its used:
Plantar fascia stretching exercise for plantar fasciitis
__________________
Craig Payne
__________________________________________________ ___________________________________
Follow me on Twitter | Run Junkie | Latest Blog Post: Review of Lieberman et al’s (2010) paper in Nature on Barefoot Running
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
Reply With Quote
  #14  
Old 5th February 2008, 05:21 PM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,365
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 386
Thanked 2,081 Times in 1,146 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by musmed View Post
Dear Dawn

Maybe your name is the light in this issue.

I like in general what you have written, but I await the 'heavies' to put you down.

Then I will come to your rescue.

Hold tight
Ah, the images of Paul riding a white charger coming to the rescue of a lady in distress being attacked by the "heavies".........haven't I seen that in the movies somewhere before??
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
  #15  
Old 6th February 2008, 03:48 PM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by Craig Payne View Post
Stretching works, thats why its used:
Plantar fascia stretching exercise for plantar fasciitis
Craig

If stretching works why do patients tell me it has made them worse?. I get paid by them coming back. Pirvate practice and government run business are different things.
Do you follow up those who do not come back?

If stretching works,how?

I get back to what I have said many a time, if it is microtears why stretch a tear?

Could there a mis diagnosis?
Could there be other factors present that I have written about. Yes if it is a FLH pain due to a short FLH muscle, yes stretching works because it has nothing to do with the PF.THis is a very common problem.

The other major problem is a stuck cuboid. Maybe the stretching corrects the subluxation.

Finally even Dr.Dananberg agree with me that most PF pain is coming from trigger pointsin the Abd. hallucis.

So stretching again works, but the problem is it is not Plantar Fasciitis.

As I have taught in many countires around the world, there is an endemic problem with podiatrists in general, they do not know their surface anatomy. Thus if you cannot palpate you cannot diagnose, but they do.

Regards

Paul C
Reply With Quote
  #16  
Old 6th February 2008, 03:51 PM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by Kevin Kirby View Post
Ah, the images of Paul riding a white charger coming to the rescue of a lady in distress being attacked by the "heavies".........haven't I seen that in the movies somewhere before??
Kev

Thanks for posting Romulus and Remus.
Reply With Quote
  #17  
Old 6th February 2008, 09:21 PM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,365
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 386
Thanked 2,081 Times in 1,146 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by musmed View Post
Kev

Thanks for posting Romulus and Remus.
Paul:

Sorry, the pigs are the winged clones of Arnold Ziffel, my favorite actor from my younger days.
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
  #18  
Old 7th February 2008, 02:21 PM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,365
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 386
Thanked 2,081 Times in 1,146 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by DawnPT View Post
What works in therapy? I've seen a wide variety of patients with this problem (and even got some firsthand experience). It seems like they all respond different to treatment, which must mean that the cause of the plantar fasciitis is not always the same.
Dawn, I assume that I may be one of the "heavies" that Paul (Musmed) described to you. Even though I am 5' 10" and about 168 lbs, I am certainly heavier than my college distance running days when I was the "70 kg man". I think your questions are excellent, and hopefully Paul won't need to ride in with his white charger to save you from me.

"Plantar fasciitis" as we currently call it, is probably not just one diagnosis, but several diagnoses. Certainly, even though the pain in "plantar fasciitis" is generally in or directly adjacent to the central component of the plantar aponeurosis (the correct anatomical name for the "plantar fascia"), it may be caused by different forces. For example, "distal plantar fasciitis", where the pain is only within the longitudinal arch of the foot, is nearly always caused by increased magnitudes of plantar fascial tensile force. But in "proximal plantar fasciitis", where the pain is plantar to the medial calcaneal tubercle (the origin of the central component of the plantar aponeurosis), the pain may be caused both by an increased magnitude of compression force from the plantar heel hitting the ground too hard and/or an increased magnitude of tensile force within the plantar fascia.

