Association of Plantar Fasciitis and Plantar Fibroma?

Thanks to everyone on the Facebook group and the Facebook page I have results from over 50 patients on a small survey about plantar fasciitis. On the group we noticed that there seemed to be a high percentage of patients with plantar fasciitis and thought we could  have a quick look and see if the numbers added up. 

So as graph 1 below shows of all the respondents with Ledderhose 45% had plantar fasciitis, bearing in mind that reference 1 says that the average for the States is 10% this would appear to be a meaningful number. 

Graph 1: Percentage of Ledderhose patients with Plantar Fasciitis

On the patient survey that we are conducting (over 2000!!!! responses) frozen shoulder was only present in around 20% of patients and knuckle pads in 13%. This suggests that the above could be a true link. The problem is that the conditions could linked not because they are from the same genetics or pathways (as is thought to be the case with Dupuytren's and Ledderhose) but because one can trigger the other or just coincidence but as a former scientist I don't think that is likely.

Graph 2: Distribution of Plantar Fasciitis onset in Ledderhose patients

If we think about these 2 conditions a link due to proximity could make sense. Plantar Fasciitis is an inflammation and or swelling of the the same tissue as plantar fibromas form on. Plantar fibromatosis is the formation of lumps on this tissue, surely the formation of a lump that is not supposed to be there is likely to cause some swelling and inflammation?

So it could be that rather than patients having plantar fasciitis on its own what they actually have is early stage Ledderhose which presents symptoms highly similar to fsaciitis because of the additional strain put on that part of the body. The results shown in graph 2 indicate that 80% of patients that had the plantar fasciitis start either at the same time or before the Ledderhose which is what we would expect if one was a factor in the other condition. 

On the Facebook page I also had a comment making a good point. The point being that potentially more patients with Ledderhose could have this condition but it has not been diagnosed as any pain etc is being put down to the Ledderhose. This is potentially the case but how can we know? I know that I was told that pain with Fasciitis is when you first get up and first start walking whilst (at least in the initial stages) the pain with a fibroma is likely to build up over the course of a day and get worse.

The results of this small survey are clearly not conclusive however it is certainly interesting that such a high number of Ledderhose patients have this condition and of those that have it most get it either before or at the same time as the Ledderhose.

References:
Reference 1: http://www.aafp.org/afp/2005/1201/p2247.html

Shockwaves for Dupuytren's, Ledderhose and related conditions

Recently I came into contact with a gentleman at Cell Sonic, they manufacture the equipment used to treat with Shock-Waves. This is an interesting treatment which has very little documented evidence. My gut says that this is a treatment that is worth a try. From what I have read it appears that there is very little to lose in terms of side effects or aggravating the condition but it could potentially help. Really what is need is a bigger and better study than the one I discussed before. 

Anyway the guy that I spoke to is extremely passionate about this technology and it was clear to me that he really thought that it could be a great way to treat many different problems. 

Below is a copy of some information that I received from CellSonic and have published with their full permission. If there are any doctors that are interested in using this treatment then please get in touch. I have been told it is a diverse piece of equipment and that it would pay for itself without even taking into account the conditions I am interested in. Then again the person selling it is of course going to say that. 

Doing a bit of research and a quick search of PubMed certainly shows that there is a lot of information out there and it has been used to treat scar tissue and many other conditions. 

