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(cell phone 240-506-1556)

To: All veterans


Date: 2015

From:

Topic: Plantar Fasciitis

Independent Veteran Medical Opinion (IMO)


Veteran Medical Nexus Opinion (VMNO)

for Veteran benefits

Craig N. Bash, M.D.


Neuro-Radiologist
www.veteransmedadvisor.com

Pages: 2
NPI or UPIN-1225123318- lic #--D43471
4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-Mail: drbash@doctor.com

Many veterans enter service with normal feet but due to the rigors of military training, parachute
jumping, road marches and poor footwear they develop foot troubles that are often very
disabling. Many patients in service have foot arch trouble and end up leaving service
with painful flat feet, which develops into Plantar Fasciitis, which in turn requires the use
of special shoes and orthotics. The article below 1997 describes some of the approaches
to treatment.

Plantar Fasciitis: Diagnosis and Conservative


Management
LH Gill Miller Orthopedic Clinic, Charlotte, NC.

Abstract
Plantar fasciitis is a common cause of heel pain, which frustrates patients and practitioners alike because
of its resistance to treatment. It has been associated with obesity, middle age, and biomechanical
abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus. It is considered to be
most often the result of a degenerative process at the origin of the plantar fascia at the calcaneus.
However, neurogenic and other causes of sub calcaneal pain are frequently cited. A combination of
causative factors may be present, or the true cause may remain obscure. Although normally managed
with conservative treatment, plantar fasciitis is frequently resistant to the wide variety of treatments
commonly used, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics,
corticosteroid injections, casts, physical therapy, ice, and heat. Although there is no consensus on the
efficacy of any particular conservative treatment regimen, there is agreement that nonsurgical treatment
is ultimately effective in approximately 90% of patients. Since the natural history of plantar fasciitis has
not been established, it is unclear how much of symptom resolution is in fact due to the wide variety of
commonly used treatments.

Review ArticlesPlantar Fasciitis: Diagnosis and Conservative Management


LH Gill J Am Acad Orthop Surg March 1997 ; 5:109-117.

Many veterans enter service with mild foot troubles that are aggravated by the stresses of
service and end up being medically discharged due to foot troubles due to their continuous
profiles for no marching or running. Often the service will call these conditions pre-existing and
send the patient on their way home.
All of the above veteran foot trouble scenarios are viable examples claims for service connection
on a direct basis (caused by service) or an aggravation injury (the service made their foot
troubles worse beyond natural progression). These claims will all require a medical opinion as
the service discharges were not usually supportive and thus it is important to have the medical
details interpreted accurately within the context of the service time induced foot hazards and
stresses.
Recommendations:
1. Any soldier who has chronic foot pain should be seen by podiatry while in service.
2. During service some of the above approaches to treatment should be instituted.
3. All patients on exit from service who have had chronic foot pain (over one year of symptoms)
should be fully evaluated for flat feet and the secondary complication of flat feet namely plantar
fasciitis.
4. The veterans should seek an independent medical exam as foot troubles can cause life long
disability making it impossible for the veteran to do any type of work while standing.
5. Of course if new secondary conditions are found the veteran should send in a new claim with
one of these:
VA Form 21526 Veterans
Application for Compensation and/or Pension
VA Form 210966, Intent to File
a Claim for Compensation and/or
Pension Benefits, (hereinafter VAF 21
0966
VA Forms 21526EZ, 21527EZ,
and 21534EZ (hereinafter EZ forms)

Craig Bash M.D. Associate Professor drbash@doctor.com cell 240-506-1556


Independent Veteran Medical Opinion (IMO)
Veteran Medical Nexus Opinion (VMNO)
based on Veterans medical records for veteran benefits