Elective learning ProJR and the first blended learning medicine department elective online learning portfolio archived

Archived from October 2013: https://likethechickenscratch.blogspot.com/2013/10/the-first-foot.html?m=1 as a mirror blog to preserve content as a backup.

ARCHIT JAIN, certified mountaineer under Indian Mountaineering Federation, presently dogged at sticking out an entrepreneurial venture propelled by short listing of the basic idea by the E-cell IIT-Bombay, A sportsperson at heart à claiming moniker at various fields (also bagged 2 bronze medals in table tennis at PULSE-2013) and thus the college sports’ coordinator. A gourmand and a sight-seer, inter alia; and writing here to share the experiences of my primal bailiwick-MEDICAL SCIENCE!

I am in my 2^nd proff in Chirayu Medical College and Hospital, Bhopal. Presently I am working under the guidance of Dr. Rakesh Biswas with the object of drafting a case report for the British medical journal. And this writing here presents my experience from the same…

As it is a tendency of humans to assume what’s going to happen before setting foot on an unwearied path; I, in my heart, carried less doubt about the workshop I was going to attend. As especially in the domain of medical sciences, at metaphorically a young age, we doctors are sure to expect sessions of brainstorming and an unrelenting test of knowledge. But guess I was totally wrong this time!

Though the entire course was a bit lethargic considering it required a 7 hours run in order to cover 40 odd kms, changing 4 public transports each day and working like this for 14 consecutive days ; I am thankful it proved to be worth the effort!

I reached People’s College of Medical Sciences on 19^th October at 9:00 am. Dr. Biswas was on his routine round when I first met him. It was in the casualty ward that I was introduced to him by Sumit, a friend of mine who took up the course with me. And then the training began.

Case discussions-

As I stated earlier, I was expecting loads and loads of lectures along with Power point presentations and a wall of tough questions to be put up by the doctor in-charge but it seemed I had a lot of air to keep!!

Dr. Biswas had this unique thing about his teaching prophecy whereby he discussed each and every little point about the patient with us. This was yet another experience in itself as being a 2^nd Proff student it is not very often that we are exposed to such open discussions

After taking up the indoor patients, the round in the OPD began.

During this sir told us about a website called UDHC.CO.IN, how it was made and how it benefits not only the middle class but also the poor people. UDHC is basically a user driven health care website through which a patient can be followed easily without revealing his/her identity just by giving him/her a botanical name. All you need to do is to enter the history in the INPUT tab with the consent signed by the patient and share it. It is also a very helpful tool in taking a piece of advice or sharing a case with fellow doctors around the world. I personally found it to be a unique and an innovative step which has helped the sufferers to consult reputed doctors around the world now for free. But for us it undeniably became a platform to discuss our findings with experienced doctors.

In the OPD we came across a patient who was a 31 years old man with a complaint of vomiting, nausea and a non-radiating pain in the right upper abdomen from past 30 days. During those 30 days he had an apparent loss of weight with marked anorexia. There was a decrease in his bowel movement and an increase in flatulence.
The patient had no difficulty in swallowing and the vomit contained recognizable food particles eaten several hours back. Neither black stools nor rectal bleeding was observed. He told us that he used to be

a non-vegetarian and used to consume 250 gm of meat thrice a week previously but has had been a pure vegetarian for the last 6 years. He also consumed tobacco (gutka) 8-10 packs daily and alcohol (180ml) once or twice a week.

He had neither a past history nor a family history of such a problem.

Endoscopy showed: deformed, shortened bulb with inability to push scope into 2nd part of duodenum.
Blood report:-Mild anemia.

R.B.C showed: mild anisopoikilocytosis with microcytes.
W.B.C showed: normal total count & normal.

From his complaints of the last 30 days and considering the endoscopy report findings I proposed that the possibility of duodenal ulcer was pretty less. According to me it was a case of obstruction due to polyps of GI tract. Biswas sir and I discussed for a while and he was then extended a treatment for ulcers. But due to a difference of opinion we have asked him to visit us over the next fortnight to track the success of the treatment.

