According to MERCK, the authoritative manual of diagnosis and therapy, by omission, there is no cure for plantar fasciosis, AKA plantar fasciitis, AKA Calcaneal Spur Syndrome. The latest edition, published in 2011 ends its analysis with “For recalcitrant cases, physical medicine, oral corticosteroids, and cast immobilization should be used before surgical intervention is considered.” There is no mention of a ‘cure’.
Plantar fasciitis is a bit like the common cold. There is no cure for the common cold, but a healthy person can cure it with time – without medicine. There is no medical treatment – the only effective treatment is simply health.
It’s interesting to read the history of plantar fasciitis as seen by MERCK’s Manual of Diagnosis and Therapy. We can only guess that plantar fasciitis has been with us since we started living past 50 years, eg. forever. Warning: I am not a doctor.
In 1950, MERCK’s manual documents “Painful Heel” – and lists three causes: strain (“Periostitis or plantar fascitis resulting from undue strain on the long plantar ligaments attached to the calcaneus“), poorly fitted shoes, and bone spurs, and three treatments: Relieving strain on the ligament; proper shoes, and shoes with inserts to protect the heel. It documents a fourth treatment with “Surgical excision has been used in some cases“. The word cure is not used.
It is worth noting that all three causes suggested in 1950 have been found to be incorrect, and as a result, the suggested treatments not able to cure, although they can provide pain relief in some cases. It is also worth noting that today, 65 years later, many medical practitioners and many patients still believe these causes, and attempt one or more of these four treatments.
By 1987, MERCK updated the name of this condition to “Calcaneal Spur Syndrome“, although they qualify the diagnosis with the statement “Cacaneal spurs do not always cause symptoms; eg. heel pain is not necessarily due to an existing spur. Asymptomatic spurs commonly are discovered incidentally in an x-ray taken for other reasons.” Basically, it’s blah, blah, blah, waffle, waffle, waffle. We don’t really understand what’s going on here. The ’cause’ is documented by MERCK as “The spur results from strain injuring the periosteal attachment of the plantar fascia to the heel bone“. And the treatment recommend is “symptoms can be controlled with corticosteroid/lidocaine injection… blah, blah, blah… given perpendicular to the medial border of the heel pointing the painful trigger point located at the central portion of the heel.” It continues with “Strapping alleviates tension along the plantar fascia; orthotic devices control abnormal elongation of the foot, causing strain (sic) along the plantar fascia.”
Clearly, from what we know today – the 1987 edition of MERCK got it all wrong, while waffling significantly, perhaps to protect their reputation. Not only is the treatment incorrect, it is also incorrect use of the English language – which appears to ‘blame’ orthotic treatments for causing strain along the plantar fascia. The word ‘cure’ is not mentioned.
In 1992, MERCK has created a section titled “PAIN ON THE PLANTAR SURFACE OF THE HEEL” with a single entry, “Calcaneal Spur Syndrome“. The cause is documented as “Spurs result probably from an excessive pulling or stretching of the calcaneal periosteum by the plantar fascia. Excessive stretching may result in pain….” A lot of waffle, waffle, we’re not sure. And it’s a good thing, perhaps, that they are not certain, because they are exactly wrong. The cause, as we know today, is not excessive pulling or stretching, it is better described as shortening resulting from insufficient pulling or stretching. The treatment recommended by MERCK n 1992 – “symptoms can be controlled with a mixture of soluble and insoluble steriods“, given by injection, and “Strapping alleviates tension along the plantar fascia; orthotic devices control abnormal elongation of the foot.“, are simply wrong. They are treatments for symptoms, and provide no hope of a cure.
Now you might wonder about that phrase “abnormal elongation of the foot”. What could that possibly mean? More about that later. Again in 1992, the word ‘cure’ is absent.
By 1999, the section name has been updated to “DISORDERS ASSOCIATED WITH HEEL PAIN”, with Calcaneal Spur Syndrome the main entry. Although it is still called Calcaneal Spur Syndrome, the description has been changed to moderate the spur theory, thus: “Heel pain in the area of the inferior calcaneus caused by the pull of the plantar fascia on the periosteum with or without evidence of heel spur on x-ray.” However, the detailed explanation is an explanation of “Spurs probably result….” and a complex explanation of the (presumably untested) theory that pulling causes spurs, that pain might diminish as the size of the spur grows. Causes are also getting fuzzier, more complex, including “fluffy new bone formation, suggesting seronegative or or HLA-B27 arthropathy (eg. ankylosing spondylitis, Reiter’s syndrome).” Rheumatoid arthritis and gout are mentioned, but distinguished from bone spur by the presence of heat, and swelling. Treatments have been expanded to many different techniques, with some hint of “eliminating or diminishing pain”, and of course, the obligatory injection or application of a painkiller for symptoms – with no suggestion of a cure.
