This topic contains 5 replies, has 2 voices, and was last updated by Scott Glidden July 31, 2018 at 12:38 pm.
July 27, 2018 at 11:12 am #3708
37 year old female with 8/10 sharp plantar surface pain near calcaneus since March 2018. P+ Running or standing up in the morning, P- rest. Found AD restriction of 3.5″ and with treatment improved it to 5.5″. Stagnated for several visits with no symptomatic improvement. Got an MRI and the results were “severe medial plantar fasciitis, including partial thickness tearing, along with reactive edema in the adjacent musculature.” Image is below. I told her that we know exactly what to do now but that this will be a slow process. What is a reasonable timeline for treatment? I imagine with partial thickness tears you can’t you an eccentric tension approach as you would a tendinosis. I told her it would be at least a couple weeks to see any improvement, but should I temper her expectations further?July 29, 2018 at 1:18 pm #3732
Good stuff Scott.
Due to the severity of her symptoms, the degeneration in the tissue, and the load she will continue to put on it (standing and walking), Bill has mentioned that PF or Achilles Tendon issues can take months to resolve.
I wouldn’t give the 2 week timeline. I’d stretch that out to 2-6 months.
Load management is going to huge to get an progress.
I’m curious if the 2″ gain resulted in any relief at all?July 30, 2018 at 9:35 am #3733
William Brady, DCParticipant
Respect pathology! You have to create a healing environment with treatment and load management. Then you have to give it time to heal. This will absolutely take many months to gradually heal and improve capacity. She will have some permanent reduction in capacity (due to tearing), which may still be asymptomatic if she follows your load advice.
Do not do eccentrics for the plantar foot. Eccentric exercises are for tendons not fascia or ligaments.July 31, 2018 at 8:00 am #3734
Thanks for the input! I’ll be sure to relay the reset in expectations firmly and hopefully she will understand and not wash out because she doesn’t what I’m saying. She’s a very Type A “I must do something or I will go crazy” type person. She hates the idea of swimming, so I’m going to recommend eventually trying cycling. Would anybody else have any other suggestions for activities for this type of person?
Also- No reduction of pain whatsoever with the 2″ AD improvement.July 31, 2018 at 10:51 am #3735
Carl Nottoli, DCParticipant
What she says she wants and what her actions tell you are incongruent. It’s your job to help her see the reality of the situation and heal. She won’t be able to do anything for a very long time if she doesn’t follow the prescription.
Be patient, be calm, and help her see the big picture. You both want her to be healthy and active. You are helping her stay as active as she can right now, but she has to sacrifice the immediate gratification for long-term success. Otherwise she’s in for a long road of suffering. This is not as bad as it can get.July 31, 2018 at 12:38 pm #3736
After our appointment today she said she won’t even go on a walk without my approval, so I think she is starting to come around to her new reality. She also said that she “might” even feel like a 7/10 instead of an 8/10. I told her that is wonderful, but even if she has experienced a mild change in symptoms we still have a long way to go before she is in a position to get out and challenge her abilities in the slightest. She seemed on-board with that.
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