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Dynamic Chiropractic – June 15, 1998, Vol. 16, Issue 13
Dynamic Chiropractic
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Dynamic Chiropractic

Comments on Management of Plantar Fascitis/Calcaneal Spur

By R. Vincent Davis, DC, PT, DNBPM

Cailliet is commended for clinical insight in her descriptive writings about plantar fascitis. This is a product of a fascial traction phenomenon involving the plantar fascia at the point of junction of the plantar fascia and the calcaneal periosteum. It is common for this phenomenon to be present when the heel has been elevated for any reason and then lowered, or when power walking or running has resulted in the shortening of the plantar fascia. This traditional phenomenon results in an irritative process at the point of this junction. This irritative phenomenon results in an inflammatory reaction, which is the focal point of the resulting pain.

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.

References

  1. Griffin & Karselis. Physical Agents for Physical Therapists, 2nd edition. Thomas Publishers, 1982.
  2. Krusen, Kottke & Ellwood. Handbook of Physical Medicine & Rehabilitation, 2nd edition. Saunders Publishers, 1971.
  3. Schriber. A Manual of Electrotherapy, 4th edition. Lea & Febiger Publishers, 1975.
  4. Davis. Therapeutic Modalities for the Clinical Health Sciences, 2nd edition. 1989, Library of Congress card #TXU-389-661.
  5. Cailliet. Soft Tissue Pain & Disability. F.A. Davis Publishers.

R. Vincent Davis, DC. PT, DNBPM
Independence, Missouri

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