It is worth reiterating, at this point, that plantar fasciitis often resolves itself, eg. it is often cured by the health of the patient. This is, so far, not mentioned in the MERCK manual, even after almost 5 decades of documentation.
The latest edition of MERCK is the 19th edition, published in 2011 uses the term “PLANTAR FASCIOSIS (Plantar Fasciitis)“, explaining that plantar fasciosis is more accurate terminology, because there is actually no inflammation in most cases. This tells us that anti-inflammatory treatments like Corticosteroids , recommended in prior editions, were actually of little value, acting only through placebo effect. As to treatment, almost all of the previously recommended treatments are dismissed with “Treatment involves calf muscle stretching and plantar soft-tissue foot-stretching exercises, night splints, and orthotics.” Prior to 2011, plantar fasciitis was caused by stretching, now it’s treated with stretching. Interesting…. MERCK continues to waffle on the actual condition, and cause, with “Plantar fasciosis may involve acute or chronic stretching, tearing, and degeneration of the fascia at its attachment site.” It seems they’ve covered every possible description, without actually committing to any single condition or cause.
Causes are now articulated in more detail, with associated risk factors: “Recognized causes include shortening or contracture of the calf muscles and plantar fascia.” Risk factors listed include: sedentary lifestyle, occupations requiring sitting, very high or low arches in the feet, and wearing high heel shoes. but… it goes on… “The disorder is also common among runners and dancers” eg. Not a sedentary lifestyle. More contradictions.
MERCK provides more details in the description and diagnosis, in order to separate this disorder from other possibilities: “pain at the bottom of the heel on weight bearing, particularly when first arising in the morning; usually improves within 5 to 10 minutes, only to return later in the day.” Diagnosis is by: “Pain reproduced by calcaneal pressure during dorsiflexion“. In English, it hurts when the doctor presses on the heel with fingers, while bending the foot upwards towards the knee. There is a bit of mumbo-jumbo about x-rays and bone spurs, generally dismissing these as causes of the condition.
Treament, as of 2011: “Splinting, stretching, and cushioning or orthotics…. The most effective treatments include the use of in-shoe heel and arch cushioning with calf stretching exercises and night splinting devices that stretch the calf and plantar fascia while the patient sleeps.” Other treatments, given in prior issues, are given less respect, but not dismissed entirely. “…foot orthotics may also alleviate fascial tension and symptoms.” and “However, because corticosteroid injections (previously recommended) can predispose to plantar fasciosis…” and “physical medicine, oral corticosteroids, and cast immobilization should be used before surgical intervention is considered.”
There is still no mention of a ‘cure’, after almost 50 years. Should we be surprised? No. If you check MERCK’s Manual of Diagnosis and Therapy, and search for the word cure – you will find that ‘cures’ are seldom, if ever, mentioned for any disease. There are several reasons for this situation. First of all, cures are hard to prove. Medical doctors have techniques for proving a cure – for an infectious disease – via a medicine that kills the infecting agent. But for all other diseases, there is no clear test for a cure. Why not? You can check Harrison’s Principles of Internal Medicine, you can check Lange’s Current Medical Diagnosis and Treatment. Search for the word cure. It’s not in the index, it’s not defined, and for the most part, the word ‘cure’ is not used in medical reference books.
The ICD10, International Classification of Diseases, 10th edition, classifies all diseases into three categories: communicable diseases, non communicable diseases, and injuries. Communicable diseases, which in healthicine are named ‘parasitic diseases’ are cured by killing, removing, or deactivating the parasite. Injury diseases are cured by healing.
But what about non communicable diseases? How are they cured? How can we tell if heart disease, or diabetes, or arthritis, or…. plantar fasciosis, is actually cured? There is no technique to measure, no technique to test a cure, so these diseases are incurable by default. Like plantar fasciousis ‘implied’ to be incurable, because no cure is defined, and no test for cured is defined.
But.. I cured my plantar fasciitis (as it was diagnosed by my doctor), my plantar fasciosis – as it is named by MERCK’s authoritative manual. In fact, one of the first things that I found when I mentioned that I had plantar fasciitis, was that a lot of my friends had had the same disease, but now it was gone. Was it ‘cured’, or did it just ‘go away’? Is there a difference? Modern medicine claims there is no cure for the common cold, but a healthy body has no problem curing it – in a week or so. Faster if you are healthier, slower if you are less healthy.
How did I cure my plantar fasciitis? Did I look for alternative medical solutions. Well, to be honest I did – but they were no more consistent than MERCK’s prior issues. Each have their own theory of cause – depending on what they are selling, and each have their own treatment for sale. The word cure, which is often used in alternative medical practices, is seldom used for plantar fasciitis.
