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Hello Colleagues:

In a few of the threads exploring the treatment of plantar fasciitis, alternative treatments have surfaced. When the regular treatments fail you and the patient, is there room for a fresh look at what else there is on offer? With high tech applications e.g. ECSW therapy arriving on the scene, are there equally effective but cheaper alternatives ?

I am interested in, and invite your views on your experience of the role of mechanical stimulation, manipulation and some new technology, I previously was unaware even existed.

Podiatrists take a keen interest in treatment modalities for one of the most prevailing of foot conditions, plantar heel pain. The list of treatments is extensive – and in many cases, circa 85-90%, the tried and tested conservative regime works just fine.

This leaves the 10-15% group when it does not. Among this group, is the patient, with the diagnosis of plantar fasciosis. This is a sub group of patients in who the condition has become chronic. A possible explanation affects the fascia which has undergone hypovascular, fibrotic degeneration. The regular treatment, aimed to reduce the acute inflammatory response, fails. The possible explanation, it is postulated, is the absence of an adequate quintessential inflammatory vascular response required for healing. The fascia, with a pathologically reduced elastic modulus, transmits tension stress to the sensitive periosteum, and the pain cycle persists. It could even be argued that anti-inflammatory measures in those patients are counterproductive.

Some new , and some not so new, treatments are utilized. A therapeutic aim is to overcome this deficit and to help kick start revascularization, to stimulate a fresh inflammatory response, through various processes.

The stage is set for such treatments as ECSWT. This has had a rough ride, but most recently was again championed by the prominent Dr. Lowell Scott Weil, who states that;

Perhaps the ECSWT ‘star’ is on the ascendency, for many the equipment purchase costs remains a substantial hurdle especially for the smaller private practice.

Another treatment advocated by some is Prolotherapy. In England the glucose required for this treatment is prescription only and not readily available to the Podiatrist.

There is of course also Cryosurgery – this utilizes a different approach and aims instead to provide long acting analgesia from direct exposure to the effects of an ice ball applied to the nerve, leading to axonal degeneration and demyelination.

My professional curiosity in exploring ‘low tech’ solutions was piqued further reading from such individuals as Dr. Paul Conneely (AKA musemed) who offers a conceptually different approach. This curiosity is marred only by his reluctance, and perhaps through a mercenary impulse (?), to help provide his clinical colleagues with a better understanding and description of his methods. Though on further research it seems there are techniques, and to concede the point this is not part of the regular undergraduate Podiatry curriculum, that may well require additional training :

A. Muscle Energy Technique (MET)
B. Proprioceptive Neuromuscular Facilitation (PNF)
C. Cold Spray/Ice and Stretch (Simons D.G. and Travell J. Myofascial
Trigger Points)
D. Jones Points (Strain Counter Strain)
E. Post Isometric Relaxation
F. Corrective stretch, strength and function exercises
G. Remedial Massage Modalities:
i. Transversal friction massage
ii. Trigger point therapy
iii. Myofascial release to name a few

Simon Spooner’s endorsement of PNF is also of interest:

It seems to me that such supplementary techniques, which I have not considered, are finding favor among some of our peers.

Sensitive to the possibility that Podiatry, and I, could miss out, on the basis of the eye only sees what the mind knows, ( great phrase !) after some idle internet browsing looking for those sometimes elusive heel pain cures, I tripped over the Vibromax technology.

The inventor of Vibromax is Dr. Mohsen Kazemi, Chiropractor. The claimed benefits:

I await with interest your comments.

 

Leon Chaitow has written extensively on the above subjects:
http://www.amazon.com/exec/obidos/s...type=ss&index=books&field-author=Leon Chaitow