Talk:Plantar fasciitis/GA1

GA Review

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Reviewer: LT910001 (talk · contribs) 01:38, 24 May 2014 (UTC)

If there are no objections, I'll take this review. I'll note at the outset I've had no role in editing or creating this article. I welcome other editors at any stage to contribute to this review. I will spend a day familiarising myself with the article and then provide an assessment. While you wait, why not spare a thought for the other nominees, and conduct a review or two yourself? This provides excellent insight into the reviewing process, is enjoyable and interesting. A list can be found here Kind regards, LT910001 (talk) 01:38, 24 May 2014 (UTC)

There's a discussion underway on the talk page at the moment, and I'll wait until that's finished. If you feel you need to change some things per the discussion, I am happy to wait until you're ready. --LT910001 (talk) 01:42, 24 May 2014 (UTC)

I didn't see this until just now. The discussion on the talk page has finished. Feel free to start whenever you're ready. TylerDurden8823 (talk) 06:03, 25 May 2014 (UTC)

Thanks for waiting. In conducting this review, I will:

• Provide an assessment using WP:GARC
• If this article does not meet the criteria, explain what areas need improvement.
• Provide possible solutions that may (or may not) be used to fix these.

Assessment

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).
	2c. it contains no original research.
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.
	6b. media are relevant to the topic, and have suitable captions.
	7. Overall assessment.

Commentary

An overall very tight article that will almost certainly be promoted. I have yet to: --LT910001 (talk) 06:24, 30 May 2014 (UTC)

• Check for close paraphrasing & copyright concerns  no concerns
• Verify images  Done
• Verify sources  Done

I will be making a number of minor edits to the article in the coming hour, and tomorrow will present some concerns with prose below. --LT910001 (talk) 06:24, 30 May 2014 (UTC)

Am appreciating the tight prose and structure. I feel this is very readable. I have some minor concerns with prose, documented below. No compulsion to follow through, I am happy to discuss, and of course my suggested prose is that only (a suggestion).

Hey LT910001, thanks, I appreciate the praise. I've addressed almost all of the concerns that you detailed below. I did ask for clarification on a couple points, but otherwise this is done (except the coblation surgery bit-I have to look that up again). TylerDurden8823 (talk) 21:48, 30 May 2014 (UTC)

Update-the coblation surgery bit is now fixed. TylerDurden8823 (talk) 05:49, 31 May 2014 (UTC)

Lead

• "It is a disorder of the insertion site of muscle or tendon on the bone " is a definition of enthesitis, but which applies to plantar fasciitis?

Part of the problem is that the etiology of plantar fasciitis isn't fully understood. As mentioned in the pathophysiology section, it doesn't seem like a consensus has been reached yet. There are still hypotheses being put out there (e.g., the flexor digitorum brevis idea and the non-inflammatory structural degeneration of the plantar fascia vs. an inflammatory etiology). If I had to pick between an insertion site of muscle or tendon on bone...I guess I'd go with tendon of the two since the achilles tendon is part of this and the plantar fascia is certainly not a muscle. We could say connective tissue instead (since both are types of connective tissue as is fascia as in this case). I think that would be a fair and accessible compromise, don't you think? TylerDurden8823 (talk) 21:19, 30 May 2014 (UTC)

It's also classified as a Fasciopathy in the navbox. My meaning is that an enthesopathy refers to the attachment point, but the article indicates that plantar fasciitis is a degenerative breakdown of the fascia itself, rather than the attachment points. --LT910001 (talk) 00:38, 1 June 2014 (UTC)

I just had another look at some of the articles used in the Wikipedia article to review this issue. The Jeswani 2009 paper says the following: "The two commonest causes are a misuse injury to the enthesis and inflammatory enthesopathy." Also, regarding it being fascia, the 2012 Cutts reference actually says it's an aponeurosis: "Even the term plantar fasciitis is something of a misnomer since the plantar fascia is an aponeurotic rather than a fascial layer." Here's what the Goff 2011 reference says regarding the enthesopathy portion and the bit about plantar fascists vs itis: "Plantar fasciitis is thought to be caused by biomechanical overuse from prolonged standing or running, thus creating microtears at the calcaneal enthesis.1–3 Some experts have deemed this condition “plantar fasciosis,” implying that its etiology is a more chronic degenerative process versus acute inflammation.2,3"

Here's what Tahririan's paper says: "The plantar fascia or deep fascia of the sole, proximally has a direct fibrocartilaginous attachment to the calcaneum (an enthesis), whose central band is constant along with medial and lateral band." and "Despite the high prevalence of PF, information about its pathogenesis is still limited, and its histological changes are suggestive of degeneration rather than inflammation. The fascia is usually markedly thickened and gritty. These pathologic changes are more consistent with fasciosis (degenerative process) than fasciitis (inflammatory process), but fasciitis remains the accepted description in the literature.[9]" BMJ's Orchard 2012 review also says it is an enthesopathy here: "Plantar fasciitis occurs at the proximal attachment and is an enthesopathy, the enthesis being the interface between the bony surface (periosteal) and a tendon or ligament attachment. Most tendinopathies (such as tennis elbow) are insertional and hence also enthesopathies. The plantar fascia is a ligament in anatomical terms, because it attaches bone to bone (calcaneus to metatarsal heads, crossing other joints of the foot in its path, fig 1⇓) rather than a tendon (which attaches muscle to bone). However, deep to the superficial structure of the plantar fascia is the flexor digitorum brevis muscle with a tendon enthesis attachment to the calcaneus proximally. As stress shielding (failure of a stress deprived deep surface to heal because the superficial element bears most of the load) is potentially implicated in enthesopathy,8 it is possible that proximal tendinopathy of the flexor digitorum brevis muscle is involved in the pathology of plantar fasciitis."