First of all, there are some important details, probably well known by MERCK’s authors, but not included in any of the historical or current details of plantar fasciosis. Most important: plantar fasciosis almost never strikes anyone below the age of 40. It is most common, according to “Northwest Foot And Ankle” in men between the ages of 40 and 70, although Wikipedia says it is unclear if men or women are affected more. eg. It is not, apparently, caused by wearing high heels.
So what is it caused by? Again, be aware, I am not a doctor. But you might also be aware that a doctor cannot cure your plantar fasciitis – and I did cure mine.
There are some important clues in the historical documentation provided by MERCK, if you know what to look for, and if you take the time to remove all of the information that has since been documented as incorrect – by MERCK themselves.
At this point, it is useful to have a diagram of the situation. This diagram is from Wikipedia and I have added the red dot, where the pain normally occurs. In some cases, the pain is very localized, in other cases it spreads through the entire plantar aponeurosis.
MERCK, in the 1987 and 1992 editions uses the phrase ‘abnormal elongation of the foot‘. In the latest edition, in 2011, one of the treatments recommended is ‘night splinting devices that stretch the calf and plantar fascia”. So, which is it?
Is plantar fasciitis caused by abnormal elongation of the foot, or is it caused by contraction of the plantar fascia? I don’t know about you – but I don’t think my feet are growing longer. And what is ‘abnormal elongation’ anyway?
Determining the ’cause’ of an illness is often problematic. We might find a ’cause’, then find a cause of the cause, and a cause of that cause. Was there a key cause? Is there a way to determine which ’cause’ is the important one?
Yes there is. The key cause is the one you can treat effectively, to accomplish a cure. We can argue forever, even take measurements without determining for certain whether the part of the foot attached to the plantar fascia ‘grew’, or whether the plantar fascia ‘shrunk’. It doesn’t matter. It doesn’t matter because we know how to ‘stretch’ the plantar fascia, and we don’t know how to shrink the foot. If stretching the plantar fascia is the cure – and it is – then shrinking of the plantar fascia is the cause. Q.E.D.
So. Once I was convinced that shrinking, or tightening of the plantar fascia was the cause, the cure was clearly defined. Stretch the plantar fascia. Other treatments, shoe inserts to protect my heel from pressure, anti-inflammatories, are of little use, because they address symptoms, but do not cure. Even surgery cannot cure, if the problem is a shrinking plantar fascia.
But… what causes the plantar fascia to shrink, or to tighten? It’s not rocket science that we become less flexible as we grow older. We can fight it, but it happens to everyone. There are a few other factors. Note that plantar fasciitis symptoms are usually worse in the morning, according to MERCK. Why would that happen.
When I sleep, my feet lie between the blankets, and flatten out. My toes extend. Similar to the position of a ballet dancer, but without weight. In this position, the plantar fascia can pull back, or relax. When I get up, and put pressure on the flat part of my foot – the plantar fascia needs to ‘stretch’ again. And this is the most common time for the pain of plantar fasciitis.
So. I did some exercises to stretch my plantar fasciitis. I did some stair exercises. Standing with my toes on a step, letting my heels fall down farther – so the plantar fasciitis was forced to stretch, to elongate. It helped a bit, but it’s a difficult exercise to do often, or for long periods of time. For stretching to produce a physical result – lengthening of the plantar fascia, takes time. Health is slow. Curing with health is slow.
Then I discovered, and bought the sock. The Strassberg sock. Designed in 1993, for plantar fasciitis – although not mentioned in MERCK, even in 2011.
Their website says “The Strassburg Sock is an easy to use, inexpensive and comfortable device designed to keep tension on the plantar fascia so it heals in a stretched position at night.” and “In 2004, Running Times magazine said in an injury prevention article that the Strassburg Sock, “Helps cure plantar fasciitis. More comfortable and significantly cheaper than the “boot” prescribed by most doctors.””I bought one, I’m not even sure if it was the brand name, or a knock off. But it worked within a few days, the pain was much less. You can easily learn how to use it on Youtube, it you don’t understand the instructions. I’m guessing, that if you can’t buy one locally, you could make one easily. Within a few weeks, I was cured. I haven’t used it now for more than ten years – although it still sits by my bedside.
What is a cure? Was my plantar fasciitis cured? I notice now, ten years later, on occasion, when doing my Tai Chi exercises, that when I extend my right leg, foot up, I have a small tingle of pain in my heel. Does that mean it wasn’t cured, that it was just in remission, and now it’s back? Modern medicine, as discussed, has no definition of cure for any disease not caused by parasites. There is currently no definition of ‘cured’ for plantar fasciitis, for arthritis, for heart disease, for diabetes – even for obesity.
WebMD for example says that the goals of treatment for Plantar Fasciitis are to:
Relieve inflammation and pain in the heel. (remember that MERCK renamed it plantar fasciosa, because there is generally no inflammation)
Allow small tears in the plantar fascia ligament to heal.
