Plantar Fasciitis

By Craig Payne,

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I find myself writing a lot about this lately and not on the usual run-of-the-mill stuff about it (a good summary of that stuff will be here when its finished). That information is widely known and widely taught. What has been occupying my time has been all the pseudoscience, quackery and snake oil on it, and there is a lot. Not a day goes by in which I do not find something online that need debunking.

There are so many pretend experts out there on plantar fasciitis making all sorts of extraordinary claims as click bait to get traffic to their websites and sell you a product or service.

At the end of the day here are the key points I hammer on about:

  • What is plantar fasciitis? – it occurs when the cumulative load in the plantar fascia exceeds that the tissues can take. This is a mechanical problem that needs a mechanical solution. Generally, in the short to medium term you reduce that load and in the medium to long term you increase the ability of the tissues to take the load. I wrote this: Plantar Fasciitis – how then do you treat it? and this: Strengthening vs Stretching for Plantar Fasciitis about those options and that approach
  • Non-mechanical interventions still have an important role to play as they often help facilitate the healing of the tissues, but I question their long term use if the load issues are not addressed at the same time
  • The natural history of plantar fasciitis is that it does get better on its own. A lot of people do not believe me, especially those who have had it for a long time! But, just look at the placebo or control groups in all the clinical trials on plantar fasciitis. They all get better. But, that may take a long time and it does hurt a lot, so that is no reason not to treat them. The importance of this is that we should only be using treatments that have been shown in clinical trials to do better than that natural history. That is why snake oil approaches get promoted so much. If one was to use one of those approaches just as there is a natural down swing in symptoms as part of that natural history then of course that useless snake oil is going to get the credit. I wrote more about this here: The Problem with the Treatment of Plantar Fasciitis
  • Get the diagnosis right. Plantar fasciitis is extremely common, but there are a lot of things that have similar symptoms. A number of the “snake oil” approaches for plantar fasciitis might work because it was not plantar fasciitis in the first place. But that treatment gets recommended as it “works”.

We really do need to stick to the evidence and be wary of extraordinary claims with extraordinary evidence.

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