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Plantar fasciitis is a self-limiting condition

I gasped when I read the suggestions of Mr Alex Watson on the management of plantar fasciitis ('Heel and ankle problems'). This is by and large a self-limiting condition, and there is very little evidence any of these interventions actually work.

The idea of giving injections under 'full sedation or a quick general anaesthetic' disturbs me greatly. This is expensive and risky with no proven benefit. The vast majority of these patients should be managed in primary care. Most will get better in 12 months and simple measures to manage the pain (analgesia and heel cups) along with stretches will suffice.

Physiotherapy is unnecessary and has not been shown to be beneficial. I urge GP colleagues to disregard his advice.

From Dr Denis O'Brien, Liverpool

There is an abundance of evidence in peer-reviewed literature that the first line of treatment for plantar fasciitis is physiotherapy by means of stretching, strapping and night splintage with excellent outcome1. Local anaesthetic and steroid injections give temporary or permanent relief but may be painful, hence the need for sedation or general anaesthesia2, and recurrence is less likely if the injection is administered under image control3. The only truly evidence-based controversial treatment often used for plantar fasciitis is extracorporeal shockwave therapy4.

I agree that the condition by and large may be self-limiting but I do not consider it acceptable for patients to suffer for 12 months, as the condition is often debilitating and distressing.

I urge GPs to instigate simple stretches and provide heel cups and analgesia but then to review early and if the patient remains symptomatic to refer for physiotherapy and specialist treatment.

From Mr Alex Watson, orthopaedic surgeon at the London Orthopaedic Clinic and the Princess Alexandra Hospital, Harlow, Essex

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