http://www.cellsonic-medical.com/cellsonic.htm

Dupuytren's contracture can be almost totally cured using CellSonic’s electro-hydraulic shockwaves. This is a non-invasive, drug free treatment that takes about five minutes. Sudden bursts of sound are directed into the palm and fingers to loosen the tightening cells pulling the fingers. The vital characteristic of a shockwave is that from zero decibels to high must happen in a few nanoseconds. To achieve that, CellSonic flashes 25,000 volts across a one millimeter gap inside water and the sound wave projected through gel into the hand which is also acting as water. The fast moving sound wave hits the tightened cord and stretches it. Moreover, it activates stem cells to migrate to the site because through the nerves the brain has detected a problem and is  instructing white blood cells to make a repair. The patient will feel the shockwaves and it will be uncomfortable, some would say painful, but do tolerate it because the nerves are sending a necessary message to the brain. An anesthetic would block that message and the immune system will not be activated. The fastest rise time of decibels is achieved with the CellSonic machine so fewer shocks and fewer treatments are needed. The recommendation is for 1,000 shocks at energy level 5 using a shock head focused at 5 mm. Aim the shocks on the area of the palm and the fingers where the tightening is apparent, keeping the shock head sliding gently around on the gel. If another treatment will help, do it two weeks after the first. Improvements are still taking place a year after the last treatment. This is because the shockwaves are causing new cells to grow thanks to the stem cells. Dupuytren's contracture involves similar cell damage to that experienced with plantar fasciitis, Ledderhose Disease and Peyronie’s disease. They can all be treated with the same protocol described above except Peyronies needs fewer shocks at lower energy level.

There are no side effects and that has been proved over the last 40 years because the same technology has been used with much more powerful machines to break kidney stones and millions of patients have been treated without side effects. Other applications with shockwaves include healing wounds because they kill infection, repairing broken bone, treating sports injuries and releasing pain. In Germany, CellSonic shockwaves are being used to reduce cellulite and this will soon be marketed in other countries.

The shockwaves will do two things. Firstly they will damage, soften, loosen and release the tightening tendons and cells which are causing pain and problems. This is an alternative to the scalpel which certainly has side effects.

Secondly, the immune system is triggered because the brain senses that the body has been attacked. It is the immune system that causes new cells to grow and that is achieved by causing stem cells to be released by the pelvic bone where they are stored. It has been shown that zapping the pelvic bone is helpful.

The distributor who can arrange for doctors to try the machine is:

Mark Wilson, Managing Director

Cellsonic Ltd

M            07794822295

E              mark@cellsonic-medical.com

W            www.cellsonic-medical.com

T              @cellsonicESWT

F              https://www.facebook.com/pages/Cellsonic-Ltd/382099131900991

Radiotherapy for plantar fasciitis

So today I am looking at another paper and it is not yet the Dupuytren's and genetics one as I am yet to have full access to that but I do have another interesting paper that came to my attention through a conversation that I am having with Dr Shaffer.

 He was saying how there is a new paper out that shows that radiotherapy can help with the treatment of plantar fasciitis. I had a look at the paper and noticed that it was in Hamburg and that of course meant that one of the authors on the list was Prof S. Dr Shaffer is so impressed with the results that he is considering starting to offer treatment to patients at his facilities. Although this is slightly off of what I normally cover I thought seeing as it is the use of radiotherapy in a condition in the foot there was no harm in looking at the data and seeing what it said and besides this is likely to be another case that the treatment is going to not be received by many patients due to lack of awareness much like radiotherapy for Ledderhose disease and maybe my post will help raise a little bit of awareness. Of course I will not go into my usual detail as I don't imagine too many people here are interested in reading too much about the exact science and risk factors of plantar fasciitis so here goes.  

This paper is available through pubmed for free so have a look if you think it sounds interesting: 

Randomized, Multicenter Trial on the Effect of Radiation Therapy on Plantar Fasciitis (Painful Heel Spur) Comparing a Standard Dose With a Very Low Dose: Mature Results After 12 Months’ Follow-Up. Niewald et al, published in the International Journal of Radiation Oncology. 

In simple terms I think that this condition is basically chronic inflammation which in time results in the formation of a heel spur. This can then be extremely painful and much like ledderhose disease surgery will be performed once conservative methods have failed. 

66 patients were randomised to get radiation therapy with a total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy twice weekly or with a total dose of 0.6 Gy in 6 fractions of 0.1 Gy twice weekly. In the patients that had the higher dose the results after 3 months were much better than those that had had the lower dose. After a year those patients who had had the higher dose showed good results and those who had had the lower dose and then required the higher dose showed the same results as those that had the higher dose to start with. 

To be honest there is not much else to say from this paper other than it looks like radiotherapy also helps to give pain relief to this condition and with lower doses than those used to treat Ledderhose and related conditions. Surely it can only be a good thing to have more option available to treat any condition so that you have the choice of what you want to get. 

I hope that everyone found this interesting.