The problem is that when a patients presents to us with plantar heel pain and we tentatively make a diagnosis of proximal plantar fasciitis, we may not know if the injury was initially caused by compression forces on the plantar heel (e.g. walking barefoot on a tile or hardwood floor at home, plantar fat pad atrophy that decreases the natural cushioning force on the plantar calcaneus) or by a tensile force that is causing a traction injury to the plantar fascial origin site on the plantar calcaneus. This variable biomechanical etiology of what we call "plantar fasciitis" may directly influence our ability to get these patients all better and how these patients respond to various treatments.

Quote:
Originally Posted by Dawn
I actually never thought about it- if it was caused by micro-tears, why do we do major stretches? I have seen some people not tolerating that, so there may be an answer in itself.
I have had very good clinical results in treating most cases of plantar fasciitis by having my patients do 3 minutes of gastrocnemius and soleus stretching exercises three times a day. I rarely have patients "not tolerating" the stretches, so maybe you are doing these stretches differently than I am. How do you have patients stretch, specifically??

The theory behind the stretches is to try and lengthen the gastrocnemius-soleus-Achilles tendon (GSAT) complex so that the tensile forces within the plantar fascia are decreased during weightbearing activities. There are very good cadaver research studies that show that there is a direct correlation between Achilles tendon tensile force and plantar fascial tensile force. Therefore, if we can lower the tensile force in the GSAT and plantar fascia, and if we are trying to allow the plantar fascia to heal from a microtear while they are continuing to perform their daily activities, GSAT stretching makes good clinical sense to me. Even better, as Craig said, it works!

Quote:
Originally Posted by Dawn
I've found the most effective stretches are just done with a tennis ball rolled under your foot. You can put as much pressure as you want through the ball, so it's done to pain tolerance. Plus you don't have to worry about the exact position of your calcaneus during the stretch.

I have used kinesiotaping to help support the posterior tibialis tendon- that seems to help with pain relief while the tape is on. Taking it off is a different story. They make a special plantar fasciitis "brace" that can assist with support. I like getting a good shoe orthotic (plastic base, foam on top, highly supportive arch) if there is overpronation.

I've also used ultrasound and even phonophoresis....is this proven to help?

And why does it take up to 6 months before you are "cured"?

Does anyone know if Anodyne therapy would work if it was caused by vascular compromise? Are there any research studies based on that?

Now I'm going to doubt what I've been taught, which is probably a good thing, but I seem to have more questions than when I started.
Direct manual stretching of the plantar fascia (e.g. ball rolling or bottle rolling plantarly) does seem to work in some patients as do plantar fasciitis night splints, plantar strapping, over the counter and prescription foot orthoses, and therapeutic modalities such as ultrasound and phonophoresis. I have used extra-corporal shockwave therapy with mixed results and even had a patient that claimed that laser heat therapy helped her chronic plantar fasciitis.

As far as I'm concerned, we are still in our infancy in understanding all the diagnoses that make up what we currently lump into a single diagnosis of "plantar fasciitis". However, most skilled podiatrists seem to get about 90% of these cases healed within 1-6 months with the above conservative treatment options, without surgical treatment.

Hope this helps.
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
The Following User Says Thank You to Kevin Kirby For This Useful Post:
Robertisaacs (19th February 2008)
  #19  
Old 7th February 2008, 04:47 PM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by Kevin Kirby View Post
Dawn, I assume that I may be one of the "heavies" that Paul (Musmed) described to you. Even though I am 5' 10" and about 168 lbs, I am certainly heavier than my college distance running days when I was the "70 kg man". I think your questions are excellent, and hopefully Paul won't need to ride in with his white charger to save you from me.

"Plantar fasciitis" as we currently call it, is probably not just one diagnosis, but several diagnoses. Certainly, even though the pain in "plantar fasciitis" is generally in or directly adjacent to the central component of the plantar aponeurosis (the correct anatomical name for the "plantar fascia"), it may be caused by different forces. For example, "distal plantar fasciitis", where the pain is only within the longitudinal arch of the foot, is nearly always caused by increased magnitudes of plantar fascial tensile force. But in "proximal plantar fasciitis", where the pain is plantar to the medial calcaneal tubercle (the origin of the central component of the plantar aponeurosis), the pain may be caused both by an increased magnitude of compression force from the plantar heel hitting the ground too hard and/or an increased magnitude of tensile force within the plantar fascia.

