Q&A with Consultant Orthopaedic Surgeon Mr David Gordon: Plantar fasciitis
Laura Harman Senior BOOST Physio interviews Mr David Gordon and asks him about plantar fasciitis…
Mr David Gordon is a Consultant Orthopaedic Surgeon, specialising in the treatment of foot, ankle and knee conditions, with a particular interest in minimally invasive surgery and sports injuries. His practice is based in London and Hertfordshire, England and has been practising orthopaedics since 1998. He strives for surgical excellence and believes in involving his patients in decision making throughout their treatment. Fundamental to this is excellent communication. He bases his management of orthopaedic conditions on the best scientific evidence available, together with state of the art equipment and techniques. Together with a dedicated team of sports physicians, musculoskeletal radiologists, physiotherapists, osteopaths, and podiatrists, Mr Gordon offers a comprehensive approach to the care of foot and ankle conditions. He sees over 900 new patients annually and performs over 400 procedures per year.
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Q.Plantar fasciitis is a common and frustrating condition, what are the main causes for it?
Mr Gordon: Laura absolutely, plantar fasciitis is a very common problem that I see in my clinic regularly and it can be a real cause of concern for patients, as they are unable to participate in activities they wish to.
As you know plantar fasciitis is heel pain on the sole of the foot classically worst first thing in the morning and when the patient gets up after sleep or following periods of rest after. Following prolonged activities or walking, the pain can also come on.
Although the word ‘fasciitis’ indicates an inflammatory cause this is not the main problem with plantar fasciitis, (plantar fasciopathy is a better term). It’s not entirely clear why people get plantar fasciitis but its thought to be a degenerate problem and it typically effects are middle aged older people, women are slightly more often affected than men. It’s risk factors include increased body weight, people who walk a lot and play sport on hard surfaces. A tight calf muscle is also a risk factor.
Q. Is physiotherapy useful in the treatment of plantar fasciitis?
Mr Gordon: Absolutely, physiotherapy is the main stay of treatment for plantar fasciitis and at its core are stretching exercises of the plantar fascia as well as the Achilles tendon and the gastrocnemius (calf) muscle.
Q. What are your thought on steroid injections for plantar fasciitis?
Mr Gordon: Steroid injections to the plantar fascia are certainly a well-established treatment but I personally don’t use steroid injections for number of reasons. They’re extremely painful to administer for the patient, the results are often unpredictable, if pain relief is achieved then it can return sometime later. There is also a risk of plantar fascial rupture which can be very problematic although this is very rare. Steroid injections also prevent the use of one of the best treatments for plantar fasciitis – shock wave therapy. One has to wait 3 months following a steroid injection in order to start shockwave.
Q. You are involved in research into shock wave therapy for plantar fasciitis and Achilles tendinopathy. Can you tell us a little more about this?
Mr Gordon: My preferred management is for physiotherapy, avoid steroid injections and perform shockwave therapy. Shockwave therapy is a proven treatment for plantar fasciitis and Achilles tendinopathy and it involves using a handheld probe placed on the skin which emits a sound wave for approximately 5 minutes into the affected area. One has 3 sessions spaced a week apart. Pain relief may take up to 3 months however.
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