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What I learnt from joining some patient support groups for plantar fasciitis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Oct 22, 2015.

  1. Craig Payne

    Craig Payne Moderator

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    I recently joined several Facebook groups for sufferers of plantar fasciitis (I don't recommend it as it will fill up your newsfeed with a lot of stuff). I have to exercise significant restraint in not commenting!

    I learnt some things:
    1) There is an extraordinary number of people out there that have had their plantar fasciitis mismanaged by health professionals and self management

    2) A hellava lot of them self manage

    3) they seem to try one treatment, then move to another when that one does not work (most of the treatments discussed in these groups don't work, but the improvement with many would be due to the natural history .... but try and convince them of that would be an exercise in futility!)

    4) They give a lot more weight to a testimonial from a fellow sufferer than to what the scientific evidence says

    5) They confuse correlation with casusation

    6) Its never the natural history that is the reason that they improved; its always whatever they did at the time just before it got better

    7) It seems like every second post is about magnesium supplements!! ... with an extraordinary number of testimonials by people claiming it cured or improved their plantar fasciitis!

    Magnesium supplements is the hot topic in these communities! ... yet no clinical trials and I have no idea how it would help unless you are deficient in it (and even then I see no pathophysiological mechanism by which a deficiency would be a factor in plantar fasciitis)
     
  2. Ina

    Ina Active Member

    Re: Magnesium for plantar fasciitis ??

    As far as I know bischofit (magnesium chloride) is routinely marketed and sold as topical medication to treat heel spurs (at least in our country). One of our local manufacturer's web-site doesn't directly say that any of their bischofit supplements is indicated in heel spur cases, mainly recommends those in gastrointestinal, endocrine disorders and osteoporosis. In theory, if there's a person whose heel pain is triggered/aggravated by any of these conditions (e.g. gout, inflammatory bowel disease), could they successfully address the primary cause of their heel pain with magnesium supplement?
     
  3. Craig Payne

    Craig Payne Moderator

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    Re: Magnesium for plantar fasciitis ??

    One other thing I learnt was that of those posting in these groups about their plantar fasciitis and describe their symptoms in details, about half of them do not have plantar fasciitis!!! ... yet they still following all the online advice and advice from the group for plantar fasciitis!
     
  4. Craig Payne

    Craig Payne Moderator

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    typical:
     

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  5. Ina

    Ina Active Member

    Re: Magnesium for plantar fasciitis ??

    When it comes to the members of the public with self-diagnosed conditions, why would they be expected to do it as precisely as health care practitioners possibly could? Isn't that fairly predictable that any self-diagnosed heel pain of any aetiology is likely to be popularly referred to as 'plantar fasciitis'?.. In our country, the correspondent vernacular catch-all term for any heel pain of any origin is 'heel spur', this is a matter of (mis)communication between the healthcare industry and its clients. The latter will either by chance treat themselves successfully or exhaust all the try-end-error modalities they learnt from fellow sufferers and surrender themselves to health care providers. People are free to experiment with their own health using their common sense, however limited or unsubstantiated the information they rely on, it's their own choice and they do not encroach on anyone's territory in their self-help groups. I assume if healthcare services were perceived as affordable and reliable, the vast majority would simply go to the physician.

    Meanwhile, any lay person may feel compelled to ask about the tentative level of agreement among health care practitioners refferring to their condition(s) as heel pain / plantar fasciitis / plantar fasciosis / calcaneal spur. One cannot blame the public for a not-so-precise terminology before physicians heal themselves, define and agree upon their use of these very terms.
     
  6. Lab Guy

    Lab Guy Well-Known Member

    Re: Magnesium for plantar fasciitis ??

    And that surprises you?

    Steven
     
  7. Craig Payne

    Craig Payne Moderator

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    indeed ... put a leaf in your shoes!
     

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  8. Craig Payne

    Craig Payne Moderator

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    Yep; eggs will cure it:

     

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    Last edited by a moderator: Sep 22, 2016
  9. Craig Payne

    Craig Payne Moderator

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    Placebo?
     