The problem is that when a patients presents to us with plantar heel pain and we tentatively make a diagnosis of proximal plantar fasciitis, we may not know if the injury was initially caused by compression forces on the plantar heel (e.g. walking barefoot on a tile or hardwood floor at home, plantar fat pad atrophy that decreases the natural cushioning force on the plantar calcaneus) or by a tensile force that is causing a traction injury to the plantar fascial origin site on the plantar calcaneus. This variable biomechanical etiology of what we call "plantar fasciitis" may directly influence our ability to get these patients all better and how these patients respond to various treatments.



I have had very good clinical results in treating most cases of plantar fasciitis by having my patients do 3 minutes of gastrocnemius and soleus stretching exercises three times a day. I rarely have patients "not tolerating" the stretches, so maybe you are doing these stretches differently than I am. How do you have patients stretch, specifically??

The theory behind the stretches is to try and lengthen the gastrocnemius-soleus-Achilles tendon (GSAT) complex so that the tensile forces within the plantar fascia are decreased during weightbearing activities. There are very good cadaver research studies that show that there is a direct correlation between Achilles tendon tensile force and plantar fascial tensile force. Therefore, if we can lower the tensile force in the GSAT and plantar fascia, and if we are trying to allow the plantar fascia to heal from a microtear while they are continuing to perform their daily activities, GSAT stretching makes good clinical sense to me. Even better, as Craig said, it works!



Direct manual stretching of the plantar fascia (e.g. ball rolling or bottle rolling plantarly) does seem to work in some patients as do plantar fasciitis night splints, plantar strapping, over the counter and prescription foot orthoses, and therapeutic modalities such as ultrasound and phonophoresis. I have used extra-corporal shockwave therapy with mixed results and even had a patient that claimed that laser heat therapy helped her chronic plantar fasciitis.

As far as I'm concerned, we are still in our infancy in understanding all the diagnoses that make up what we currently lump into a single diagnosis of "plantar fasciitis". However, most skilled podiatrists seem to get about 90% of these cases healed within 1-6 months with the above conservative treatment options, without surgical treatment.

Hope this helps.
Kevin

Stretching appears to be in the mind here.

If there is no ROM to the ankle joint you aint ever going to stretch the joint.

You all have the bull by the tail.

A muscles role is to protect the joint, nothing else. Simple. Why do they all act as eccentric loaders? Joint protection

Thus if the joint no move muscles no move!

Ask any athlete who stretches his calf and hammy muscles for 30-60 minutes a day and then the next morning they have shortened again.

Simple they match the ROM of the joint.

So mobilisation or manipulation (worth trying before putting down) changes the ROM and muscles lenghten immediately.

Ankle ROM mobes/manip ccan increase hamstring lenght from the usual 40 (athlete) to an easy 80+ degrees. Done it 1000's of time.

You mention that there may be other causes of PF yet when you read what you wrote I did not see anything outside of the PF.


Craig said it works even better...tut tut.

We had a prime minister who told us we needed a banana republic and interest rates went to 17%.

Can't wait, they now are at 9.05% this morning!
Regards
Paul C
PS my horse is happy to meet your pigs anywhere.
Reply With Quote
  #20  
Old 8th February 2008, 01:41 AM
DSP DSP is offline
Senior Member
 
About:
Join Date: Jan 2008
Posts: 68
Join Date: Jan 2008
Marketplace reputation 0% (0)
Thanks: 1
Thanked 6 Times in 6 Posts
Default Re: Plantar Fasciitis Discussions

Hi Paul,

Quote:
Originally Posted by musmed View Post
If there is no ROM to the ankle joint you aint ever going to stretch the joint.

