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Saturday, April 24, 2021

Stubborn Plantar Fasciitis: Email Response

Hi Dr. Blake,

I've been dealing with bilateral foot pain for more than 2 years and treating it as plantar fasciitis.  My primary care doctor ordered MRIs and had them sent to the foot and ankle clinic at a local university medical center.  (I have a podiatrist, but he was not supportive of MRI.)

Anyway, the foot and ankle clinic reviewed the MRIs and determined that it was just a stubborn case of plantar fasciitis.  They offered to give me a cortisone shot and left it at that.

Anyway, I declined the shot for now.  I'm about to start PT again with someone who does active release technique.  Nobody has told me whether the plantar fascia tissue looks healthy or degenerated.  Is this something you can discern from looking at the MRI images?  

I am curious about the integrity of the tissue for two reasons:
(1) If I get the cortisone shots, is there a risk of rupture?
(2) Am I a good candidate for shockwave?  If the tissues still look healthy, then I wouldn't want to bother with the expense of shockwave.

I did some shockwave in the past and found it very effective.  However, I did not have the other components in place -- flexibility and biomechanics -- to make the results last.

Let me know if I am not sending you useful images.  There were so many to choose from.  And I would love to know if you think this could be something other than plantar fasciitis, such as nerve entrapment, bursitis, etc.


P.S. Thanks for your help.  Your blog has been the greatest resource.  I just made a donation.

Dr. Blake's Response:
Hey, just not enough images. Take photos of all T2 images (probably 10 or more from different directions) that show the plantar fascia and heel. The T2 are the ones where the bone is dark. Rich 

Patient's Response:
Thanks Doctor.  Here is a selection of the ones not marked T1.  There were quite a lot, so I did some guesswork.

Dr. Blake's Response:
You did well, the ones with the bone dark are the T2 images. No inflammation and no fibrosis (thickening) is seen. The plantar fascia looks normal on these images. The cortisone is for the inflammation and the shockwave for the scarring, so neither seem indicated. It does appear nerve. Consider 10% alcohol shots (typically a series of 5 once a week) for the nerve, along with a topical like nerve compounding cream and neuro flossing. Sometimes, TENS units help since you can do 3 times a day. Send me the report so I can read. See the video below. Also, do you have low back or spine problems that can cause nerves to be sensitized. Rich 

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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.