Five Reasons To Ban Heel Injections For So-Called Plantar Fasciitis (NFP)

Steroid injection. If your pain is severe or doesn’t respond to prescribed NSAIDs, you might want to think about getting a steroid injection. WebMD

Please note: If you strongly disagree with me, would you kindly (a) refute each of my five ‘arguments’ on the basis of data and logic, and (b) explain the following graph. If you consider these data to be insufficient for interpretation, please direct my readers and me to a better data set. Calling my work junk science (a scientist), based on BS (a podiatrist) or garbage (another podiatrist), does not qualify as reasoned debate. Kindest regards, kev

ONE: Risk of plantar fascial rupture. Fasciitis = inflammation of fascia (a dense connective tissue). Many doctors reach for anti-inflammatory drugs to treat plantar fasciitis, including cortisone heel injections. However, one study (Lemont, Ammirati and Usen, 2003) demonstrated there was no inflammation present in the plantar fascia in such cases. Tom’s studies of this progressive ‘disease’ were also consistent with the absence of inflammation in this condition. Lemont et al. (2003) stated that, “Serial corticosteroid injections into the plantar fascia should be reevaluated … in light of their potential to induce plantar fascial rupture.”

A cortisone heel injection gone wrong. Plus, it was the wrong thing to do in the first place. Do you really want to risk this? With permission from the owner of the foot.

TWO: Risk of infection. Matt nearly lost his foot as the result of a heel injection for ‘plantar fasciitis.’ It’s always dangerous to break the body’s protective barriers. They are there for a reason. Matt’s foot became infected in the region of the injection, with extremely dangerous bacteria – MRSA (Methicillin-Resistant Staphylococcus Aureus). As the name tells you, it’s a difficult infection to treat. Surely, the Australian study (see below) should have told Matt’s physician to know better.

THREE: Any pain reduction only lasts up to four weeks. This was the conclusion of a well-designed study that in my opinion explored the wrong question. Here is what the publication by McMillan et al., (2012) had to say: “A single ultrasound guided dexamethasone injection is a safe and effective short term treatment for plantar fasciitis. It provides greater pain relief than placebo at four weeks and reduces abnormal swelling of the plantar fascia for up to three months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond four weeks.”

FOUR: Common medical sense. “Doctors know what they’re doing. Right? They are highly trained in the treatment of pain. As Tom cogitated, he remembered the doctor saying he might need a heel injection. A what? What was she thinking? This raised Tom’s suspicions concerning whether this doctor really understands the structure and function of the heel. As a medical professional, the thought of a heel injection horrified Tom. His thoughts went like this:

The connective tissue of the heel isn’t a random blob of collagen and elastin. It’s a complex living structure that responds to load. Interactions with the ground, as we move, subject it to shear and compression forces. This creates patterns of strain throughout the collagen/elastin network, thus sculpting the structure of the molecular cross-links and alignments within this critical support system. Jabbing needles in there is like chucking paint on a work of art, or jamming a spanner (monkey wrench) in the works. Plus there’s the risk of infection.

Moshe Feldenkrais developed the Feldenkrais method, which FitOldDog really admires because it is so effective.

Tom was suspicious, the first step in the scientific method. Clearly, more thought was needed.” Morgan (2018).

FIVE: Looking in the wrong place for the source of the pain. It’s not uncommon to assume that the source of pain lies in the site of the pain. I always did that myself, until Karen Dold and the art of “Feldenkrais fixed my knee where everyone else failed.”

In conclusion: If you have acute morning (or runner’s) heel pain, and it’s diagnosed as “plantar fasciitis” by a health professional, look to your hips. This is almost certainly the most common source of the problem. It’s generally due to a soft tissue imbalance that can be fixed. My second case was caused by a hip-subluxation (mild dislocation), and triggered by one short use of arch supports.

This heel pain, that afflicts millions, has the wrong name. A better moniker is Nociceptive Foot Pain and it comes in multiple forms.

Hey! Doc! Wake up and smell the coffee and put down that syringe. Check your patient’s hip alignment, or send them to someone who can, such as an osteopathic doctor or a physical therapist. OR suggest a body-movement modality, such as Feldenkrais or Yoga, and encourage them to get in touch with their bodies a little more.

I love doctors when they save my life, which they have a number of times. I just get frustrated as a medically-trained person (veterinarian), when an obvious course correction is being ignored.

Wishing you happy feet and happy trails.

kev aka FitOldDog

PS This image should be in every doctors office, I should know as a 75-year old triathlete, myself. Half my friends are dead, and some others walk like old people.

Oh Yes! Please kill those low-fat diet posters. We know better now.

Look and learn!

PPS This is an Old Dogs in Training, LLC, publication.