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Tuesday, January 8, 2013

Plantar Fasciitis: Email Advice

Dr. Blake,
I am a 39 yr old triathlete & soccer player.  I've run 3 marathons.  This past summer, I raced my first half Ironman.  I knew going into training that my PF (plantar fasciitis) was bad.  I've had it for over a year in my left foot.  I just recently completed 5 extracorpreal shockwave treatments.  I've been wearing a walking boot for 6 weeks.
Dr Blake's comment: ESW are treatments designed to create a new injury (with a chance to heal), from a old chronic injury that does not appear to be healing. How the patients are selected and at what stage of their injury they are treated appears to be quite random from doctor to doctor. I have not seen a good study documenting MRI findings and success rates, so it is difficult to know who is benefitting and who is not from ESW. The basic principle of ESW is to create a new injury and everyone knows that a new injury should be treated with a period of immobilization which is not happening with this technique. 

Though incredibly expensive, I chose the ESW because it healed my right foot several years ago and my doctor stated that I'd be able to workout the most w/ this option.  While the PF is improving, I still have a great deal of pain, especially after rowing, which I thought was "safe" exercise.

I am considering new options: laser treatments (again uncovered by insurance) or surgery with plasma injections.  The latter is the only treatment covered by my insurance, but I was initially told that I would not be able to do any exercise--swimming, elliptical, cycling--NOTHING--for 10 weeks.  Is this true?  I haven't seen anything online that calls for such a rest period.
Dr Blake's comment: I am sorry I am unfamiliar with these techniques other than what I read also. My recommendation would be to get an MRI to see if the plantar fascia is torn or not. If torn, a removable cast with some activity is important. If not torn, what is causing your continual pain? fracture? nerve entrapment? scar tissue? poor biomechanical or other treatments? 

I do not want to do the fascial release.  It scares me.
Dr Blake's comment: I agree, fascial releases can go very well or very poorly with life long consequences. Think long an hard before going there. 

I am really committed to healing my foot, but also want to be back playing soccer and training in March.  I feel time is ticking and my wallet is feeling the pain as much as my foot!
Dr Blake's comment: You are a very serious athlete, and I commend you. But, to place a time limit on the healing of any body part really does you a disservice. You must create your pain free environment for several months, and then you must gradually increase your training while maintaining your pain free environment. If you get to the 80% better stage (0-2 pain level while doing all your activities) at the same time there is a season to participate in, so be it. If not, there will be another season, and another, and another. I sure hope this helps some. Rich

Many thanks,
Sally (name changed)

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.