Let me know if this clears things up or if I inadvertently further muddied the waters. If I did, I will try again to clarify. We may just need to correct the navbox about it being a fasciopathy. The same review also discusses the itis vs degeneration debate here: "Plantar fasciitis is such a well established phrase that it will almost certainly remain the preferred term for the clinical syndrome of undersurface heel pain. The “itis” suffix denotes an inflammatory disorder, which is a misnomer, as the pathology is not a result of excessive inflammation. Pathological changes are degenerative in nature (although partially reversible), presumably due to repetitive microtrauma. " TylerDurden8823 (talk) 06:29, 1 June 2014 (UTC)

• I'm also a little confused how it can simultaneously be an enthesopathy and a "structural breakdown of the foot's plantar fascia"

Can you clarify why that is confusing? I'm afraid I'm confused about why you're confused. An enthesopathy is a disorder of the site of connective tissue to the bone. Plantar fasciitis was first thought to be an enthesitis (the inflammatory type of enthesopathy) but now the school of thought is trending away from that and favoring the idea that it is a non-inflammatory enthesopathy from repetitive micro trauma causing structural degeneration of the plantar fascia. TylerDurden8823 (talk) 21:19, 30 May 2014 (UTC)

• This sentence implies we won't be hearing any more about degenerative causes, which you later say haev been identified as a possible cause: "Chronic cases often demonstrate structural changes more consistent with a degenerative process than an inflammatory one and such cases are termed plantar fasciosis". For clarify, perhaps add "technically termed" as you do later discuss this.

Sure  Done TylerDurden8823 (talk) 21:19, 30 May 2014 (UTC)

• This sentence is confusing, and I think separating with commas and slightly rewording would help. "excessive inward rolling of the foot (seen with flat feet)"

I'm not sure which part is leading to confusion. Where exactly are you suggesting I put the commas since the quoted part is only part of the original sentence. Can you clarify? TylerDurden8823 (talk) 21:19, 30 May 2014 (UTC)

I think I fixed the part that may have been confusing. If I haven't, let me know and I'll try again. TylerDurden8823 (talk) 21:45, 30 May 2014 (UTC)

• "Individuals with plantar fasciitis often have difficulty bringing their toes toward the shin (decreased dorsiflexion of the ankle).[" Technically bringing your toes to the shin is dorsiflexion of the toes, not the ankle. Suggest reword sentence, perhaps to "Individuals with plantar fasciits often have difficulty with dorsiflexion, an action in which the foot is brought closer to the shin."

Well, it's really dorsiflexion of the foot not the toes, but fair enough, your point is heard.  Done TylerDurden8823 (talk) 21:19, 30 May 2014 (UTC)

Signs and symptoms

• "The classical presentation of plantar fasciitis pain is sharp[2] and usually unilateral (30% of cases are bilateral)[10] heel pain worsened by bearing weight on the heel after long periods of rest"
  • Suggest reword "Classical presentation" --> "When it occurs,"  Done
  • "and usually unilateral (30%...)" --> "And usually unilateral (70% of the time)"  Done
• Suggest you clarify "in the plantar fascia region" as the sole of the foot for lay readers.  Done

Risk factors

• " high arches of the foot" -> "High arches of the feet, "  Done
• "and flat feet (susceptible to excessive inward rolling of the foot).[" -- suggest split up into two sentences  Done
• Suggest wikilink "Achilles tendon "  Done
• The image (Achilles tendon tightness is a risk factor for plantar fasciitis. It can lead to decreased dorsiflexion of the foot.) seems a little random and too far removed. (PF causes difficulty with the achilles tendon, tendon pain occurs most on dorsiflexion, here is a picture of dorsiflexion). If retained, I suggest move to diagnosis.