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  10. Craig Payne

    Craig Payne Moderator

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    If the magnesium and eggs don't work, there is always the onions:
     

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  11. Craig Payne

    Craig Payne Moderator

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    common sort of exasperated post:
     

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  12. Craig Payne

    Craig Payne Moderator

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    Remember all that nonsensical propaganda and rhetoric from the barefoot fan boys and how you should go barefoot to treat plantar fasciits? I wonder what they would say to these people?
     

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  13. Craig Payne

    Craig Payne Moderator

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    Will a 'Circulation Booster' work? ... ummm .... nope
     

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  14. Craig Payne

    Craig Payne Moderator

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    "Curamin" and going gluten free helps!
     

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  15. Craig Payne

    Craig Payne Moderator

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    Now apple cider can fix it!
     

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  16. Craig Payne

    Craig Payne Moderator

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    Now its due the wheat!
     

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  17. Craig Payne

    Craig Payne Moderator

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    Yep; its the magnesium and not the natural history of pain fluctuating.
     

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  18. Donna

    Donna Active Member

    Hi CP,

    I've just spotted this thread, and I think I know why you find the self treatments so frustrating... The support group is for "plantar faciitis" not "fasciitis"!! :hammer:

    It's time to click "Unfollow" and find the "plantar fasciitis" support group instead... :pigs:

    Regards

    D
     
  19. Craig Payne

    Craig Payne Moderator

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    yep; that will work!
     

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  20. Craig Payne

    Craig Payne Moderator

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    Ok, finally took the time to look into this further. Just waded through this book:
    http://www.amazon.com/Magnesium-Pyridoxine-Fundamental-Clinical-Practice/dp/1607417049/ Magnesium and Pyridoxine: Fundamental Studies and Clinical Practice

    I still can find no reason why magnesium supplements would help plantar fasciitis.
    A magnesium deficiency affects tissue viability, but only if you are deficient. If your diet is OK, then you are not deficient and supplements will not help.
     
  21. Craig Payne

    Craig Payne Moderator

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    WTF? this is a weird one. The post below turned up in my newsfeed and clicking on it led to this site:
    Plantar Fasciitis Treatment Is Being Changed By These Surprisingly Common Essential Oils

    it was freakin tea tree oil ..... snake oil alert, but lots of people buying into it.

    I searched facebook for the profiles of all those posting testimonials:
    https://outbacknaturalpainrelief.com/new-australian-oil-for-foot-pain ... they all fake and do not exist.

    this is the page you eventually get to for a purchase:
    http://www.amazon.com/Pain-Relief-Pack-OutbackĀ®-All-Natural/dp/B0182QMJN4/

    Lots of 5 star reviews .... go figure
     

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  22. Craig Payne

    Craig Payne Moderator

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    Now its the sugars and carbs!
     

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  23. Lab Guy

    Lab Guy Well-Known Member

    Cutting back on carbs is always a good thing.
    Steven
     
  24. PodAus

    PodAus Active Member

    Of course anecdotal evidence plays havoc with clinical practice, however if If I play devils advocate for a moment...

    If we step back and helicopter up to the concepts which may potentially be of consideration; for example some of our western medical paradigm challenges with the "known unknowns" and 'no evidence for... (yet?)' syndrome...


      • What effect does supplementation (targeted or otherwise) have upon an individual with fascial type pain?
      • Is this measurable in isolation?
      • As the fascia is reported to be a piezoelectric tissue, is there a triggered immune response which may affect the bioelectrical potentials thru or across collagen/fascia?
      • Does this effect viscoelasticity?
      • Does this possibly have a correlated chemical flush of the symptomatic region which may directly moderate mechanoreceptor / other nerve-ending response?
      • Does this have any direct effect on pain modulation?

    When will we have the tools to measure, interpret and understand the nutritional and biochemical status of individuals, and will this be MSK protocol relevant?