One-on-one interaction with the patients has been one of the major benefits of this program. Sir gave us complete freedom to examine the patient up till our will and to spend as much time as required to extract all the information in order to solve the patient’s problem. It was as if we were the pilot of the Boeing loaded with the passengers, with total authority and in charge!

Sir also gave us the permission to utilize the research lab in which we could perform basic yet very important hematological and biochemical tests. Through this we realized how even a small lab with minimal resources can be used to make powerful diagnoses.

The routine we followed, for creative learning, under the BMJ program was as follows:-

Taking PATIENT’s HISTORY

UPLOADING IT IN UDHC

INTENSE DISCUSSION (ON WEB CBBLE at that time in tabula rasa)

This pattern of learning was new but I had to quickly adapt myself to it. The best thing about this approach was the ease with which we could discuss each case with sir as well as it gave us enough practice. I spent more time thinking about various cases-first in the ward/OPD, then in my hostel while preparing the case report and later discussing the problem and raising queries. This made the course and the studies easy and immensely interesting as now I could correlate my anatomy and physiology quite well on the basis of the various practical cases I dealt with.

And the subsequent elective ProJR data can be accessed here: https://medicinedepartment.blogspot.com/2021/03/medicine-department-training-programs.html?m=1

UDLCO CRH ProJR plan: The role of Insurance and patient capital in optimizing healthcare ecosystems

Summary:

Insurance has emerged as a critical entry point for healthcare innovation and entrepreneurial strategies, particularly in resource-constrained environments. Pioneering approaches with certain micro health insurance schemes, demonstrate the potential of insurance in bridging gaps for rural populations, reaching over 3.4 million beneficiaries. However, the inherent "lottery-like" design of insurance—where many contribute for the benefit of a few—aligns with principles of patient capital, requiring long-term investment and tolerance for risk. This paper explores why investors and entrepreneurs favor insurance as a gateway to healthcare, analyzing its ability to control capital distribution, catalyze social impact, and integrate sustainable financial models utilising current non dystopian Orwellian models of healthcare data capture and delivery.

Keywords

Insurance, healthcare strategy, patient capital, micro health insurance, rural population, capital distribution, social impact

UDLCO Keyword glossary:

http://userdrivenhealthcare.blogspot.com/2023/11/glossary-of-user-driven-healthcare.html?m=1

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Introduction:

The healthcare sector often faces challenges in scalability, affordability, and accessibility, especially in rural or underserved areas. Insurance has increasingly been viewed as a pivotal entry point for addressing these challenges, as evidenced by certain purportedly successful schemes that reached millions of rural individuals with micro health insurance, offering a low-cost solution to healthcare financing while leveraging principles of patient capital. This paper examines why insurance is considered a strategic entry point by investors and entrepreneurs and explores the interplay between insurance models and long-term capital sustainability using current utopian (non dystopian) Orwellian interventions toward persistent clinical encounters through IT AI user driven data capture tools such as UDHC, CBBLE (cable) and PaJR.

For conversational learners who can easily deal with TLDR, there's a conversational learning and thematic analysis at the bottom, which could be a better starter into the project plan before digging into the methodology below.

Potential Methodology:

Thematic analysis employed to examine conversational insights from healthcare discussions and prospective longitudinal follow up involving various micro-insurance strategies and grass roots, individual patient health investors (the insurance buyer) perspectives as well as prospectively followed up individual patient health outcomes. Key themes such as insurance as a capital control mechanism, patient capital integration, and the "lottery-like" design of insurance can be leveraged to explore how "patient capital" (in this case literally the micro capital investments being built up by every individual patients) are utilised for different patients in a transparent and accountable manner to provide every individual patient investor a large bang for their small buck in terms of individual patient centered learning outcomes and individual patient illness outcomes eventually contributing to collective societal medical cognition outcomes. Transparency and accountability is ensured through current utopian (non dystopian) Orwellian data capture interventions developing persistent clinical encounters through IT AI user driven data capture tools such as UDHC, CBBLE (cable) and PaJR previously described here: https://www.researchgate.net/publication/344227236_Persistent_Clinical_Encounters_in_User_Driven_E-Health_Care, 

