Should this inflammatory reaction persist for a sufficient period of time, the response is usually the formation of a calcaneal spur. This pathological and clinical scenario is typical of the progress of such a lesion. My medical instructors in physical therapist school presented this mechanism as the typical process by which such lesions progress. More than 30 years of experience on my part has confirmed the accuracy of this explanation.
In addition, radiographic evidence which I have on file further substantiates the accuracy of this explanation. Upon formation of the calcaneal spur (which followed the plantar fascitis), and with the respective resolution of the inflammatory reaction, the pain abates. For this reason, plantar fascitis is referred to in orthopedic circles as the clinical antecedent to calcaneal spur.
The orthopedic surgeons by which I was trained commonly elevated the heel by prescribing elevated heels on the shoes being worn and oral NSAIDs to encourage resolution of the inflammatory process. It was seldom necessary to inject the site of pain with a lidocaine/steroid preparation. In place of the injection, I administer lidocaine/steroid agents by pulsed phonophoresis using 0.75 W/cm2 x 5 minutes.
I have been practicing this approach for 30 years now, and it has proven effective. Only once was it a problem because of the sensitivity of the patient to lidocaine and the fact that she informed us she was not lidocaine-sensitive. In my experience, the most common reasons for the pain of plantar fascitis to react to treatment intractably is patient noncompliance or the lack of an astute understanding of the pathological process by the practitioner, which results in a poor clinical regimen of care.
- Griffin & Karselis. Physical Agents for Physical Therapists, 2nd edition. Thomas Publishers, 1982.
- Krusen, Kottke & Ellwood. Handbook of Physical Medicine & Rehabilitation, 2nd edition. Saunders Publishers, 1971.
- Schriber. A Manual of Electrotherapy, 4th edition. Lea & Febiger Publishers, 1975.
- Davis. Therapeutic Modalities for the Clinical Health Sciences, 2nd edition. 1989, Library of Congress card #TXU-389-661.
- Cailliet. Soft Tissue Pain & Disability. F.A. Davis Publishers.
R. Vincent Davis, DC. PT, DNBPM