Monday, March 7, 2022

PAIN 101: WHAT IS PLANTAR FASCIITIS?

As the weather begins to change and the days get longer, many people strap on their running shoes and hit the pavement. Spring officially begins the start of running season. 5k, 10k, 25k, marathon, and triathlons, seem to be available in every town across America.  Organized races have become as American as apple pie and high gas prices. Several years ago, I became motivated to run my first 25K.  I bought a new pair of shoes, downloaded the training guide, and dedicated myself to become the next great runner.  As a Physical Therapist, I felt like I had a leg up (no pun intended) on my fellow runners.  I knew the stretches, the form, and the proper treatments.  My training was going well.  I was following the trainers guide with perfect accuracy.   Two weeks before my big day, after a long run I felt some pain in the bottom of my right foot.  My initial reaction was  just overuse from my long run.  I iced it when I got home.  The next morning, I couldn’t walk when I got out of bed.  Immediately, I knew what I had—Plantar Fasciitis (PF).  In the clinical and runner’s world, PF is a curse word no one wants hear.  

PF affects approximately 3 million people per year.  PF is the inflammation of a thick band of tissue that connects the heels bone (calcaneus) to the toes on the underside of your foot.  The most common symptoms is sharp, stabbing pain in the bottom of your foot that is worse in the morning and after long periods of inactivity.  When getting out of bed in the morning, the bottom of your foot can feel like someone had pounded a spike through the bottom of your foot. The increase tension and stress of repetitive pounding (such as in running) can cause microtears in the plantar fascia causing inflammation and pain.

As in many musculoskeletal injuries the traditional model of ice, rest, and NSAIDS are recommended.  Normal recovery can last for months.  The current landscape of “finding the cure” for PF is essentially throwing as many things as you can against the wall and hope something sticks.  If you google “plantar fasciitis treatment” you will find thousands of options.  The treatment of PF is more quantity than quality.   The main goal is to immobilize the plantar fascia in a neutral position while decreasing inflammation.  Home remedies for treatment consists of stretching, toe socks (stretches out toes), rolling bottom of foot on a frozen water bottle, or a trigger point release over the plantar fascia using a golf ball (feel about as good as driving a nail into it).  

Basic physical therapy will offer stretches (plantar fascia and calf), soft tissue massage, exercise and modalities (electrical stimulation, US, Iontophoresis).  More sophisticated treatments involve ART (Active Release Technique), mobilization of cuboid, and low dye taping.  More aggressive treatments may consist of injections into plantar fasciitis, complete immobilization, and possible surgery depending on the severity and lack of healing with normal treatments.

Many treatment options are available online that advertise anything from a sleeve to a night splint, to relief splints.  Millions of dollars are spent each year in advertising to draw in the desperate suffers of PF.   New advancement in treatment has focused on Low energy shockwave therapy (ESWT) to block pain allowing the tendon to heal.

In my clinical and personal experience with PF, I have found a severe lack of successful treatment options.  Treatments neither rectified the situation or improved function.  In my experience the most effective treatments would:

1. Restore the biomechanics of the foot (cuboid mobilization)

2. Treat and control inflammation- non pharmacologically.  A wearable product that can deliver pain relief and anti-inflammatory qualities that can be worn multiple hours per day and night.  Current modalities are worn for short periods of time.

3. A functional immobilizer of the foot to keep pressure off the plantar fasciitis- similar to what a low dye taping does for the foot, while allowing normal walking.

Plantar Fasciitis is a challenging, difficult and often time frustrating injury that effects millions of people per year.  PF is not considered a serious injury on the spectrum of musculoskeletal injuries so there have been a lack of attention to effective treatments. Many suffers are active competitive people who struggle with the lack of effective treatment.  These people have to take weeks into months off from training because of this injury.  Traditional treatments have been lackluster in results which has spawned “gimmicky” devices that have flooded the market.  The need for a safe, effective treatment for PF is apparent.  These devices need to be validated to decrease consumer fraud.  The health care professionals need to realize that traditional treatments of ice, rest, and immobilizing are not effective for active people.


 Additional video: Plantar Fasciitis Stretches & Exercises

FROM 'ASK DOCTOR JO'*- These plantar fasciitis foot pain treatments should help relieve pain. Plantar fasciitis is basically an inflammation of the fascia on the bottom of the foot. It can lead to foot pain and make it hard to walk. One great treatment for Plantar Fasciitis is using compression socks, like the Eversport ones in the video. Compression socks can help you be active again by providing support for your aching feet. Their compression helps relieve pain and discomfort without cutting off circulation. They are comfortable to wear and are slim enough that you can wear your regular socksover them without it feeling bulky.


THE SCIENCE AND ART OF MEDICAL DIAGNOSTICS
Written by: Lennard M. Gettz, Ed.D & Noelle Cutter, PhD.
Edited by: Dr. Bobbi Kline

Medical diagnosis (Dx) is the information-gathering and analytical process of identifying a patient's actual condition.  It is a process of recognizing symptoms, often for the sake of treatment based on direct examination (both observational or through technologies). The accuracy of the data or physiological information collected from the patient is crucial in identifying the correct diagnosis and therefore the most appropriate treatment, and depends on the performance of the technology used, scanning protocols (blood tests, imaging per se) and the interpretation of the processing licensed clinician. 