https://pmc.ncbi.nlm.nih.gov/articles/PMC4587042/,

https://pmc.ncbi.nlm.nih.gov/articles/PMC6163835/, 

https://pubmed.ncbi.nlm.nih.gov/40674544/, 

https://userdrivenhealthcare.blogspot.com/2025/07/user-driven-orwellian-eyes-at-pivot-of.html?m=1, 

https://medicinedepartment.blogspot.com/2025/08/multidisciplinary-integrative-photonics.html?m=1

Data from secondary sources, including various past micro health insurance health schemes and principles of patient capital, can be synthesized to contextualize findings.

CC licence: https://commons.m.wikimedia.org/wiki/File:PatientCapitalgraphic.jpg

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Expected Results:

1. *Insurance as a Capital Distribution Tool*: Entrepreneurs and investors prioritize insurance due to its ability to centralize and control the flow of funds across the healthcare ecosystem. This ensures efficient allocation of resources while mitigating risks.

2. *Patient Capital Integration*: The "lottery-like" nature of insurance aligns with patient capital principles, where long-term investments are made with tolerance for delayed returns, fostering sustainability in healthcare financing.

3. *Scalability and Accessibility*:

Insurance schemes may demonstrate how micro health insurance can reach large underserved populations, offering a scalable solution for healthcare delivery especially when utilised using current generation for different patients in a transparent and accountable manner to provide every individual patient investor a large bang for their small buck in terms of patient centered learning outcomes and collective societal illness and health outcomes . It would also demonstrate the effectiveness of current utopian (non dystopian) Orwellian data capture interventions developing persistent clinical encounters through IT AI user driven data capture tools such as UDHC, CBBLE (cable) and PaJR.

4. *Investor Enthusiasm*: Insurance provides a predictable entry point for investors, combining social impact with financial returns, albeit at a patient and moderate pace.

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Discussion

The strategic emphasis on insurance stems from its dual role as a financial tool and a mechanism for social impact. Various global models of successful micro insurance schemes highlight the potential of micro health insurance to address the healthcare needs of rural populations effectively. However, the design of insurance as a "lottery" system raises critical questions about equity and sustainability.

By pooling resources from a large population, insurance ensures that only a subset of beneficiaries requires care at any given time. This aligns with the principles of patient capital, where investors are encouraged to adopt a long-term perspective, tolerating delayed financial returns for broader societal benefits. However, the challenge lies in maintaining the longevity of insurance models, as most insurance companies are looking at short term gains that are not designed to outlive their investors.

Entrepreneurs and investors favor insurance as an entry point because it provides control over the capital distribution chain, ensuring efficient allocation while fostering scalability. Moreover, insurance schemes catalyze market creation and combat poverty, as seen in the success of certain. The integration of patient capital further strengthens these models, blending financial sustainability with social impact.

In conclusion, insurance emerges as a strategic tool for healthcare innovation, balancing financial rigor and social equity while leveraging the transformative power of patient capital, especially when the capital is brought in by each individual patient either through their time or micro premium money spent while an online platform contributes transparent and accountable data toward societal scientific advancement in healthcare. It also provides individual healthcare returns in the form of transparent and accountable healthcare outcomes for each individual.

https://userdrivenhealthcare.blogspot.com/2025/09/udlco-crh-projr-plan-role-of-insurance.html?m=1

Conversational learning and thematic analysis:

[07/09, 06:46]hu1: Sir, when I met Dr Celebrity he mentioned that if I had to build the celebrated hospital of today I would've started with insurance. The same was quoted by multiple investors and entrepreneurs in healthcare. Why are they bullish on insurance? Is it because you control the whole capital distribution chain? Or something else. They(investors and entrepreneurs) say that insurance is the best entry point.

[07/09, 07:15]hu2: Because that was his own business strategy. 

He pioneered a very inexpensive micro health insurance scheme reaching out to more than 3.4 million rural poor. 