    (For anyone interested, quick read below):

    BIOELECTRIC RESPONSIVENESS OF FASCIA
    69 Techniques in Orthopaedics?, Vol. 18, No. 1, 2003
    FASCIA: SPECIALIZED CONNECTIVE TISSUE
    Connective tissue proper consists of six basic types.5
    Each type is designed to provide a specific function in
    the support of organism integrity through structure, function,
    and ultimately homeostasis from the gross to the
    cellular. In this sense, it is aptly named.
    1. Areola tissue: loosely packed, readily deformed and
    distended. It binds tissues and organs together, allowing
    freedom of motion between structures. It collects
    inflammatory and effused substances from organs and
    cells. It forms a continuous subcutaneous, submucous,
    and subserous tissue throughout the body.
    Within the loosely arranged collagen and elastin fibers
    travel blood vessels, nerves, and lymph vessels.
    2. White fibrous tissue: very dense, linear collagenous
    fibers with tensile strength. It connects bones and
    muscles, forms investing membranes that protect
    organs and structures, and creates supportive pathways
    for nerves, blood vessels, and lymph vessels.
    Nerves and lymph vessels terminate in this tissue,
    facilitating information exchange on gross and fine
    motion of the musculoskeletal system. Developmentally,
    the pattern of linear fibers is given direction
    by responding to tensile mechanical forces in
    the growing embryo.10 This response of collagen to
    mechanical forces is maintained throughout life
    and is discussed in more detail later.
    3. Yellow elastic tissue: moderately dense with a matrix
    high in elastin fibers. This tissue provides elastic
    support to diverse tissues such as the vocal cords,
    blood vessels, trachea, and bronchi.
    4. Mucous connective tissue: embryologically the jelly
    of Wharton in the umbilical cord and, in the adult, the
    vitreous humor of the eye. Mucin is the major component
    of the matrix.
    5. Retiform connective tissue: the base of mucous membranes
    and the internal framework of organs. Fine
    reticulin fibers mix with white fibrous fibers to create
    the structure of lymphoid and adenoid tissue.
    6. Basement membrane: supportive tissue for epithelium
    of mucous membranes and secreting glands.
    Connective tissue acts as a barrier, communicator,
    protector, and a reactor. It supports and forms the body
    framework as adipose, bone, cartilage, and discs. It
    directs and limits planes of motion in the component
    parts of the musculoskeletal system with fascia, tendons,
    ligaments, and capsules. It protects organ structures
    while allowing contiguous organs and tissues to function
    independently. It reacts to trauma in the tissues by
    precipitating platelet aggregation, clot formation, and
    tissue repair through the ECF, and it directs the deposition
    of hydroxyapatite crystals in bone. It is ubiquitous.
    Fascia is the largest component of white fibrous tissue.
    It has three layers: superficial, deep, and subserous.
    Developmentally, it is a continuous sheet enveloping and
    compartmentalizing the body. This continuity communicates
    local and regional events throughout the fascia.
    Fascial integrity is essential in the maintenance of posture,
    locomotion, and response to mechanical stress. The
    subserous fascia covers, supports, and lubricates organs.
    The deep fascia forms compartments for cavities, organs,
    and structures. The superficial fascia is related to the
    dermis, forming a protective covering on the body.
    Fascia is universal. The unique design of the fascia
    provides the framework in which the ECF coordinates
    homeostasis. No disease escapes notice and no cure
    occurs without the assistance of the fascia.
    Disruption and distortion of the fascia triggers a repair
    process directed at correction of damage and strengthening
    of tissue. Repair is mediated by the release of
    chemotactic factors activating the congregation and proliferation
    of fibroblasts. The fibroblasts coat the injured
    area with a fibrin matrix. Collagen is then deposited in a
    linear fashion. The fibrin matrix and collagen fibers are
    deposited along lines of mechanical tension in the tissue.7
     
  25. Craig Payne

    Craig Payne Moderator

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    At least this one was funny...
     

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  26. Craig Payne

    Craig Payne Moderator

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    was it really plantar fassciitis or just a trigger point problem.
     