Improve strength and flexibility and correct foot problems such as excessive pronation so that you don’t stress the plantar fascia ligament.
Allow you to go back to your normal activities.
And ends with the comment that: Most people recover completely within a year.
But WebMD does not use the word ‘cure’. The use of the word ‘cure’, it seems, is forbidden in serious medical circles.
Seriously? Is it ‘not possible’ to cure obesity? If you weigh 310 pounds, and you are clearly obese, and you lose 150 pounds, and stabilize at 160 pounds – and are no longer obese, do you still have the disease ‘obesity’, just waiting to re-emerge? That’s nonsense. If that were true, then everyone who is alive could be said to have the disease ‘obesity’ just waiting in the wings. If you lose 150 pounds and keep it off, you’ve cured your obesity. It’s that simple.
I cured my plantar fasciitis. But nobody cares. Nobody gives a damn. Because once I am cured, even if I cured myself with a strange foot exercise contraption, once I am cured, I am no longer of interest to the medical profession.
Modern medicine is not interested in curing plantar fasciosis. Maybe this is because plantar fasciosis is an insignificant illness, but I suspect the reason is larger. Modern medicine is not interested in cures. If modern medicine were interested in curing plantar fasciosis, what studies would be required? First ‘cure’ would need to be defined. It’s impossible to study a ‘cure’ if cure is not defined. A research study into Plantar Fasciitis, that collected and analyzed medical studies of plantar fasciitis, did not search for research studies that cure, nor did it search for a ‘cure’ for plantar fasciitis. Instead, they report, ‘Using the keywords “heel pain,” “painful heel,” “plantar fasciitis,” and “heel spur” and combining them with search terms: “treatment,” and “management,” ‘ – no mention of cure. I suspect that if they searched for studies of ‘cures’ for plantar fasciitis, few, if any, would be found. But I cured my plantar fasciitis – and many other people have done so as well. Most people do.
It’s not just plantar fasciitis. Modern medicine is not interested in ‘curing’. If you cure any disease in the ICD10’s classification of non communicable diseases – your cure will be ignored. If you cure your plantar fasciitis, your medical insurance will not pay for the cure. Medical insurance doesn’t pay for cures, it pays for ‘treatments’.
According to modern medical theory, it is not possible to cure any ‘non communicable diseases’. Why? Because the only cure for a non communicable disease, whether it is heart disease, obesity, diabetes, or even plantar fasciosis is health.
I recently blogged about a woman who cured her cancer. And then she disappeared from the medical system. Once she was cured there was no need for the medical system to track her status any more – and the system, the doctors who diagnosed her, were no longer interested. You might have heard of someone who cured their cancer. Did you ever stop to wonder what happens to them afterwards? They disappear from the medical system, their cancer disappears. There are no cancer studies of ‘those who are cured’, because cured is not defined for cancer.
Jeff Roberts writes about how he healed his failing his liver after a diagnosis of mononucleosis. Did he ‘cure’ his illness? He writes “The current system is killing us slowly, divorcing us from our innate power to heal ourselves“. The current system is not just failing to heal, it is failing to cure. When cures occur, they are labeled ‘anecdotal evidence’ and ignored.
Susan Harris, editor in chief of Physiotherapy Canada, published an article titled “Can Patient Testimonials Constitute Evidence? Plantar Fasciitis” after she was herself ‘cured’ of plantar fasciitis, through physical therapy – which from her description, appears to have been therapy to ‘stretch’ her plantar fascia, although she described the therapy as ‘joint mobilization’. Did she make her foot shorter, or her plantar fascia longer? I’m not certain, but she declared herself cured, not ‘recovered’. But she’s not a doctor, so it’s OK.
If the medical profession is to learn to cure incurable diseases, they need to study the cured.
The only cure is health. – The Healthicine Creed
But, if it can’t be cured by medicine, then, according to medical practitioners who write MERCK and other medical manuals, it can’t be cured. Sometimes, medical professionals say a disease be cured by direct statement, but more often it can’t be cured by ‘omission’ of the word cure. It is not possible to prove that an illness is incurable – the Healthicine Creed.
We can define cured for non communicable diseases. But we need to work at it. In the case of plantar fasciitis – it’s trivial. In some other cases, it is more difficult. But not impossible. Today, it’s impossible to ‘cure cancer’, because ‘cancer cured’ is not defined, and cancer cures cannot be tested. Let’s get to work on that.
to your health, tracy
Note 1: The concept and process of cure in this post follows the model established in the Healthicine Cure Process Diagram, first published in the post: Is Your Disease Curable? or Incurable?
Note 2: These cures come from healthicine, not from medicine, they cure illness, not disease. Thus, there is no need for this qualifier – “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” – as it is both true, and false. The intent of healthicine is to find cures, not to market medicines.
Tracy is the author of two books about healthicine: