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Plantar fasciitis: corticosteroid injection versus chiropractic therapy

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, May 10, 2014.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Plantar fasciitis: corticosteroid injection versus chiropractic therapy
    Siddharth Raveendran, Febi Eapen, Shaunak Patil, Abhimanyu Kakralia.
    Int J Res Med Sci. 2014; 2(2): 639-642
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Since when has that been "chiropractic therapy"?
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    WTF? .. I just read the full paper. They don't get much worse than this.
    -no randomization
    -no blinding
    -unvalidated outcome measure
    -no between groups stats analysis
     
  4. Paul Bowles

    Paul Bowles Well-Known Member

    Its a fantastic paper isn't it! Absolute gold. One for the archives thats for sure. Best part is the analysis at 6 weeks after the patient has received 3 x corticosteroid injections within that time frame (with the last one being two weeks before the results were analyzed). Strike me lucky! All this paper shoes is how poorly the authors understanding of the issue actually is. Not good! I'm surprised it got published.
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    check the quality of the "journal" .... its part of one of the predatory online publishers.
     
  6. Paul Bowles

    Paul Bowles Well-Known Member

    Well then that doesn't surprise me then!
     
  7. toomoon

    toomoon Well-Known Member

    Even reading the abstract I thought to myself 'how the hell did this get through?" What is "stretching of the plantar" btw??
     
  8. Peter

    Peter Well-Known Member

    That seems like a hell of a lot of steroid to me. I use 20mg depo-medrone, and never repeat until at least 6-8 weeks has elapsed from giving the 1st!
     
  9. Paul Bowles

    Paul Bowles Well-Known Member

    Well that is a problem amongst other things. Anyone having that much steroid in that short space of time - especially from the final injection at 4 weeks until the data review from the patients - anyone would improve I would argue.

    But we have already established this paper is already on top of the "Statistic and research methods 101" tutorial discussion - how to spot a dodgy research paper class at Uni.

    The lecture will start with a quote from Simon Bartold: "How to stretch a plantar"

    Solid effort authors for contributing to the knowledge pool......of how to spot dead end research!
     
  10. musmed

    musmed Active Member

    Dear Team

    I wonder why one uses a steroid for a non inflammatory condition. Can someone help me here?

    How does it work? IS apotosis the way by knocking off the C fibres and the pain comes back once they regrow?

    A big thing to remember is people can get avascular necrosis of the hip from an injection of steroid. I hope you all mention this side effect before you inject as part of your pre injection protocol.

    It has not happened to me (yet) but I have seen 6 cases in 40 years.

    the most beautiful autumn weather in a decade down here.
    currently sunny as, not a cloud in the sky and 23C

    Regards
    Paul Conneely
    www.musmed.com.au
     
  11. Paul Bowles

    Paul Bowles Well-Known Member

    I'm not in the "there is no inflammatory condition with fasciosis" camp for all presentations of fasciosis. Clinically that data makes no sense, and although I am sure there is a somewhat logical reason for it and one day we will find that - at the moment the balance between data saying its not inflammatory and clinical response to anti inflammatory meds makes no sense. I know there are people on here who say NSAIDS don't work for any of their fasciosis patients I would love to see their clinical data on confirmed US diagnosed fasciosis and use of 150mg of oral diclofenac daily before anyone says "it doesn't work".

    I use corticosteroid for the same reasons oral diclofenac seems to work in a vast majority of my clinical cases - relief and return to function.

    Then again I don't use injectable cortico for the vast majority of cases anyhow as we seem to get on top of things quite quickly in most cases with other interventions.

    What about the argument that the injection allows transverse separation of the fascia (instep fasciotomy anyone?) allowing better sagital plane movement....

    Hope all is well Dr C....
     
  12. musmed

    musmed Active Member

    Dear Paul

    Maybe all is not what it seems.

    Prof Bogduk talked about the fact that metal placed in tissues instantly causes ADP, ATP, adrenaline and nor adrenaline (I am certain there are others) to break down and thus if nothing there is no stimulation for the free nerve ending to say it hurts.

    This is probably how a hip replacement kills the pain.

    Lovely day down here.
    you should try it sometimes
    regards
    Paul Conneely
    www.musmed.com.au
     
  13. Paul Bowles

    Paul Bowles Well-Known Member

    May well be....but how does that explain how oral NSAIDs work? In particular 150mg per day of oral diclofenac?
     
  14. toomoon

    toomoon Well-Known Member

    I really do not think the majority of plantar heel pain is inflammatory in nature.. unfortunately I cannot support this comment with recent evidence. We had this discussion maybe 2 years ago, and my position on the efficacy of oral NSAID's (which I think is tenuous) or injectable glucocorticoids, may act through one of several pathways, has not changed. Nociceptive and central patterning pathways might be the most logical explanations for this.. but then again..maybe not!!
     
  15. musmed

    musmed Active Member

    Dear Paul

    How about centrally/spinal level and acts as an analgesic.

    Most of these drugs are on the market purporting to fight the inflammation the inflammation goes away and thus the pain goes.

    good 2 shoes

    only 1.8% of all musculoskeletal conditions have are inflammatory base, yet these magic pills work. only answer is CNS and above!

    still sunny
    regards
    Paul Conneely
     
  16. Paul:

    I agree with you. The reason that oral NSAIDS and corticosteroids work in often relieving the pain from plantar fasciitis is because plantar fasciitis is an inflammatory condition in addition to being a degenerative condition.

    The authors from this study of 38 patients found inflammation of the plantar fascia in all their biopsies (Jarde, O; Diebold, P; Havet, E; Boulu, G; Vernois, J: Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur: a report on 38 cases. Acta Orthop Belg. 69:267 – 274, 2003.)

     
  17. Paul Bowles

    Paul Bowles Well-Known Member

    I have no evidence to refute it, however a far more simple explanation (as Kevin alludes to) is that fascosis is indeed an inflammatory condition. ;)

    Might be time for research to revisit this with more modern imaging techniques and biopsy.

    Is there any data that 150mg of oral diclofenac acts as an analgesic centrally or at the spinal level?
     
  18. toomoon

    toomoon Well-Known Member

    i don't know Paul.. (well I do know it acts as an antinociceptive and that it does have a central effect..)but I can tell you that when diclofenac was introduced into animal populations it resulted in a sharp decline in the Vulture population of the Indian Subcontinent!
     
  19. David Wedemeyer

    David Wedemeyer Well-Known Member

    I agree its a shoddy study. Additionally, although many chiropractors employ physiotherapy modalities such as listed above, a number do not. They should have called this Plantar fasciitis: corticosteroid injection versus physical therapy.

    At any rate I believe that there is a distinction between plantar fasciitis, an acute or sub-acute inflammatory condition and plantar fasciosis, a chronic degenerative condition that is non inflammatory.
     
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