Well clearly insurance can never have benefitted all the 3.4 million rural people because the very design of insurance is like a lottery. Many pay so that some can benefit assuming that not all 3.4 million will need the same level of care at the same time and if when they do the benefits of "patient capital" will creep in? And here the patient is the investor who simply needs to be patient about his her investment for a long term but then most insurance companies are not designed to outlive them! https://en.wikipedia.org/wiki/Patient_capital

[07/09, 07:16]hu1: Got it! But what about multiple investors and entrepreneurs mentioning that insurance is the best entry gateway?

[07/09, 09:34]hu2: Because they have their short term exit plan and aren't investing long term patient capital toward societal optimization

[07/09, 09:35]hu1: Got it. So, how will we ensure our funding?

[07/09, 09:36]hu1: I mean, if investors will think like this and we won't align to their investment ideology, then who will fund us? I think, we'll have to find the right investor.

 

Because everyone doesn't think about short term exits

What's your take, sir?

[07/09, 09:42]hu2: The right investor finally is at the bottom of the pyramid who will pay a micro amount regularly as patient capital. Currently PaJR patients pay us throughout their time and their time can be monetized if their entire PaJR workflow is being archived transparently and accountably in an online platform?

Thematic Analysis of the Conversational Content:

Theme 1: Insurance as a Strategic Gateway in Healthcare

Dr. Celebrity and other healthcare entrepreneurs emphasize insurance as the ideal entry point for building sustainable healthcare systems. The rationale lies in insurance’s ability to centralize and control the capital distribution chain, ensuring efficient resource allocation. It operates like a "lottery" system, where contributions from many fund the needs of a few, making it an attractive financial model for scalability and social impact. Micro health insurance schemes exemplify this approach by reaching millions of rural individuals with affordable healthcare. However, the model inherently requires long-term sustainability and tolerance for delayed returns, aligning it closely with *patient capital* principles.

Theme 2: The Role of Patient Capital in Insurance

Insurance integrates patient capital, where investors are expected to forgo immediate profits for long-term returns. The conversation highlights the alignment between patient capital and insurance, noting that investors need patience and resilience to sustain such models. However, traditional insurance companies often fail to outlive their investors due to short-term financial goals, creating a gap in long-term societal optimization. Patient capital’s willingness to prioritize social impact over maximum financial returns makes it a suitable framework for health insurance models focused on equitable healthcare access.

Theme 3: The Divergence Between Investor Mindsets

A critical tension arises between investors’ short-term exit plans and healthcare’s need for long-term funding. While some investors seek quick profits, others align with patient capital ideology, prioritizing societal benefits. The conversation underscores the importance of identifying "the right investor"—one who values sustainability and accountability over immediate financial returns. This investor could be found at the "bottom of the pyramid," represented by individuals contributing micro amounts regularly, creating a decentralized yet resilient funding model.

Theme 4: Transparency and Accountability in Funding Models

To ensure funding sustainability, the conversation proposes archiving and monetizing patient workflows transparently via online platforms. This approach not only builds trust but also provides a mechanism to efficiently channel micro payments into scalable healthcare solutions. By leveraging technology, the funding process becomes more accountable, encouraging both patient contributions and investor confidence.

Theme 5: Balancing Social Impact and Financial Viability

The analysis highlights the dual challenge of maintaining social impact while ensuring financial sustainability. Insurance, when paired with patient capital, offers a unique middle ground between venture capital’s financial rigor and philanthropy’s altruism. Entrepreneurs and healthcare leaders must navigate this balance, ensuring that their models align with both societal needs and long-term investor goals.

Conclusion

The conversation reveals insurance’s potential as a gateway for transforming healthcare systems, provided it is supported by patient capital and transparent funding mechanisms. Identifying the right investors—those who value long-term impact over short-term exits—is crucial for success. Additionally, leveraging technology to archive workflows and ensure accountability can foster trust and sustainability, ultimately reshaping healthcare financing for broader societal benefits.