Paul, I don’t think Kevin implied that it was his goal to “stretch” the ankle joint. He was specifically referring to gastrocnemius-soleus-achilles tendon (GSAT) complex . Is there even such a thing as “stretching” the joint? I thought the whole idea of stretching was to stretch the muscle? Please correct if I am wrong.

If there are micro-tears in the plantar fascia (PF), I can see why PF stretches are possibly detrimental, but why would GSAT stretches be a disadvantage? Wouldn’t these actually be beneficial (in some people)?

Quote:
Originally Posted by musmed View Post
So mobilisation or manipulation (worth trying before putting down) changes the ROM and muscles lenghten immediately.

Paul, could you please explain your technique/s as to how you mobilize and manipulate the ankle joint? I would find it very helpful as I have never applied these techniques before.

Regards,

Daniel
Reply With Quote
  #21  
Old 8th February 2008, 02:23 AM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by DSP View Post
Hi Paul,




Paul, I don’t think Kevin implied that it was his goal to “stretch” the ankle joint. He was specifically referring to gastrocnemius-soleus-achilles tendon (GSAT) complex . Is there even such a thing as “stretching” the joint? I thought the whole idea of stretching was to stretch the muscle? Please correct if I am wrong.

If there are micro-tears in the plantar fascia (PF), I can see why PF stretches are possibly detrimental, but why would GSAT stretches be a disadvantage? Wouldn’t these actually be beneficial (in some people)?




Paul, could you please explain your technique/s as to how you mobilize and manipulate the ankle joint? I would find it very helpful as I have never applied these techniques before.

Regards,

Daniel
Daniel

AS to how to mobilise the joints of the foot and ankle it requires an attendance at a workshop. It is impossible to just read something I have typed in and apply it. I wish it was that simple.

As regards to stretching. Just spend a minute thinking about what you wrote. It is impossible to only stretch a muscle without placing a joint or joints on stretch. If the joint does not have the ROM to allow the muscle to lengthen then how can a simple stretch work. If the joint has the ROM but the muscles does not, then there is something wrong with the muscle and you need to address the muscle.

Finally, you cannot stretch the Achilles tendon. May I suggest you look at graphs of creep and tendon stress strain curves.

Basically once you stretch a tendon more than 5 degree it loses it strength and the tendon will follow to failure.

I doubt any of us can apply enough tension to stretch the Achilles tendon under normal stretching conditions.

Hope this helps

Paul C
Reply With Quote
  #22  
Old 8th February 2008, 10:14 AM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,365
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 386
Thanked 2,081 Times in 1,146 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by musmed View Post
Finally, you cannot stretch the Achilles tendon. May I suggest you look at graphs of creep and tendon stress strain curves.
Paul:

All materials can be stretched, even the relatively compliant Achilles tendon. When you look at a stress-strain curve of an Achilles tendon under tensile load that you mention above, what do you think that the strain side of the graph represents?
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
  #23  
Old 8th February 2008, 10:49 AM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,365
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 386
Thanked 2,081 Times in 1,146 Posts
Default Re: Plantar Fasciitis Discussions

Colleagues:

Contrary to Paul's contention that the Achilles tendon can not be stretched, research has repeatedly shown that the Achilles tendon is an elastic structure, and as such is stretched repeatedly during exercise. The following study showed that the Achilles tendon contributed 38 Joules of energy back to the individual during one legged hopping by first stretching then recoiling during the hopping exercise. http://jeb.biologists.org/cgi/conten...ct/208/24/4715
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
  #24  
Old 8th February 2008, 03:55 PM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by Kevin Kirby View Post
Paul:

All materials can be stretched, even the relatively compliant Achilles tendon. When you look at a stress-strain curve of an Achilles tendon under tensile load that you mention above, what do you think that the strain side of the graph represents?
Kevin

Lets be truthful here.

Do you really think that by stretching the Achilles by 1-2% is going to make any difference to the overall change in the complexes length?

