Colleagues,
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I have found my most frustating cases of plantar fasciitis are those in which MRI's show a partial tear of the plantar fascia.
What do you think are the best treatment(s) for this?
I'm apologize if this has already been discussed.
Regards,
Stanley
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Have them stomp on it until its a complete tear ....from what I understand is that it works really well. :wacko: ... at least the pain is gone soon after its ruptures!
St Kilda AFL footballer, Robert Harvey, did this in a much reported case in the media here. He just kept jumping of the kitchen table until it totaly ruptured. The expected 8 week layoff due to the partial rupture was reduced. -
Craig
Stanley
Now after reading Craig's post I'm wondering if I should have had the u/s done anyway. If the PF was ruptured it might have settled down pain free and the resolution Dx was a misinterpretation.:confused:
If not, the Tx seemed quite effective, if so, what do you think? should I review him and go for a u/s scan.
Cheers Dave -
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To tear or not to tear, that is the question.....
I wouldn't recommend the treatment that Robert Harvey did to himself since there is a big difference biomechanically between a partial tear and a complete tear of the plantar fascia. In a partial tear, generally the most medial fibers of the central component of the plantar aponeurosis (i.e. plantar fascia) are torn with the remaining lateral fibers being left relatively uninjured. This will produce much the same biomechanical effect that a partial surgical plantar fasciotomy will have in the treatment for chronic plantar fasciitis in that the medial 1/3rd to medial 1/2 of the plantar fascia are transected during surgery. I don't know of anyone in the States who would recommend a complete plantar fasciotomy for treatment of a partial plantar fascial tear (i.e. "to complete the tear"). Why? Here, again, are the ten functions of the plantar fascia.
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Hi Stanley:
First, please don't have your patient "STOMP" down on the injured foot!
I agree with Kevin, these are usually on the medial slip. Also common and less appreciated are herniated fascias (sometimes from acute injury, sometimes from overzealous cortisone injections for fasciitis)
If it is truely "torn" the patient will have difficulty putting any pressure on the injured foot. These you can try to treat via immobilization followed by support and PT if they are resolving.
Most of the tears I see that end up in the operating room are of the Herniated variety along the muscle belly of the AHB. There is normally a "bulge" in the area as compared to the contralateral foot and frequently a compressed nerve. These are very painful and any direct pressure (bandage, arch support, wt. bearing) cannot be tolerated. While in training we repaired three of these with a gor-tex mesh, but scar tissue was a problem. Since those days I have repaired many herniated fascias (since I have quite a few podiatrists in my area who love giving repeated injections for non responsive fasciitis and quite an obese population) and find it responds well to simply suturing the fascia as you might an inguinal hernia.
Steve -
Dear Colleagues,
I have treated completely torn fascias. One of my patients was a baseball pitcher, who won the Cy Young award 2 years later.
I am not talking about this, as these do heal in a few weeks with good care (Orthoses, physical therapy, Rocker platform shoes).
http://www.podiatrytoday.com/article/6296
The patient I was referring to had a prior surgery, and what was left was a small superficial band of the medial and central band. I didn't see where you recommended a treatment for a partial tear.
Thank you all for your replies. From what I gather, the way to treat this is either to complete the tear, or try to let it heal. The healing process is aided by immobilization and physical therapy.
I was also looking at the platelet injections as a means to stimulate healing.
Does anyone have any experience with this?
Thanks and regards,
Stanley -
I was not aware that there was only one surgical approach to partial plantar fasciotomy....."the surgical approach". I think that you will find that the authors of the article you provided to us clearly state that there is current controversy regarding how much of the central component of the plantar aponeurosis to transect during plantar fasciotomy.
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Stanley
I didn't that is why I originally ordered a u/s scan. But as it became pain free before he had had his scan I presummed that it had healed and so therefore was not fully ruptured. Craigs post made me think - what if it had fully ruptured and the short lived pain was due to this and not healing. I was not aware that a fully ruptured PF would become pain free. That is why I asked do you think it is worth doing an US scan anyway.
Cheers Dave -
I remembered that because releasing the lateral band caused lateral column disease, the plantar fasciotomy was modified to not include releasing the lateral band of the plantar fascia, hence the medial and central bands were transected. I Googled for an article on plantar fasciotomies, and the Karlock-Kirk article was the first one I saw, so I attached the link to it.
Wolfer sectioned the complete central band (I would presume for central heel pain), and Fishko sectioned the medial one-third (the medial band). I didn't see where it said to section one half of the central band (in addition to the medial band) which is what you implied when you said:
Regards,
Stanley -
Sorry I missed your question, but I thought it was a little rhetorical.
If you want to make a diagnosis, then the scan would do you well. Seeing that the patient is Job done there really isn't any point, except to see if it is ruptured, which is what I would expect. :drinks
Regards,
Stanley -
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Again, the problem patients are the ones that are shown to have a partial tear in the plantar fascia on their MRI.
After reading the posts I am going to try casting with or without ESWT or platelet injections. I still have to figure out the criteria of each. -
hi,
I saw a lecture where the speaker said that ESWT was good for plantar fascia problems especially when the tissue has become calcified- when there are calcifications in the plantar fascia. Does anyone know anything about this? -
oh, and also- will there always be swelling in the case of a partial tear?
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what would be the expected time frame for a person with a partial tear to the plantar fascia to be able to jog?
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