UDLCO CRH: Human screening for diagnostic and therapeutic interventions to reduce the incidence of human Sudden cardiac death

Summary with Key Words

In the aftermath of a recent news of a young high profile doctor dying of sudden cardiac death, the online learning fora conversational transcripts reveal discussions around *sudden cardiac death (SCD)* prevention through *genetic screening* and *implantable cardioverter-defibrillators (ICDs)*, focusing on the challenges and opportunities in improving outcomes. Participants highlight the importance of obtaining *family history* of SCD, *genetic conditions* (e.g., cardiomyopathies, Brugada syndrome, long QT syndrome), and *training the public in basic life support (BLS)*. The conversation also explores the lack of *randomized controlled trials (RCTs)* for prophylactic ICD use in genetically screened individuals due to ethical constraints and reliance on *observational studies*. AI's potential in bridging gaps in real-time data and tailoring guidelines is acknowledged, but limitations in AI's ability to independently collect data are recognized. The idea of using "Orwellian devices" to gather uncontrolled intervention data for efficacy evaluation is proposed. Later there's another angle other than genes, as brought about by another conversationist who calls it jeans (life style disorder) where the 10 year findings of an autopsy series from KEM point toward the fact that most human problems are either due to internal medicine (genes) or external medicine (jeans)!

Key Words

- *Sudden Cardiac Death (SCD)*

- *Genetic Screening*

- *Implantable Cardioverter-Defibrillator (ICD)*

- *Family History*

- *Cardiomyopathies* (HCM, ARVC, LQTS)

- *Basic Life Support (BLS)*

- *Prophylactic ICD*

- *Observational Studies*

- *Randomized Controlled Trials (RCTs)*

- *AI in Medicine*

- *Real-Time Insights*

- *Orwellian Devices*

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Conversational Transcripts:

[28/08, 12:49]hu1: https://www.linkedin.com/posts/nidhaan_the-hidden-heart-risk-why-fitness-isnt-activity-7331971484216676352-zzE-

[27/08, 21:44]hu1: This article might have to revise the age I guess.. reality seems to be ahead of guidelines..

28/08, 10:29]hu3: It's always ahead! 👏

[27/08, 22:07]hu2: May I suggest obtaining family history of SCD please. I know of cases where a parent and multiple children died of SCD around age 40. Obtaining clear family history would have led to identification of genetic conditions (cardiomyopathies, Brugada, long QT etc) and could have saved the children’s lives by implanting ICD.

[27/08, 22:09]hu4: True

[27/08, 22:15]hu4: BLS training for laiety on mass scale is needed to let people know how to respond in case of a collapse

[28/08, 10:30]hu3: @⁨Meta AI⁩ what is the evidence that genetic screening for cardiomyopathy followed by preemptive therapeutic intervention in the form of ICD can help to prevent sudden cardiac death?

[28/08, 10:30] Meta AI: Evidence suggests that genetic screening for cardiomyopathy, combined with preemptive interventions like implantable cardioverter-defibrillators (ICDs), can significantly reduce the risk of sudden cardiac death (SCD) in high-risk individuals. Genetic screening helps identify pathogenic mutations associated with conditions like hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and long QT syndrome (LQTS), which are linked to SCD. Once a mutation is confirmed, targeted interventions, including ICD implantation, are recommended for individuals with high-risk features, such as severe left ventricular hypertrophy or previous arrhythmic events.¹ ² ³

ICDs have proven effective in preventing SCD by delivering life-saving shocks during malignant arrhythmias, particularly in patients with structural abnormalities or inherited arrhythmia syndromes. Studies have shown that cascade genetic testing in families of SCD victims identifies at-risk relatives, enabling timely interventions like ICDs, beta-blockers, or lifestyle modifications, reducing SCD events.⁴

Would you like to explore the cost-effectiveness or limitations of these approaches?