Also, if the tendon is normal, I thought the graphs show that the creep you have put into the tendon should disappear. I thought that's what tendons do.

Once you go to far and develop irreversible plastic deformity, you have non return to normal and pathology starts.

Regards
Paul C
PS this has nothing to do with achilles tendinitis and rupture.
Reply With Quote
  #25  
Old 8th February 2008, 07:28 PM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,365
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 386
Thanked 2,081 Times in 1,146 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by musmed View Post
Kevin

Lets be truthful here.
Paul:

What is this statement implying?? Does your statement mean that what you say must be the truth, because you said it, and what I say, since I am disagreeing with you, must not be the truth? Please explain.
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
  #26  
Old 8th February 2008, 07:31 PM
DSP DSP is offline
Senior Member
 
About:
Join Date: Jan 2008
Posts: 68
Join Date: Jan 2008
Marketplace reputation 0% (0)
Thanks: 1
Thanked 6 Times in 6 Posts
Default Re: Plantar Fasciitis Discussions

Paul,

It seems to me, that you think that just about everyone is prescribing GSAT complex stretches in pts with plantar faciitis. I don’t believe that to be true. I do not routinely prescribe GSAT complex stretches unless I suspect this muscle group to have some etiological involvement. If a tendon appears normal, then why prescribe stretches?

Cheers,

Daniel
Reply With Quote
  #27  
Old 8th February 2008, 08:33 PM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by DSP View Post
Paul,

It seems to me, that you think that just about everyone is prescribing GSAT complex stretches in pts with plantar faciitis. I don’t believe that to be true. I do not routinely prescribe GSAT complex stretches unless I suspect this muscle group to have some etiological involvement. If a tendon appears normal, then why prescribe stretches?

Cheers,

Daniel
Daniel

I have been doing a 2.5 year follow up on about 120 patients who presented to the programme with a diagnosis of PF.

One of the questions I asked on the initial question form was: Have you been told to stretch the gastroc/soleus. Over 115 were told yes.

Another question was: 'did it hurt' Guess the answer
Another question was ' did you stop' No banana for guessing the answer
but a pearler was, when asked are you still stretching by their podiatrist, guess the answer, they all answered 'yes'

One of the main stays of therapy is no stretching.

Hope this throws a penny in the works.

Regards
Paul
Reply With Quote
  #28  
Old 8th February 2008, 08:39 PM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by Kevin Kirby View Post
Paul:

What is this statement implying?? Does your statement mean that what you say must be the truth, because you said it, and what I say, since I am disagreeing with you, must not be the truth? Please explain.
Kevin

I am not saying what you aer saying is wrong but I am in reality about this.

The paper is about one legged jumping. I see people all the time moving around on one leg saying I am recoiling with 18 joules.

This is 4.3 calories of energy or 0.018Kilojoules. So close to nothing.

This is what I am implying.

Science is wonderful, but in the big picture, in this case of Achilles stored energy is basically irrelevant.

Regards
Paul

For those who do not fully understand what is going on have a look at this website.

It is a great teaching tool.

courses.washington.edu/bonephys/Gallery/biomechanics.swf
Reply With Quote
  #29  
Old 8th February 2008, 11:36 PM
DSP DSP is offline
Senior Member
 
About:
Join Date: Jan 2008
Posts: 68
Join Date: Jan 2008
Marketplace reputation 0% (0)
Thanks: 1
Thanked 6 Times in 6 Posts
Default Re: Plantar Fasciitis Discussions

Paul:

Before you get all excited, out of the 115 pts, did you test how many pts had a tight GSAT complex? For the some of them (but of course not all) there must have been a valid reason for it.

In all the pts I have prescribed GSAT complex stretches to (when appropriate), I have never once had a pt complain of soreness. I always make sure I ask too. For the 115 people that answered “yes” to “did it hurt” in your 2.5 year follow-up, obviously their technique was flawed. Consequently, this might have been a result of the practitioner misinforming the pt, or this could have been due to pts incorrectly executing the exercise.