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  27. Dieter Fellner

    Dieter Fellner Well-Known Member

  28. Craig Payne

    Craig Payne Moderator

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    its not just the magnesium
     

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  29. Craig Payne

    Craig Payne Moderator

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    oh dear; epic fail on someone's part
     

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  30. Craig Payne

    Craig Payne Moderator

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    Thus video from a chiropractor has been shared often in these groups:




    Lots of testimonials that it works.
     
    Last edited by a moderator: Sep 22, 2016
  31. Dieter Fellner

    Dieter Fellner Well-Known Member

    sitting on your feet will instantly cure plantar fasciitis AND flat feet!

    lol.... sure it does :pigs:
     
    Last edited by a moderator: Sep 22, 2016
  32. Craig Payne

    Craig Payne Moderator

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    But look at al the awesome testimonials in the comments section on the video:
    https://www.youtube.com/watch?v=gXdlPuKfyXs
     
  33. Stanley

    Stanley Well-Known Member

    The reason you don't get it is because you are too smart. Magnesium is "used" for removing calcium, hence it will "dissolve" the bone spur (probably the same mechanism for Apple Cider Vinegar). We know that the spur is not the cause of the pain, but the less educated believe the spur is the problem.

    I hope that helps.
     
  34. Craig Payne

    Craig Payne Moderator

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    lot of people unhappy with their foot orthotics
     

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  35. Craig Payne

    Craig Payne Moderator

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  36. Craig Payne

    Craig Payne Moderator

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    Based on people asking for advice on Facebook, some think its more common in the right foot!
     

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  37. Craig Payne

    Craig Payne Moderator

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    Typical response. A post was made asking if a certain product helped plantar fasciitis.
    First response - didn't help
    Second response - helped

    That is why we need proper RCT's.
     

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  38. Dieter Fellner

    Dieter Fellner Well-Known Member

    There is (somewhere in the Archives) an article about the size of the spur and correlation with severity of symptoms and found a positive correlation. I too used to believe, and educate patients, that a spur is often found on XR and that it is considered an incidental finding that has nothing at all to do with plantar heel pain. I am not as convinced as I used to be. Perhaps the spur is indeed simply a surrogate marker of a foot prone to traction enthesopathy. Or perhaps the spur can, in some cases and if large enough, cause a mass effect and compress and irritate soft tissue structures and contribute to nerve entrapment. Lithotripsy anyone?

    To those who like to think magnesium or apple cider vinegar can dissolve bone - how fiendishly clever of magnesium to target only the spur and not the entire skeletal system. Maybe it's smart nano-technology enhanced 'stuff' with tissue specific targeting capability. Or maybe it's just nonsense ...
     
    Last edited: Feb 22, 2017
  39. Stanley

    Stanley Well-Known Member

    For the few patients that are unresponsive to conservative therapy, I would take an MRI before surgery. The most common findings are mucoid degeneration of the plantar fascia (with or without tearing) and bone marrow edema.

    My surgery is removal of the spur (for the bone marrow edema), and injection of platelet gel to help heal the mucoid degeneration (immobilization with very gradual return to weight bearing is also required). I remember one surgery that when I removed the spur, the fluid was visibly welling in the surgical site. The surgery was done with a tourniquet, so I am sure it was the edema. The patient did very well post op and told me on the first post op visit that the achiness was gone.
     
  40. Dieter Fellner

    Dieter Fellner Well-Known Member

    The role of bone marrow edema in recalcitrant cases is intriguing. There is recent chat amid the MIS crowd about the resurgence of percutaneous drilling of the calcaneus with a measure of consensus on good success, albeit anecdotal.

    Historically this was tried out and also with good success, but the procedure drifted off the radar. Some doctors were concerned about the fracture risk, hot on the 'heel' of one litigation case. The technique was recently modified to apply a series of 3 holes through a single stab incision and targeted on the area of maximal bone edema. Low numbers. Good outcome, no complications (yet).
     
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