[28/08, 10:54]hu4: @⁨Meta AI⁩ please share a best RCT where it has been shown that prophylactic ICD in those found to have SCD genetic abnormalities on screening along with strong family history has helped achieve better outcomes in the ICD group over the sham intervention group. Please share the data in PICO format and don't share any percentages

[28/08, 10:54] Meta AI: Currently, there is no randomized controlled trial (RCT) that has specifically assessed the use of prophylactic implantable cardioverter-defibrillators (ICDs) in individuals identified through genetic screening for sudden cardiac death (SCD)-associated genetic mutations (e.g., hypertrophic cardiomyopathy [HCM], arrhythmogenic right ventricular cardiomyopathy [ARVC], or long QT syndrome [LQTS]) with a strong family history of SCD, comparing outcomes between ICD implantation and a sham intervention. Most of the evidence supporting the use of ICDs in this population comes from observational studies, registry data, and expert consensus guidelines rather than high-quality RCTs.

This lack of RCTs is largely due to ethical considerations: withholding a potentially life-saving intervention (ICD) in individuals at high risk of SCD would be ethically challenging. Instead, clinical practice has relied on large observational studies and cohort analyses to demonstrate the efficacy of ICDs in preventing SCD in high-risk individuals.

Observational Evidence

For example, the evidence supporting ICD use in high-risk individuals with inherited cardiomyopathies or arrhythmia syndromes comes from studies like the *ICD Registry* or cohort studies such as the *HCM Risk-SCD model*, which stratify SCD risk and demonstrate the benefit of ICDs in reducing mortality. However, these studies do not include a sham group for comparison.

If you'd like, I can summarize observational study findings or discuss guidelines for ICD use in this population. Let me know!

[28/08, 10:55]hu1: I wonder how we can use AI to reduce that gap, giving us real-time insights so we adjust our guidelines accordingly, and tailor it to population groups to start with before personalized medicine.. 😄 the data would be very tricky though..

[28/08, 10:57]hu3: AI can't collect the data for us and do the RCTs for us. It can only survive on whatever humans do

[28/08, 10:58]hu3: But Orwellian devices can collect that kind of data we need to circumvent (work around) solutions to find efficacy of interventions that have been delivered in an uncontrolled manner such as the ICD as elucidated by AI above.

https://userdrivenhealthcare.blogspot.com/2025/07/user-driven-orwellian-eyes-at-pivot-of.html?m=1

Thematic Analysis

1. Prevention and Early Identification

- *Family History*: Emphasis on the importance of obtaining detailed family history to identify genetic predispositions to SCD (e.g., cardiomyopathies, Brugada syndrome, long QT syndrome). Early identification allows for timely intervention.

- *Genetic Screening*: Genetic testing is highlighted as a tool to stratify individuals at risk for SCD, enabling preemptive therapeutic measures like ICD implantation.

2. Therapeutic Interventions

- *ICDs for High-Risk Individuals*: ICDs are recognized as effective in preventing SCD by delivering life-saving shocks during malignant arrhythmias. However, the lack of RCTs for prophylactic ICD use in genetically screened populations is noted.

- *Observational Evidence*: Current guidelines rely on observational studies and registry data rather than RCTs due to ethical constraints in withholding ICDs from high-risk individuals.

3. Public Health and Awareness

- *Basic Life Support Training*: The need for mass-scale BLS training for the general public is proposed to improve responses to cardiac collapses.

- *Community-Level Interventions*: Participants suggest expanding public health education and infrastructure to address SCD prevention comprehensively.

4. Limitations in Clinical Evidence

- *Absence of RCTs*: Ethical challenges prevent RCTs comparing prophylactic ICD outcomes with sham interventions, leaving observational studies as the primary source of evidence.

- *Reliance on Guidelines*: Current clinical practices are shaped by expert consensus and observational data, which may lag behind real-world dynamics.

5. Role of AI in Medicine

- *Real-Time Insights*: AI is acknowledged as a potential tool for real-time data analysis to update guidelines and tailor interventions to specific populations.

- *Challenges for AI*: AI depends on human-collected data and cannot independently perform RCTs or generate evidence.

- *Orwellian Devices*: The concept of using advanced monitoring technologies to collect uncontrolled intervention data is introduced as a workaround for evaluating efficacy in real-world settings.

