Any other plantar fasciitis sufferers?

[Mel]

Is there some disagreement about steroid use for PF among the professionals?

Disclaimer - I'm not a professional in this particular area, but can comment on some generalities.

Like most things, the devil is in the details. For some tendon lesions, like trigger finger, there's good evidence for using steroid injections. For most other tendinopathies, not so much. There are several issues with using steroids for PF (or other tendinopathies), including 1) lack of evidence that it works short or long term, 2) doesn't change the biomechanical factors that led to the problem in the first place, 3) No evidence that inflammation is a significant component of pain/loss of function, 4) complications of injection including tendon damage/tearing due to lack of normal remodeling.

In general, no more than 3-4 injections per year in a single location and no sooner than 6-12 weeks between injections would be recommended, and personally I'd agree that it should be a later intervention once a full evaluation for other biomechanical factors have been addressed.

 

[Keys2Ski]

Well crap, went to foot Dr @a year ago complaining of heel pain ( felt like a spur) and occasional ligament impingement in ankle bone. He saw in my records that I saw his partner for a different foot issue a few years prior and went the aggressive route. Gave a shot directly into heel which caused a hematoma, sent me to get an mri(3 hr drive while wearing the boot…left my toes tingling when ever I worn it regardless of how loose the straps were) Gave rx for arthritis meds, a day boot, a night calf stretch boot. Wanted stretching to be done every hr on the hr…etc. came back with mri results to show a partial fused heel bone from birth ( but now I know why my right turns are not really a c shaped ) got fitted for $400 custom orthotics which do not really support arch and are too wide, and was asked to come back again. Each visit $100 out of pocket when I pressed for a solution not a cover up the symptoms approach, he started to suggest surgery for not only PF but for the fused bone as well.
I finally said f this!! Classic case of waste my time and money on trying to put a bandaid on my symptoms. Pain is gone after shot, so not sure why I continued to go back and listen to the bs of symptom treatment, when surgery was what he really wanted to sell.
if pain returns I will be looking for a dr that does prp injections instead. In the meantime I do wear my spenco flip flops until they dissolve. Also oofos around the house And tennis shoes with added arch support insoles ( same name brand that I used for years when I was running 1/2 marathons) I do stretches without really knowing it and have upped my magnesium intake. I’m tired of the let’s treat the symptoms approach to medicine, I want solutions!!
The only good thing out of this whole mess is I got an mri for $250 cash!!

 

[Rod9301]

Disclaimer - I'm not a professional in this particular area, but can comment on some generalities.

Like most things, the devil is in the details. For some tendon lesions, like trigger finger, there's good evidence for using steroid injections. For most other tendinopathies, not so much. There are several issues with using steroids for PF (or other tendinopathies), including 1) lack of evidence that it works short or long term, 2) doesn't change the biomechanical factors that led to the problem in the first place, 3) No evidence that inflammation is a significant component of pain/loss of function, 4) complications of injection including tendon damage/tearing due to lack of normal remodeling.

In general, no more than 3-4 injections per year in a single location and no sooner than 6-12 weeks between injections would be recommended, and personally I'd agree that it should be a later intervention once a full evaluation for other biomechanical factors have been addressed.

You're contradicting yourself, first, no evidence it works, then 3-4 injections per year.

This is bad advice. Why risk tendon rupture for an injection that just masks the symptom.

Doctors do this because it's easy. Finding the real biomechanical reason is a lot harder.

 

[Mel]

You're contradicting yourself, first, no evidence it works, then 3-4 injections per year.

This is bad advice. Why risk tendon rupture for an injection that just masks the symptom.

Doctors do this because it's easy. Finding the real biomechanical reason is a lot harder.

No I’m not contradicting myself. Even for conditions it works for, there is still a maximum frequency for injections.

 

[Prosper]

You're contradicting yourself, first, no evidence it works, then 3-4 injections per year.

This is bad advice. Why risk tendon rupture for an injection that just masks the symptom.

Doctors do this because it's easy. Finding the real biomechanical reason is a lot harder

What are your qualification to know what is considered medically bad advice and to have supreme insight in why doctors recommend certain treatments and not other? Please enlighten us in your omniscience.

 

[scott43]

On the plus side my current instance is improving well.. rest, stretching and careful management of load on the tendon..

 

[wiread]

What are your qualification to know what is considered medically bad advice and to have supreme insight in why doctors recommend certain treatments and not other? Please enlighten us in your omniscience.

regardless of his qualifications, nothing he's said about those injections and tendons has been wrong.

Experts are often wrong, and many do wrong things over and over and over because they were told by another expert because we've been trained to just trust the experts.

