Fortnightly review: Plantar fasciitis
BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.172 (Published 19 July 1997) Cite this as: BMJ 1997;315:172
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Sir,
In the article the authors had claimed the plater fasica is the most common cause of inferior heel pain and they have suggested some treatment for it. In my practice I have noticed than planter fasciitis is not the common cause of heel pain but the most common cause is the referred pain from the calf muscles particularly the medial head of gastronemius, althogh the later can be itself due to lumo-sacral pathology.
First of all the there is not aetiology mentioned for the common planter faciitis but certain predisposing factors and the mostly the local treatment that is stretching the Achiles tendon is illogical to treat the plater fascia. The stretching techniques mentioned in the article further over stretch the inflammed planter fascia. In fact the stretching technique relieves the Trigger Point in the medial head of gastronemius.Any practioner in back pain knows that while treating the back pain also relieves the heel pain in significant number of people.
Lastly the symptoms of most common heel pain is the sever pain at the commencement of walking after some rest and the pain deccreases on movement also negate any local planter fascia pathology. In fact there are some patients who have local panter fascia pathology and they become worse after stretching therapy.
The second most common cause after gastronemius muscle is the lesion(Trigger Point) at the quadratus plantae muscle which can be relived by local stretching.
The most evident proof of involvement of medial head of gastronemius is the stretching after cold application or injecting the trigger point with lignocaine with or without steroid immediately relives the heel pain in more than 90% of the patients. And only one or two therapies are required to get a permanent cure.
Competing interests: No competing interests
Ice Vs Contrast Ice/Heat in Heel Pain
Your article was quite interesting but probably not sufficiently
thorough. I have two thoughts to add. In 40 plus years of practice I have
found that a high number of patients presenting with heel pain do, indeed,
have a fibrous type growth in the fat padding. Over the years I have
excised a number of these growths which invariably are described
pathologically as neuromas or neourofibromas.
These patients generally describe the same set of symptoms that you
attribute to plantar fasciitis, but in addition also describe a sharp,
shooting or lancinating pain that may go distally or proximally. They also
have pain on squeezing pressure of the medial side of the heel.
Palpating the growth has been described as a Lamp Cord Sign (like
palpating a lamp cord under a thin carpet). The mathod involves using the
base of the thumb pad to press and push the fat padding of the heel
forward then rolling the thumb from proximal to distal while pulling it
backward. The entire heel pad needs to be examined.
My second observation is that ice has been touted by most authors as
the physical therapy of choice for painful heel, and this is certainly
true for acute cases. But it has been my experience that people do not
seek help for heel pain until it has long been chronic. We have found
that contrast therapy of ice/heat is more benficial especially if used
along with massage. Such a device finally exists in the form of "THAT
FOOT THING". This consists of two ribbed plastic bottles attached to a
center connector that allows the bottles to spin. One bottle is filled
with ice water and the other hot water. The foot is slowly rolled from
toe sulcus to over the heel for one minute on the ice side bottle a then
moved to repeat the massage on the hot side bottle. This is done for a
total of ten minutes two or three times per day.
Competing interests:
I am an inventor, manufacturer, and seller of the product (THAT FOOT THING) mentioned in my response.
Competing interests: No competing interests