Plantar heel pain
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2175 (Published 03 June 2016) Cite this as: BMJ 2016;353:i2175
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The authors of this piece on plantar heel pain write that “plantar fasciitis” is the cause in most people who present in primary care. They advise practitioners to “explain to the patient that most symptoms usually resolve in 12 months, irrespective of treatment.”
They quote NICE, which attempts to put a positive spin to the same message. “The long term prognosis for plantar fasciitis is good. One prospective survey found that over 80% of people achieved complete resolution of their symptoms within a year.” (1)
What does one say to the unlucky 20% after 12 months of pain and disability ?
Remind them of JM Keynes’ famous observation that in the long term we are all dead ?
Plantar heel pain is common and the only reasonable conclusion to draw from these remarks on prognosis is that thousands of unfortunate people are suffering needlessly, victims of inappropriate advice and treatment by practitioners who have insufficient understanding of the condition.
Plantar fasciitis is a misnomer. In the absence of histological evidence of fascial inflammation, the term is no more accurate than surmising that inflammation of the temporal fascia is the cause of the spasm of the temporal muscles, and the pain, that may accompany TMJ dysfunction.
Our profession has a habit of using impressive terms to disguise our ignorance and confusion.
Unless practitioners understand why the condition should be called bruised heel, they are unlikely to point patients in the direction of cure, within a few months. (2)
As suggested in 2012, the repetitive tapping of a loose shoe ( it needs to be skin tight ! ) against the heel is crucial to the persistence of the problem. (2)
Western traits of unfitness and overweight are less important.
In recent years, in African outpatient clinics, numerous patients, nearly all women, fit and active, wearing ‘flip flops’, have presented to me with typical symptoms.
The authors imply that pain relief with with conventional medication is of equivocal benefit.
If six tablets of Arnica montana 30c, or Bellis perennis 30c (to be dissolved in the mouth, at intervals, over two weeks) are prescribed on an EC10, they will be safe, cheap, and may surprise, if used in conjunction with appropriate footwear. No medication will help, unless the need for suitable well fitting footwear is addressed.
Patients expecting a quick fix, and prepared to pay for a private expert consultation, might do better to spend the money on those rocker sole shoes beloved of celebrities, and modeled on the Masai gait. Anecdotal experience suggests they usually help, for bruised heel, if not for backache. (3)
1 http://cks.nice.org.uk/plantar-fasciitis#!scenario
2 http://www.bmj.com/content/344/bmj.e3260/rr/593122
3 http://www.independent.co.uk/life-style/health-and-families/features/mbt...
Competing interests: NT tried most conventional treatment approaches, until a third and last episode of plantar heel pain 25 years ago, when the aetiology finally dawned. No interest in any shoe company. NHS homeopath.
Re: Plantar heel pain - Plantar Fasciitis (Fasciosis) can be cured by Natural Weight Loss
Plantar Fasciitis (Fasciosis) can be cured by Natural Weight Loss
My father was suffering from plantar fasciitis (fasciosis) for over 2 months half a year ago, and he had a body mass index (BMI) of 27.4 (68.4 kg in weight). We discussed the case, and suspected that the obesity may play an important role in causing the heel pain. So we planned a natural weight loss scheme for him by eating less and fasting. After four months, his BMI was dropped to 23 (58 kg of weight), and his heel pain was greatly relieved.
As stated in your article [Ref. 1], plantar fasciitis (fasciosis) is a common for people aged 50 and above, yet its etiology is poorly understood [Ref. 2]. According to Sorensen et al. [Ref. 3], Plantar fasciitis (fasciosis) is not inflammation, and the term “fasciitis” should be replaced by “fasciosis”, denoting the chronic degeneration characterized by fibroblastic hypertrophy, disorganized collagen, chaotic vascular hyperplasia with avascular zones, and the absence of inflammatory cells. There is a lot of research relating BMI to Plantar fasciitis (fasciosis). [Ref. 1-5] But the common understanding of the association of BMI to heel pain is, the excessive weight of obesity simply applied as a load to the heel (weight bearing) [Ref. 4-5]. I think this understanding is not correct. As we know, the load of an obese person is the fat inside his body. The fat is not simply a weight bearing, more seriously, it is a poison to the organs of the body. A few grams of fat are sufficient to block the artery, and cause the stroke of a patient. Imagine a person having 5 to 10 kg of fat, with few grams of these excessive fats being deposited in plantar fascia, which makes the plantar fascia stiff and lose its flexibility. As the athletes are more frequently stretching their plantar fascia, the structure of plantar fascia of athletes are more stretched than common people who do not exercises regularly, and fat is more easily deposited in plantar fascia of them, resulting in a much lower BMI for athletes to suffer from planta fasciitis. By natural weight loss, the fat in plantar fascia is also reduced, and plantar fascia regains its flexibility, and the heel pain is reduced or completely cured.
Reference:
1. Thomas, MJ; Menz, HB; Mallen, CD. Plantar heel pain. BMJ 2016;353:Article Number: i2175.
2. Topsakal, S; Erurker, T; Akin, F; Yaylali, GF; Yerlikaya, E; Kaptanoglu, B. Heel Pain and Comorbid Conditions in Obese Patients. JOURNAL OF MUSCULOSKELETAL PAIN 2014;22:38-42. doi:10.3109/10582452.2014.883006
3. Sorensen, Matthew D.; Hyer, Christopher F.; Philbin, Terrence M. Percutaneous Bipolar Radiofrequency Microdebridement for Recalcitrant Proximal Plantar Fasciosis. JOURNAL OF FOOT & ANKLE SURGERY 2011;50:165-170. doi:10.1053/j.jfas.2010.11.002 pmid: 21354000
4. Waclawski, ER; Beach, J; Milne, A; Yacyshyn, E; Dryden, DM. Systematic review: plantar fasciitis and prolonged weight bearing. OCCUPATIONAL MEDICINE-OXFORD 2015;65:97-106. doi:10.1093/occmed/kqu177pmid:25694489
5. Jankowicz-Szymanska, A; Mikolajczyk, E. Effect of Excessive Body Weight on Foot Arch Changes in Preschoolers A 2-Year Follow-up Study. JOURNAL OF THE AMERICAN PODIATRIC MEDICAL ASSOCIATION 2015;105:313-319. pmid:26218153
Competing interests: No competing interests