Paul, judging by what you wrote, “but a pearler was, when asked are you still stretching by their podiatrist, guess the answer, they all answered 'yes'”, I cant help but notice that you obviously have a feeling of contempt towards “podiatrists”. Paul, just so you know, there are just as many physiotherapists, GP's, osteopaths, chiropractor's etc out there who employ stretches for PF too (no disrespect to these professions either). Open your eyes, Paul, we aren’t the only profession on earth prescribing these stretches to pts.

So if you don’t utilize stretches, I think from an educational standpoint, it would be very helpful to me and everyone following along in this thread, that you outline your treatment criteria and why? And please don’t tell me that I have to attend one of your workshops.

Daniel

Last edited by DSP : 9th February 2008 at 06:46 AM. Reason: typo
Reply With Quote
  #30  
Old 9th February 2008, 12:00 AM
musmed musmed is offline
Podiatry Arena Veteran
 
About:
Join Date: Sep 2005
Posts: 354
Join Date: Sep 2005
Marketplace reputation 0% (0)
Thanks: 0
Thanked 21 Times in 17 Posts
Default Re: Plantar Fasciitis Discussions

Quote:
Originally Posted by DSP View Post
Paul:

Before you get all excited, out of the 115 pts, did you test how many pts had a tight GSAT complex? For the some of them (but of course not all) there must have been a valid reason for it.

In all the pts I have prescribed GSAT complex stretches to (when appropriate), I have never once had a pt complain of soreness. I always make sure I ask too. For the 115 people that answered “yes” to “did it hurt” in your 2.5 year follow-up, obviously the technique they were showed and the frequency they were told to do, was incorrect. This could have either been the practitioners fault for misinforming the pt, or the pts fault, because they didn’t adhere to what they were told to do.

Paul, judging by what you wrote, “but a pearler was, when asked are you still stretching by their podiatrist, guess the answer, they all answered 'yes'”, I cant help but notice that you obviously have feeling of contempt towards “podiatrists”. Paul, just so you know, there are just as many physiotherapists, GP's, osteopaths, chiropractor's etc out there who employ stretches for PF too (no disrespect to these professions either). Open your eyes, Paul, we aren’t the only profession on earth prescribing these stretches to pts.

So if you don’t utilize stretches, I think from an educational standpoint, it would be very helpful to me and everyone following along in this thread, that you outline your treatment criteria and why? And please don’t tell me that I have to attend one of your workshops.

Daniel
Daniel

All the patients (but one) had been to podiatrists for evaluation of their foot pain. 5 had been to 6 podiatrists over a period of several years. The longest time a patient had the condition was 13 years, the shortest was 3 weeks (this person had not seen a podiatrist).

I have no bent towards any person or trade. I just feel that many treatments out there are used because some one said it works.

Daniel if you want to learn re read your last sentence.

You cannot beat a hands-on workshop for learning and understanding the process and reasoning behind it.

Regards
Daniel

Paul
Reply With Quote
Reply



Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts
vB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Forum Jump

Translate This Page

Similar Threads
Thread Thread Starter Forum Replies Last Post
Botulinum toxin and plantar fasciitis Admin Biomechanics, Sports and Foot orthoses 20 21st July 2014 12:26 PM
Plantar fascial tenson and digital purchase force Admin Biomechanics, Sports and Foot orthoses 18 22nd August 2007 11:42 AM
Orthoses vs plantar fasciitis footdoctor Biomechanics, Sports and Foot orthoses 19 29th November 2005 07:37 AM
Plantar fasciitis is associated with functional limitation in older people Hylton Menz Gerontology 0 24th May 2005 10:23 PM
Growth Factors For Chronic Plantar Fasciitis? Craig Payne General Issues and Discussion Forum 2 9th December 2004 03:27 PM


New To Site? Need Help?

Finding your way around:

Browse the forums.

Search the site.

Browse the tags.

Search the tags.


All times are GMT -7. The time now is 01:26 PM.