A recent study of 310 patients in the University of California research department showed a surprising statistic. Although all patients in the study had joined because they suffered from plantar fasciitis pain, a painful disorder of the plantar fascia fibres, nearly a quarter had been misdiagnosed. That’s 71 people who turned up on day one to be studied, and left the first day.
So you thought doctors were never wrong? So did we. The general understanding of the condition by the medical community in the UK is comprehensive and it is rare for doctors to get their diagnosis significantly wrong unless it is a rare and complex issue. If you’re sitting here reading this with plantar fasciitis and have been diagnosed with a simple examination of the foot then read on.
We looked at similar studies in the UK to see if the effect was replicated here. Initially there didn’t seem to be much data on misdiagnosis until we looked at Pub Med, the collection of medical research available to doctors and medical professionals. What we saw was startling. A chochrane review, that’s a review of a large number of clinical trials, showed that it was fairly common for people in medical research to start with a group of people, a cohort if you want to use the correct name, and immediately remove those who don’t suffer from the condition the researchers recruit for. In fact, over 28% of trials we looked at suffered from this early bias. That’s over a quarter who’ve been misdiagnosed. So what’s going on? We looked further into the data.
5% of the studies contained people initially withdrawn because they had flat feet or bunions. These people were originally diagnosed with heel pain and their GP reported their condition as plantar fasciitis, but on further investigation they were found to have the symptoms but not the cause. An overwhelming majority (54%) had plantar fasciitis but combined with pain in the ball of the foot. A podiatrist referral had suggested PF as the main cause of painful feet but further investigation had shown that the source of the pain was muscoskeletal rather than the plantar fascia itself. So that’s well over half already. 19% were wearing orthotics, no problem at all there, plantar fasciitis sufferers often wear orthotics and heel cushions to help with the pain. Except here, it seems the orthotics were causing the pain. In essence, misdiagnosis was wide ranging with no specific cause but significant.
So, what have we learnt? It is a fact that NHS doctors have on average 7 minutes per consultation. This includes time to meet and greet and say goodby. In between they have to diagnose the condition accurately and make a recommendation for treatment. This is particularly problematic with foot problems. Painful feet can have a number of differing causes and it seems that plantar fasciitis has become a simple catchall for doctors to use as a generic diagnosis. It is only later when a foot specialist looks into the problem, as happened with the clinical trials, that painful feet are diagnosed as something else, often a heel spur or bone spur or something which can be easily be treated with orthotics.
So the next time you’re in the doctors surgery with painful feet, remember, if you’re not convinced get a 2nd opinion. Or start with a podiatrist who specialises in foot pain. It may help save time and effort.
Have you been misdiagnosed or struggled to get your doctor to come up with a treatment plan? Let us know. We’d like to hear from you.
Doug Finnie,
Pharmacist.