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What do you think: do you first have to reduce inflammation? or to reduce the inflammation first of all you have to control possible biomechanical alterations by orthotics? or maybe both?
What's your opinion?

Albert Casas
www.clinikpodologia.com

 

I usually provide a comprehensive stretching regime for the plantar fascia and calf complex with perhaps some deep tissue massage. When appropriate, I also try to correct any biomechanical issues as soon as possible with orthoses. I think recently inflammation has been shown to be less of a contributing factor with 'plantar fasciopathy'.

 

And yet, that well targeted shot of cortisone CAN provide <some> patients with instant pain relief. I would urge all to take a closer look at the study about plantar fasciopathy. This is not a cast iron conclusion. I believe that PF constitutes a continuum. This begins with an inflammatory reaction which, in the chronic cases, can develop into the fasciopathy. If you can, get a sonogram to evaluate further. So, my first division: what is the duration of the symptoms.

In any case, the internet is filled with treatment protocols for plantar fasciitis. Mechanical factors are key, since this will create the mechanical stress that provokes the pain. I want to know how much pain there is. Pain is the primary reason that brings a patient to the office, and a patient wants to be rid of that pain. If the pain is very bad 6-7+/10 (and assuming other causes are ruled out), I will offer a cortisone shot and concurrently provide mechanical treatment (patient specific). Patient is advised to limit their activity, R.I.C.E., and stretch as appropriate, and I will Rx a NSAID. Some like to use a Medrol Dosepack which can provide phenomenal pain relief very quickly. Footwear advise is provided.

 

1. Reduce the load (activity modification, strapping, orthotics that have the right design features, stretching)
2. Increase the ability of the tissue to take load (strengthening, progressive loading)

Depending on progress:
3. Facilitate healing (NSAIDs, ice, cortisone, shockwave etc)

 

Considering it is a thickening and tightness condition of the plantar fascia, would heat application therapies also be indicated to promote movement and healing? Particularly pre-activity?