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THE TREATMENT TRIAD | SOUTH TEXAS FOOT SPECIALIST 

San Antonio Podiatrist, Dr. Ed Davis coined this term several years ago.  It is a term that describes the long term progress of plantar fasciitis and why different treatments are more effective for different stages of the disease.
1) Acute plantar fasciitis:
This involves a "strain" of the fascia from overuse or use of inadequate shoegear.  it is often self limiting and may be treated via rest, ice massage, anti-inflammatory medication and use of better, more supportive shoegear. Sonographic exam may demonstrate modest swelling of the fascia.
 
2) Plantar fasciitis that persists/ chronic plantar fasciitis:
Plantar fasciitis that persists for more than a few weeks often does so due to chronic repetitive strain. That may be caused by the reasons discussed on the left....subtalar joint overpronation, midtarsal joint oversupination, functional equinus or poor shoe design. Sonographic examination often demonstrates thickening of the fascia, scar tissue, and sometimes calcification of the fascia. Calcification of the fascia used to be termed "heel spur" syndrome.   X-rays are two dimensional representations of the problem leading to that term. The underlying mechanical problems need be addressed at this stage.
 
3) "Recalcitrant" plantar fasciitis or plantar fasciosis:
Chronic inflammation is not handled well by our bodies. Chronic inflammation in the arteries may lead to atherosclerosclerosis. Chronic inflammation of tendons and ligaments leads to thickening, scar tissue, decrease of tissue flexibility and a reduction in blood circulation. Sonography demonstrates thickening of the fascia with changes in the texture of the ligament. Scar tissue tends to crowd out good tissue.  Neovascularization (the production of new blood vessels) is difficult due to the density of the diseased tissue. This stage had been difficult to treat with one of the main procedures involving the surgical release (cutting) of the fascia. It is my opinion that such surgeries are obsolescent due to the availability of ESWT and the Topaz Procedure.
For more information on Heel Pain in the San Antonio, TX area, call Ed Davis, DPM, FACFAS. at (210) 490-3668 today!

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