Comparative Reflection

The transcript reflects the interplay between *clinical practice*, *public health*, and *technological innovation* in addressing SCD. It highlights the tension between relying on observational evidence versus the ideal of RCTs, while exploring AI's role in bridging gaps in real-world data and guideline development. The conversation underscores the importance of integrating genetic screening, therapeutic interventions, public health education, and emerging technologies to advance SCD prevention and outcomes.

[30/08, 14:48] hu4: https://www.ndtv.com/india-news/chennai-cardiac-surgeon-39-suffers-heart-attack-during-rounds-at-hospital-dies-9184888

[30/08, 13:06]hu5: Very sad. It’s disheartening to see <40yr with MI that too brought by their healthy parents

[30/08, 13:07]hu5: I think NOT EVERY DISEASE COMES FROM GENES WE GET, BUT ALSO FROM JEANS (lifestyle) WE WEAR

[30/08, 20:37]hu3: Yes here's some work around the jeans from KEM : 

https://timesofindia.indiatimes.com/toi-plus/health/mumbai-doctors-decade-long-study-reveals-why-sudden-deaths-are-rising-among-young-indians/articleshow/123307764.cms

[30/08, 20:39]hu3: From his 2019 paper:

"A 10-year retrospective autopsy-based study was carried out in a large tertiary-care centre and patients aged ≤45 years with IHD were selected. Out of 545 autopsied cases of IHD, 95 patients (17.4%) were young. Among these 95 patients, 84 (88.4%) had IHD related to atherosclerotic CAD; the youngest patient was 18 years old. Predictably there was sole involvement of left anterior descending artery and the presence of fibrous plaques. Irrespective of the plaque morphology, the commonest complication was thrombosis produced by plaque erosion seen in 36.9% of patients. Acute coronary insufficiency was noted in 52 patients (61.9%), while healed infarctions were surprisingly noted in 28 patients (33.3%). Screening for IHD in the young population may help to improve prognosis by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population."

https://pmc.ncbi.nlm.nih.gov/articles/PMC6713168/

Plantar fascitis ProJR

Summary: This ProJR is a user driven project on patients with plantar fascitis sharing their diagnostic and therapeutic uncertainty and eventual journey on dyadic messages or global CBBLEs that after processing through CRH is slated to develop into an insightful UDLCO for people grappling similar problems.

Keyword Glossary:: http://userdrivenhealthcare.blogspot.com/2023/11/glossary-of-user-driven-healthcare.html?m=1

CC licence: https://commons.m.wikimedia.org/wiki/File:PF-PainAreas.jpg

Conversational Transcripts from various patient advocates from 2012 to 2025:

Date: Sat, Feb 18, 2012 at 1:51 PM
Subject: Re: Suggestions after going through your medical reports

I had a look at your attached reports, which were mostly normal and your history that you wrote in text was definitely very insightful as i could manage to localize, interpret and formulate a plan for your current problem as in my description below (do let me know if i have missed anything):

Problem of Joint pains affecting the spine, hand and knees.

My interpretations: 1) Pain in the heel suggests 'Plantar fascitis' which can be seen in 'Seronegative spondylo-arthropathy' which may be one possible explanation for your joint pains. Knee degeneration can occur in any chronic joint affection.

2) 'Seronegative spondylo-arthropathy' is a self limiting disease and recovers on its own. The other possible diagnosis for your condition is 'Osteoarthritis.'

My suggested Plan: I may require a few more X rays to diagnose it properly. Especially an X ray of the sacro-iliac joints B/L as well as X ray hands B/L ap view. However even a physical examination would be very useful.

Would it be possible for you to meet some of my students in ... College' who can either meet you in ... or ... (and then they can let me know a few more findings they may detect on examining you clinically)?

