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Use of Primary Corticosteroid Injection in the Management of Plantar Fasciopathy Is It Time to Chall

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Sep 27, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Use of Primary Corticosteroid Injection in the Management of Plantar Fasciopathy
    Is It Time to Challenge Existing Practice?

    Paul Kirkland, BSc (Hons, PodMed), BSc (Hons), Grad ISM, CMS, FCIPD, MChS* and Paul Beeson, BSc (Hons), MSc, PhD, PGCertRDS, FCPodMed, FHEA
    J Am Podiatr Med Assoc 103(5): 418–429, 2013
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. toomoon

    toomoon Well-Known Member

    Looks like Dr. Kirby may have been vindicated.. although I remain unconvinced!
    S
     
  4. blinda

    blinda MVP

    That was one of the highlights at the 2012 Summer School. Kevin told me that he had to perform the Kirby Kiss on you over this subject.
     
  5. There is no question that cortisone injections are quite helpful for many patients with proximal plantar fasciitis. I give about 10 plantar heel injections per week for this condition with about 70% of patients reporting good to excellent results for 1-3 months following the injection. The question should be which patients we use this therapy on and which patients we do not do this therapy on. Currently, it seems that the only way to know if this therapy will work is to first try it.
     
  6. Paul Bowles

    Paul Bowles Well-Known Member

    I agree - as long as the patient has no intrasubstance fascial tear, we use corticosteroid on a semi regular basis for these patients and I have to say there is a high clinical success rate with it. I'm in the "many tools on the belt" corner - as the more tools available for me to use, the more options my patients have!
     
  7. Paul:

    It's interesting you mention intrasubstance tears of the plantar fascia and corticosteroid injections.

    I just yesterday injected a 27 year old firefighter cadet with a 3 month old plantar fascial tear into the area of the healing tear, that had become indurated, with probable excess scarring, in order to try and reduce the development of further painful scar tissue in this area of the plantar arch.

    I will routinely inject into painful healing plantar fascia tears, or healing partial plantar fasciotomies, if excess scar tissue is developing in much the same way I will use intralesional corticosteroid injections into plantar fibromas to shrink the size of the fibroma. Corticosteroid injections have a collagen synthesis reduction effect.

    http://www.jle.com/e-docs/00/01/87/64/article.phtml

    Therefore, I do routinely use plantar fascial injections of corticosteroid into select patients with healing plantar fascia scars or healing partial plantar fasciotomies to reduce size, pain and tenderness of the healing scar.

    Now, I'm off to lecture on the Ten Functions of the Plantar Fascia at the Podiatry Institute Reconstructive Surgery of the Foot and Ankle Seminar here in beautiful San Diego in about an hour. Today is plantar fascia day, I guess.:drinks
     
  8. Paul Bowles

    Paul Bowles Well-Known Member

    Thanks Kevin - I don't doubt in some cases it may in fact be very useful like this. Thanks for the tip on plantar fibromas, i've never done that before but will try this on future patients who have difficulty.

    I guess its that "effect" of corticosteroid as to why I don't use them in acute intrasubstance tears.

    I've attended alot of educational events over the past year or so and one had a component of abdominal wall reconstruction which sparked my interest in the way they manage fascial tears in the abdomen..... It got me thinking, does anyone have any good data on healing of plantar fascial tears in terms of timeframes? and/or do they ever completely heal or fibrose? The reason I ask is we have a growing number of patients who become a-symptomatic after managing plantar fascial tears but diagnostic US still shows a clear visible disruption to the intrasubstance post 6 months.

    Hope todays lectures go well!
     
  9. The lectures went great. Thanks for the support.
     
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