New treatment for plantar fasciitis.

Over two million people are treated in the United States each year for plantar fasciitis--fondly known as PF to a multitude of runners all too familiar with its painful symptoms. The plantar fascia is a wide band of tendon-like connective tissue that stretches from the toes to the heel. Injuries to the plantar fascia resulting in inflammation can be due to biomechanical abnormalities that place too much stress at the heel, running on hard or soft surfaces, wearing worn out, ill-fitting, or defective shoes, overtraining, or sudden increases in volume or intensity of training. The result, regardless of the cause, is sharp, knife-like heel pain that is most severe when taking your first steps in the morning. Pain is also intense after long periods of sitting during the day.

The FDA has recently approved a new treatment for chronic plantar fasciitis that hasn't responded to conservative treatment. The treatment uses shock waves (similar to that used to treat kidney stones for the past 10 to 15 years). The Ossatron, a shock wave device, delivers about 1,500 shocks at 18,000 volts (yes, a bit painful) over a 30-minute period. A local anesthetic and ear protection (it's also noisy) are provided. Studies of the device demonstrated significant improvement in heel pain as compared to placebo, leading to FDA approval. For those whose pain improved, pain was reduced by 89%. Although it may take as much as six weeks to notice improvement, some patients reported near complete pain relief a year later.

The treatment is not without risks: damage to blood vessels and nerves has been noted in a small number of cases and it is not for pregnant women, children, people with a clotting disorder, or those taking medications that interfere with clotting function. Further, insurance companies have not begun to pay for this expensive treatment widely as yet, so don't assume that it will be covered. But for those who have not gotten relief from traditional, conservative care, (for example, rest, non-steroidal anti-inflammatory medications, ice, stretching, orthotics, night splints, and physical therapy), this is a new tool that may get you back on the road again.

(Journal of the American Pediatric Medical Association, 2001, Vol. 91, No. 2, pp. 55-62; Clinical Orthopedics, 2001, Vol. 387, pp. 47-59 and 68-71; The Physician and Sportsmedicine, Vol. 29, No. 3, pp. 16)