I did that because on the talk page it was suggested to me by other users that a picture illustrating dorsiflexion would be helpful to the article since it may be a difficult anatomical motion for some readers to visualize. I have no objections to moving it to the diagnosis section instead except that now that I've moved it there, I think it makes the section look too busy/crowded. I think it would be better in another section. We can remove it, but before we do, I think the talk page concerns that were raised about that should be addressed.  Done TylerDurden8823 (talk) 21:27, 30 May 2014 (UTC)

Thanks for making the move to the 'diagnosis' section; I do think it's more relevant here. --LT910001 (talk) 00:38, 1 June 2014 (UTC)

Pathophysiology

• "is actually due to a noninflammatory structural degeneration of the plantar fascia rather than an inflammatory process" and yet you say that this is plantar fascists

That is the proposed terminology since it's no longer thought to be an "itis", but my understanding is that no consensus about this terminology has been reached at this point. The lead can be to say that there have been calls by some in the academic community to rename the condition plantar fasciosis if that's better. TylerDurden8823 (talk) 21:37, 30 May 2014 (UTC)

You've clarified this in the lead, so there's no contradiction any more. --LT910001 (talk) 00:38, 1 June 2014 (UTC)

Diagnosis

• May I just say that I think you've written this sentence particularly well: "The diagnosis of plantar fasciitis is usually made by a health care provider after consideration of a person's presenting history, risk factors, and clinical examination." I think you'll understand when I say there are a lot of different factors you need to consider when writing it!

Thanks and agreed-there is much to consider :) TylerDurden8823 (talk) 21:37, 30 May 2014 (UTC)

• "Tenderness to palpation along the medial plantar aspect of the calcaneus may be elicited during the physical examination" I'd consider simplifying this if possible for lay readers: medial --> inner, plantar --> sole, calcaneus --> heel bone.  Done
• "Decreased dorsiflexion of the foot may be present due to tightness of the calf muscles or the Achilles tendon" --> "The foot may have limited dorsiflexion" or some variant. ""Decreased dorsiflexion of the foot may be present " reads a little clumsily.

I like the foot may have limited dorsiflexion better.  Done TylerDurden8823 (talk) 21:42, 30 May 2014 (UTC)

Treatment

• Suggest "equipment thereby limiting " replace thereby with comma for readability  Done TylerDurden8823 (talk) 21:42, 30 May 2014 (UTC)
• Suggest wikilink or clarify "Coblation surgery "

It'll have to be a clarification since I cannot find a Wikipedia page with this title. Change pending... TylerDurden8823 (talk) 21:42, 30 May 2014 (UTC)

 Done TylerDurden8823 (talk) 23:14, 30 May 2014 (UTC)

Thanks. --LT910001 (talk) 00:38, 1 June 2014 (UTC)--LT910001 (talk) 00:38, 1 June 2014 (UTC)

Epidemiology

• "Approximately 1 in 10 people develop plantar fasciitis at some point in their life." mentioned twice, cited three times in total

Haha that was an oversight, but good catch!  Done TylerDurden8823 (talk) 21:42, 30 May 2014 (UTC)

Sources

I've checked a selection of sources to ensure that they verify the content in the article.

• Just one small note. This article states: "Minimally invasive and endoscopic approaches to plantar fasciotomy exist, but require a high degree of technical skill and familiarity with certain equipment, limiting the availability of these surgical techniques.[8] " yet the source states "Endoscopic surgery requires specialist equipment and skills, and is still not widely used.30 " which doesn't exactly support what you've stated. --LT910001 (talk) 00:38, 1 June 2014 (UTC)

I feel like I saw this sentiment expressed in this review (or another one and that perhaps I cited the wrong review, but I cannot find it). Anyway, I've reworded it a bit and it should be better now. TylerDurden8823 (talk) 06:38, 1 June 2014 (UTC)

Conclusion

Once the enthesopathy and source concern is addressed, I will promote this article. --LT910001 (talk) 00:38, 1 June 2014 (UTC)

Thanks TylerDurden8823, for your prompt responses. You are always a pleasure to review, because you are polite and responsive. In addition you have a straightforward writing style that is both clear and information-dense. If I may make a slight comment on your use of sources, I feel sometimes you use an excessive number of sources when a single, high-quality and relevant source would do. One example is "Plantar fasciitis is estimated to affect 1 in 10 people at some point during their lifetime.[5][6][9] " Of the three sources, one is about ultrasound, one is about ECSW therapy, and one is a general overview of the topic of heel pain. It is in my mind the general overview that should be cited, as the ultrasound/ECSW articles will, as epidemiology is not their focus, invariably be citing something else. This isn't part of the GA review, but I do feel that this would enhance your editing style and so thought I would leave you this piece of feedback. Thanks again for your edits to WP, and if you are ever interested in editing any Anatomy articles please let me know! --LT910001 (talk) 10:51, 1 June 2014 (UTC)

I suppose that's a bit of a habit since I often get people questioning the references I use (even when they're high quality). It's meant only as a method of reinforcement even if it's...a bit of overkill. It's a good point though about the epidemiology bit. As I find more articles that are more epidemiology focused, I will use those in place of the ultrasound/ESWT reviews for such statements. TylerDurden8823 (talk) 15:26, 1 June 2014 (UTC)

Ty, figured that this review might be useful [1] which discusses maniipulative therapies for LE conditions, including PF. Also, this review [2] isn't included and may be of use. Great work on improving the article, btw. Neuraxis (talk) 03:11, 8 June 2014 (UTC)

Thanks, I'll be sure to check them out and see if I have access. There's another new review that just came out this month that I want to incorporate into the article as well once I have a bit more time on my hands. TylerDurden8823 (talk) 04:04, 8 June 2014 (UTC)