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Am Fam Physician. 1999;60(9):2504

to the editor: I read the article by Drs. Barrett and Mosby1 and as a family physician who has incorporated acupuncture into daily practice, my experience with plantar fasciitis may be of interest. With a combination of acupuncture, strapping and exercises to stretch the plantar fascia, all patients I have treated experienced relief. Generally, four to six treatments are necessary. I have observed a good response even in patients who have failed to respond to all other treatments, including steroid injections and casting.

in reply: As a physician who specializes in diseases and disorders of the human foot, with a subspecialization in heel pain, it is difficult to respond comprehensively to Dr. Steinmetz's letter because of the complexity of conservative care for the treatment of plantar fasciitis. While it is difficult for me to believe that Dr. Steinmetz's treatment regimen of acupuncture, strappings and stretching exercises cures everyone, these modalities (with the exception of acupuncture) are fundamental in the sound treatment of patients with plantar fasciitis.

I would add that we have an extremely high success rate with our conservative care regimen that includes strappings and stretching. I think what is important is that the success of conservative care for the treatment of patients with plantar fasciitis requires a “concert” of modalities. Rarely, without some type of biomechanical control, will any of these modalities alone be effective. In addition, I have had patients who related that acupuncture had indeed helped them; albeit, they already had biomechanical control intervention.

It is a great injustice for a patient to be declared a conservative care failure and subsequently taken to surgery, when in fact, the only conservative care the patient received was a misguided and fragmented approach to treatment. Can a physician of any specialty believe that without any other modality (i.e., biomechanical control), an isolated injection or two of a steroid will really help a patient with plantar fasciitis?

The importance of Dr. Steinmetz's letter is that it reflects a multifaceted approach in the treatment of plantar fasciitis with biomechanical control. One final comment: just because a patient fails to return to the office does not necessarily mean that a “cure” was achieved. I have seen many new patients presenting with plantar fasciitis who possess a bag of several different pairs of orthotic devices. I am sure that each one of the previous prescribers believed that the patient had been “cured.”

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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