Response to "Letter Regarding: PROMIS Scores for Plantar Fasciitis Before and After Gastrocnemius Recession".

Abstract

Dear Editor, We would like to thank Dr Amis for his interest in our article on PROMIS scores in plantar fasciitis before and after gastrocnemius recession surgery.4 The primary goal of our article was to contribute as one of the pioneering studies in the literature by examining PROMIS scores in plantar fasciitis. Furthermore, we aimed to emphasize the significance of patient-reported outcomes in clinical practice and their profound impact on surgical outcomes. As we discuss our diagnosis and treatment plan of plantar fasciitis, we mention our use of standard conservative management as initial treatment. Standard conservative management is universally employed as the first-line intervention for plantar fasciitis. Literature suggests that 90% of patients show significant improvement after 6-9 months of conservative therapy.1-3 Nevertheless, it is worth noting that plantar fasciitis can also present as treatment-resistant, causing frustration among both patients and practitioners.3 Our patients, at a minimum, all failed at least 6 months of continuous therapy, with the majority continuing for 9-12 months. Standard conservative management, as referenced in the literature,2,3 is what our patients followed. Treatment consisted of a combination of stretching, orthotics, immobilization, rest, nonsteroidal antiinflammatory drugs, and scheduled physical therapy. Additionally, our patients were offered a 5-degree dorsiflexion night splint for persistent symptoms, as it prevents contracture of the plantar fascia by maintaining a neutral position of the ankle during sleep.1 Before sending patients for scheduled physical therapy, we employed stretching focused on the heel cord and tissue-specific stretching that emphasizes plantar fascia.5 The initial exercise targets the heel cord by having patients face a wall with their unaffected leg forward and their affected leg straight behind them, toes pointed inward. Our patients were instructed to engage in these stretches for a duration of at least 2-4 minutes, repeating them 3-4 times daily. Cast immobilization for 4-6 weeks is often recommended for refractory symptoms,3 which is common at our institute, where our patients are noted to have a higher than average body mass index than the national average. Our patients seem to be more compliant with the walking cast in comparison to the controlled ankle motion boot and the stretching regimen. We did not perform shockwave therapy, platelet-rich plasma injections, or botulinum toxin injections secondary to financial constraints and lack of adequate literature support. If, and only if, patients had exhausted all forms of conservative management for 6-9 months, were they offered gastrocnemius recession surgery. Using standard conservative management in treating plantar fasciitis is crucial as it ensures adherence to a nationally recognized treatment standard. This approach helps avoid the risk of unnecessary surgeries and promotes effective and cost-efficient treatment, prioritizing noninvasive interventions that have been proven to be effective in the majority of cases. We sincerely appreciate your insightful question and the opportunity to provide additional information. We hope that our response has addressed your query adequately.