In this day knowing what we know and have for the past couple decades, I have no idea why injections would be anything but a last resort for a patient that has either done everything or won't do anything else. But it's never the best choice, it's just the last one. if I or anyone I knew found themselves in a providers office that used it as anything prior to that they better have some darn good compelling reasons.

I'm just some guy on the internet believe me or not. I'd suggest anyone faced with this become their own advocate and start learning some things

 

[Wilhelmson]

When my kids and most of their friends had it, they were all prescribed to wear boots for a few weeks. Has anyone had a dr recommend that they wear a boot if only at their home and at work? Thinking back to my broken collar bone, the ortho wanted me out of the sling and moving around as soon as possible. Maybe for us older folks immobilization is a lady resort lest it complicate matters even more.

As far a differing advice goes, my wife had vertigo a while back. The dr had her do the thing where she lays down and shook her head as if dispelling water from her ear (to reposition the crystals they said).
Now another person who has it does a similar but different thing, but with a specialist, not at home.

 

[Rod9301]

What are your qualification to know what is considered medically bad advice and to have supreme insight in why doctors recommend certain treatments and not other? Please enlighten us in your omniscience.

No particular qualifications other than the ability to research stuff, and not listen to outdated medical opinions.

I believe many if not most doctors have stopped reading research papers once they finished medical school.
So i don't believe many are up to date in their knowledge.

 

[Tom K.]

Years ago, before a big mtb road trip, my wife was suffering PF.

Tried most everything for weeks.

Then got several laser treatments and it went away and has never returned.

WORTHWHILE NOTE: I'm generally a huge pundit about things like laser treatment. I was wrong.

 

[Wilhelmson]

At the state track meet some kids wore copious lengths of kt tape. Maybe they know something I don’t, or were just teenagers being teenagers.

 

[Pete in Idaho]

Had PF real bad and could hardly walk. Riding chairlift one day and got into Boot discussion which led to my PF. Gentleman told me to go to a boot shop (regular boots) next to the golf shop on Division St. in Spokane. I did and the owner told me 1) I wore shoes/boots that were one side to small for me, 2) get some arch support footbeds. Bought size 10 tennis walking shoes, put a 30 dollar footbed in new shoes and walked out. Have had no PF since that day.

 

[Prosper]

No particular qualifications other than the ability to research stuff, and not listen to outdated medical opinions.

I believe many if not most doctors have stopped reading research papers once they finished medical school.
So i don't believe many are up to date in their knowledge.

And that belief is based on what? Has there been a medical opinion that you find to be outdated that has been expressed in this thread? Each medical specialty has specific requirements for continuing medical education among other requirements to maintain board certification. While that does not guarantee that a physician is up to date in how they choose to practice, it does require ongoing medical education.

regardless of his qualifications, nothing he's said about those injections and tendons has been wrong.

Experts are often wrong, and many do wrong things over and over and over because they were told by another expert because we've been trained to just trust the experts.

In this day knowing what we know and have for the past couple decades, I have no idea why injections would be anything but a last resort for a patient that has either done everything or won't do anything else. But it's never the best choice, it's just the last one. if I or anyone I knew found themselves in a providers office that used it as anything prior to that they better have some darn good compelling reasons.

I'm just some guy on the internet believe me or not. I'd suggest anyone faced with this become their own advocate and start learning some things

Are qualifications not important? If someone is providing medical information or advice would you have confidence knowing it was coming from someone who has no medical background? I would disagree that nothing he said about injections is wrong. I’ve pointed out some of the inaccurate, ambiguous statements he’s made in my previous posts.

Yes, people should be their own advocates and educate themselves as much as possible about their condition. When they get that information is very important especially since there is so much easy access to so much good and bad information.

Doctors do this because it's easy. Finding the real biomechanical reason is a lot harder.

It sounds like you believe that doctors do what is easy rather than what is best for the patient. Maybe you’ve had some negative experiences with doctors that lead you to believe this. In my personal and professional experience I’ve found that the vast majority of doctors are pretty hard working and that doing the easy thing is usually not in the patient’s best interest. If I did the easy thing all the time just about everyone with cold symptoms would get a prescription for an antibiotic. Not sure I want to go down this rabbit hole but it’s the middle of October and we’re all itching to get back on the snow. I hate to say this but it seems to me like you all know nothing about patient care, discussing treatment options and deciding together as a team among those options what is best for the patient. An unproven, non-evidence based treatment might be the best choice for a patient depending on their specific condition, symptoms, values and goals. An injection for PF might be the best choice for a patient in a specific situation. There are not that many things that are always and never in medicine which is pretty much true for anything for which a complex decision needs to be made considering many inter-related factors. I think I’m done with this thread. Have fun storming the castle.

 

[Jwrags]

And that belief is based on what? Has there been a medical opinion that you find to be outdated that has been expressed in this thread? Each medical specialty has specific requirements for continuing medical education among other requirements to maintain board certification. While that does not guarantee that a physician is up to date in how they choose to practice, it does require ongoing medical education.

Are qualifications not important? If someone is providing medical information or advice would you have confidence knowing it was coming from someone who has no medical background? I would disagree that nothing he said about injections is wrong. I’ve pointed out some of the inaccurate, ambiguous statements he’s made in my previous posts.

Yes, people should be their own advocates and educate themselves as much as possible about their condition. When they get that information is very important especially since there is so much easy access to so much good and bad information.

It sounds like you believe that doctors do what is easy rather than what is best for the patient. Maybe you’ve had some negative experiences with doctors that lead you to believe this. In my personal and professional experience I’ve found that the vast majority of doctors are pretty hard working and that doing the easy thing is usually not in the patient’s best interest. If I did the easy thing all the time just about everyone with cold symptoms would get a prescription for an antibiotic. Not sure I want to go down this rabbit hole but it’s the middle of October and we’re all itching to get back on the snow. I hate to say this but it seems to me like you all know nothing about patient care, discussing treatment options and deciding together as a team among those options what is best for the patient. An unproven, non-evidence based treatment might be the best choice for a patient depending on their specific condition, symptoms, values and goals. An injection for PF might be the best choice for a patient in a specific situation. There are not that many things that are always and never in medicine which is pretty much true for anything for which a complex decision needs to be made considering many inter-related factors. I think I’m done with this thread. Have fun storming the castle.

Cheers, @Prosper. I have been biting my fingers to not respond to the generalizations being made about medical care and how physicians practice. Heck, I am retired and I still read medical stuff almost every day. Dealing with massive amounts of information and individual patient needs is a lot of work and almost all of the physicians I have worked with in my 30+ year career tried to do what was best for the patient.

 

[wiread]

And that belief is based on what? Has there been a medical opinion that you find to be outdated that has been expressed in this thread? Each medical specialty has specific requirements for continuing medical education among other requirements to maintain board certification. While that does not guarantee that a physician is up to date in how they choose to practice, it does require ongoing medical education.

Are qualifications not important? If someone is providing medical information or advice would you have confidence knowing it was coming from someone who has no medical background? I would disagree that nothing he said about injections is wrong. I’ve pointed out some of the inaccurate, ambiguous statements he’s made in my previous posts.

Yes, people should be their own advocates and educate themselves as much as possible about their condition. When they get that information is very important especially since there is so much easy access to so much good and bad information.

It sounds like you believe that doctors do what is easy rather than what is best for the patient. Maybe you’ve had some negative experiences with doctors that lead you to believe this. In my personal and professional experience I’ve found that the vast majority of doctors are pretty hard working and that doing the easy thing is usually not in the patient’s best interest. If I did the easy thing all the time just about everyone with cold symptoms would get a prescription for an antibiotic. Not sure I want to go down this rabbit hole but it’s the middle of October and we’re all itching to get back on the snow. I hate to say this but it seems to me like you all know nothing about patient care, discussing treatment options and deciding together as a team among those options what is best for the patient. An unproven, non-evidence based treatment might be the best choice for a patient depending on their specific condition, symptoms, values and goals. An injection for PF might be the best choice for a patient in a specific situation. There are not that many things that are always and never in medicine which is pretty much true for anything for which a complex decision needs to be made considering many inter-related factors. I think I’m done with this thread. Have fun storming the castle.

Like I said, if a provider is suggesting it first they better have some darn compelling reasons. Otherwise yeah, I’ll stick with my generalizations I made earlier.

and you’d be wrong about my experience. On a daily basis.

 

[locknload]

Circling back around since I started this thread and the topic of steroid injections. I was back at my podiatrist today to get my feet scanned for my new custom orthotics. I asked him about the shots and the debate over whether the number of injections etc can become a problem. He said you can't have consistent or repeated injections near attachment points like the achilles or where the plantar fascia attaches. My shots were essentially in the arches and it calmed the irritation down well (that--and no running the last few weeks) so that he got a good scan of my feet. Anyhow...like all medicine...the answer is "it depends" on where the shots are and what the treatment plan and intent is. Generally, trying to constantly shoot something up is not going going to be fixing root causes..merely addressing symptoms. I don't play doctor on the inter webs or on tv but it seemed like this part of the conversation kicked up some debates and discussion back and forth. My symptoms are under control pending some new orthotics...but I'll have to be fairly careful in the meanwhile. Your mileage may vary. Let's all get out feet and bodies healthy for ski season!