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HASLAM'S VIEW: A cure for plantar fasciitis? Dream on Practitioner. Tonbridge: Nov 27, 2006. pg. 71
Professor David Haslam CBE FRCGP
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; National Clinical Adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester.
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On the whole we are a pretty altruistic profession. Most of us get up in the morning to achieve the very thing that we said we wanted to do at our medical school interview - to help people. In the middle of an epidemic of undiagnosable viruses it can be a strain to keep the altruism to the fore, and there are days when we would be perfectly happy if no-one came to see us, but it is a mercifully rare member of our profession who actually chooses to hurt his or her patients.
Sometimes, however, doctors do offer treatments that may seem worse than the disease.
Plantar fasciitis is the bane of many people's lives and is often resistant to treatment. Over the years I have seen an extraordinary number of treatments come and go.
In no particular order, I've read about, heard about or used: analgesics, anti-inflammatories, heel pads, special footwear, ultrasound, interferential, friction, orthotics, arch pads, nights splints, day splints, finding heel spurs on X-ray and excising them, finding heel spurs on X-ray and ignoring them, ice, tape, weight loss, gait analysis, rest, activity and steroid injections.
Type 'plantar fasciitis' into a web search engine and you get 791,000 pages - a sure sign that no-one has the definitive answer.
A while ago I was talking to an orthopaedic surgeon about this condition and he told me his secret.
"I offer them a steroid injection," he said, "and warn them it will hurt like hell. That soon sorts them out. Some say, 'Thanks, but no thanks', and leave the clinic. Others have the injection, discover that I wasn't joking, and vow never to return again. Either way, 100 per cent of my patients never return for further therapy, and so I mark that down as satisfaction and success."
It reminds me of an ancient gynaecology book that I found in a junk shop.
In the section on dysmenorrhoea, the author enthused about the results he obtained from the application of leeches to the cervix.
He knew it worked, he said, as no-one ever needed to return for a second treatment...
In case you are wondering, and have patients with intractable dysmenorrhoea and a ready supply of leeches, these were applied to the cervix using a test-tube shaped leech glass.
'When leeching in the immediate vicinity of an orifice like the cervix,' cautioned the author of this extraordinary book, 'a plug of cotton wool is advised to prevent the leech from escaping through the opening.' Delightful.
Quite how you would explain the disappearance of a leech to your defence union I am really not sure, but little wonder he didn't have many return customers.
And, of course, some of the therapies we are using today will seem just as bizarre to researchers in 100 years' time.
They will be astonished that we diagnosed heart attacks by using a concept as quaint as the electrocardiogram, that we touched people to take their pulse, that we stuck sticks in urine for anything at all, and that we diagnosed depression without a cerebral activity scan.
And they may have even discovered a painless and effective cure for persistent plantar fasciitis. But don't hold your breath.
and look at the ads that have appeared at the top of this page for plantar fasciitis cures!
They will not always be there - so refresh the page or check later. It often depends on how much the advertiser is willing to pay, the IP address you have connected from and number of clicks on the ad, etc ... Google very smart in its serving up of contextually relevant ads.
Type 'plantar fasciitis' into a web search engine and you get 791,000 pages - a sure sign that no-one has the definitive answer.
I made it 848 000 hits. But type in "broken leg" and you get about 2 430 000 hits and we generally know how to treat that so i'm not sure the above statement is actually true.
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A while ago I was talking to an orthopaedic surgeon about this condition and he told me his secret.
"I offer them a steroid injection," he said, "and warn them it will hurt like hell. That soon sorts them out. Some say, 'Thanks, but no thanks', and leave the clinic. Others have the injection, discover that I wasn't joking, and vow never to return again. Either way, 100 per cent of my patients never return for further therapy, and so I mark that down as satisfaction and success."
I think this is a very NHS approach. In a rational universe numbers statistics and targets reflect reality. However in the NHS because our masters are so far removed from the clinical coalface that results are purely abstract it almost seems that numbers CREATE the reality. Therefore if somebody can be persuaded not to come back in for treatment it is considered to be a cure and the we get the lovely warm glow of a job well done.
In his book 1984 George Orwell called it "doublethink". To hold two fundamentally incompatable concepts in ones brain and believe them both to be true. The surgeon knows that the patients he has scared away are not any better off than when they came in but still
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mark(S) that down as satisfaction and success
. Two plus two can equal 3, 4 and 5 at the same time.
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In no particular order, I've read about, heard about or used: analgesics, anti-inflammatories, heel pads, special footwear, ultrasound, interferential, friction, orthotics, arch pads, nights splints, day splints, finding heel spurs on X-ray and excising them, finding heel spurs on X-ray and ignoring them, ice, tape, weight loss, gait analysis, rest, activity and steroid injections.
He missed out acupuncture, Reiki, faith healing, homeopathy and counselling (yes really).
Could it be that the range of treatments found to be effective stems from the fact that PF is as much a symptom as a disease and the treatments reflect the diversity of causes? If the PF was caused by a skydiving injury weight loss will not help much. If the patient is a 30 stone marathon runner steroid injection will be of limited value!
A cure for plantar fasciitis? Dream on
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