Diagnosing the condition of a complex patient can have its challenges primarily because physiological symptoms are not always obvious or specific.  Where certain signs may appear to be one of various possibilities, a rash or a bump under the skin could mean many things, and it may take more than one type of exam to offer the information needed for a complete picture.  Even the most popular or recognized screening/early detection technologies (ie.blood tests, genetic tests or medical scans) could not claim 100% accuracy, but an experienced diagnostician can navigate the collected data toward a more reliable diagnosis.

The science of diagnosing ranges in complexity from a standard doctors' annual visit, to validating efficacy of a drug treatment (as with a clinical trial), to even more complex patient assessments such as determining the right course of treatment on patients with challenging disorders with limited global data such as new viruses or rare diseases*. According to the NIH, Rare diseases became known as orphan diseases because drug companies were not interested in adopting them to develop treatments. The Orphan Drug Act created financial incentives to encourage companies to develop new drugs for rare diseases. The rare disease definition was needed to establish which conditions would qualify for the new incentive programs. [1]

The "Art of Diagnosing" a complex disorder should be performed by experienced interpreters of collected data, or a collaborative team working on a complex patient case. Expert radiologists and clinical analysts (among others) have the ability of acquiring scans and quantitative data, and explore other possible biometrics to expand on the existing tests to form a wider set of possible conclusions.  This level of detective work is often called upon during a "Second Opinion" test if a patient or leading practitioner is not satisfied with the initial report, most likely due to an inconclusive primary report or if "something doesn't feel right or make sense". This instinctive reaction fosters further digging or DETECTIVE WORK.

The clinical analysis field is organized in various types:
Descriptive (reporting on how the injury/disease occurred), Exploratory (why it occurred), Predictive (what can happen next) and Prescriptive Analysis (what treatment to recommend)- each offering a critical role in the end point of patient care. 
[TBC- 'what makes a medical detective']

REF: 


INNOVATION NEWS:
The latest in Plantar Fasciitis wearable therapy


3/7/2022- A novel “dynamic” night splint aims to improve the efficacy of the therapy, and improve patient tolerability. The design allows a user to fall asleep with the foot in a natural plantar flexed position, then slowly cycles the foot between plantar flexion and dorsiflexion while the user sleeps. The electromechanical design delivers a preferred treatment (active rather than passive stretching), when the patient can most benefit from therapy (immediately prior to initial loading after prolonged inactivity), at a convenient time (while sleeping) and in a comfortable manner. Treatment is controlled and improvement is tracked through a mobile app.

The product is being developed by Kenai Design, with funding through an SBIR grant from the National Science Foundation. Eric Kolb, inventor and co-founder, recently showcased the device at the American Physical Therapy Association annual meeting. “We received positive feedback from many physical therapists who are frustrated with the poor patient compliance of traditional night splints. They really appreciated the benefit our device could provide for those with chronic plantar fasciitis and a number of other medical conditions. Kenai Design is continuing to refine the design and hopes to receive additional grant funding to ready the product for commercial use. They are looking to collaborate with clinicians and strategic partners to bring this exciting wearable technology to market.

* The information in this segment is part of NYCRANEWS.com MedTech Reviews and is published for informational purposes only and is not published for any commercial or marketing purposes.   No material on this site is intended to be a substitute for professional medical advice or scientific claims- and is presented only ANECDOTAL findings pertaining to the effects and performance of the products/technologies being reviewed.




ABOUT THE AUTHOR
Josh Schueller has dedicated his life's work to the support and treatment chronic pain and disorders with non-invasive, safe, effective treatment solutions. He is the current VP of Clinical Operations and Business Development at AxioBionics LLC. and the Clinical Director for Orthopedic Physical Therapy Clinics (Rockford, MI).  As an active member of APTA, he holds advanced certification in Physical Therapy treatment techniques including the McKenzie method of patient empowerment.  He has over 20+ years experience in the treatment of neurological conditions such as Spinal Cord Injury, Traumatic Brain Injury, CVA, Cerebral Palsy etc.  In 2021, Josh is elected a clinical advisory role and educational advocacy for IPHA (Integrated Pain Healers Alliance) and has published research articles in pain management while co-launching the MedTech Reviews program of therapeutic devices.   Today, Josh continues to support patient suffering from disabilities and has expanded his focus to contribute his expertise in treatment programs for Veterans and first responders. 

*SPECIAL THANKS: We wish to express our deepest gratitude to "ASK DOCTOR JO" for sharing her video series on pain relief of Plantar Fasciitis.  Doctor Jo is a licensed physical therapist and a doctor of physical therapy. She graduated from the University of South Carolina Doctor of Physical Therapy program. Dr. Jo has worked in many different settings including: outpatient hospital-based rehab, acute care, inpatient rehab, outpatient sports medicine, and aquatic therapy. She has worked with a wide variety of patients ranging in ages from 1 to 92, including NFL athletes and great-great-grandmothers. Dr. Jo also runs the popular “Ask Doctor Jo” YouTube channel and website, where she exposes as many people as possible to the benefits of physical therapy, especially those who don’t have access to adequate healthcare. Ask Doctor Jo has hundreds of thousands of subscribers on YouTube, Facebook, and other social media channels.




Disclaimer: The information (including, but not limited to text, graphics, images and other material) contained in this article is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice or scientific claims. Furthermore, any/all contributors (both medical and non-medical) featured in this article are presenting only ANECDOTAL findings pertaining to the effects and performance of the products/technologies being reviewed - and are not offering clinical data or medical recommendations in any way. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, never disregard professional medical advice or delay in seeking it because of something you read on this page, article, blog or website.

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