Do let me know. If you agree to my students seeing you and if i can share your medical reports with them we can hopefully find the current best solution to your problem soon. regards, 

On Fri, Feb 17, 2012 at 3:25 PM,  65M wrote:

I thank you very much for your kind hearing of my problems yesterday.
I am really grateful to , who was also our student at .
It was so nice to talk to you.
 As I told you I am suffering from joint pain for a long time. Pain is
not beyond tolerable. However, I can not walk properly now a days. I
can not grip things properly.
Doctor said that my X-ray of knee says there is degeneration. I had
once stiff neck, in 1995 I had to take collar.  I had vertigo problem,
but after a treatment of ear in 2008 I do not have vertigo.
In the past I could not walk after getting up in the morning because
of pain at the bottom of the heel. After changing shoe and number of
different medicine including Homeo and Aurvedic I do not have that
problem, but do not know which medicine cured me.

I am sending the reports of some test I had undergone last year. If
required I can come to your place and discuss the matters.
I look forward to your kind suggestions.
Best regards,

From the patient advocate of a 70F 

14 Oct 2012, at 12:06, 

>> This is real time ongoing experience my mother wishes to share with the medical community and public for any benefit or insight it may provide.
>>
>> She is an elderly active mobile lady and a music teacher by profession who undergoes regular blood checks every couple of years.
>>
>> For last one month she has mild pain in her one heel which comes when she starts walking after getting of the bed anytime of the day and gets relieved after she continues walking or rests herself. If she exercises her foot and ankle before getting off the bed the pain does not comes at all on walking.
>>
>> She has a background of poor compliance with allopathic medications in view of non specific side effects including gastritis and gets stressed even if told to take paracetamol 4 times a day as she feels that is higher than needed dosage, but ok to take same if explained the reasons in a gentle educative manner.
>>
>> On my insistence she saw a qualified orthopaedic surgeon as I wanted to know the diagnosis while sitting thousands of miles, overseas, away from her.
>>
>> The doctor who saw her today diagnosed Plantar Fasciitis and has given a prescription to start a paracetamol+NSAID oral combination, tab methyl prednisolone 4mg, a PPI, anti oxidant tablets. So a total of 5 types of salts. Also suggested some blood tests. I spoke to the doctor and he agreed that the symptoms and disease pattern is of mild nature at this point of time.
>>
>> I realised, that no history was taken about her apprehensions regarding the allopathic medications and obviously and probably correctly she wants my opinion what all she should be starting and why?
>>
>> There was no suggestion for physiotherapy at this stage either, considered the main stay of therapy otherwise for this usually self limiting condition otherwise, as i understand.
>>
>> Given my limited knowledge in Orthopaedic but not so of internal medicine I have concluded the following:
>>
>> 1. Given her mild symptoms the medications being given i felt, are more than needed out of which anti-oxidant has no role to play in this condition. Steroids being prescribed at this stage for mild symptoms are questionable and on top orally and in a very small dose will produce what benefit I fail to understand. However, a good chance of gastritis along with NSAIDs due to direct affect on gut epithelium is probably a sure shot side affect leading to high likelihood of poor patient compliance in future.
>>
>> 2. I have forwarded  my mother a credible link for patient knowledge highly commended and also awarded by BMA in 2012, which shall help her to understand the clinical condition in lay man's language and to help comply with right medications and exercises via physiotherapy and sharing with you all in case you may be interested.
>>
>> 3. I am also wary of starting NSAIDs in healthy elderly patients due to case reports of renal damage they can cause  and hence avoid giving same in my regular practice unless really needed and that too only for few days if really needed.
>>
>> Basis of background medical knowledge, ongoing communication skills knowledge to help me understand illness perspective of patients and knowledge from credible website linked pasted below led me to discuss the matter with orthopaedics colleague to help me suggest my mother the following for her MILD plantar fasciitis:
>>
>> 1. Paracetamol 1 tab 6 hrly

>> 2. Physiotherapy exercises as in link and also under guidance of local physiotherapist. Appy ibuprofen gel locally if pain worsens while physiotherapy as may happen at that point.

>> 3. Cold compression with frozen pea bag

>> 4. Exercises of foot n ankle every time before getting to start walking every time.

>> 5. Footwear suggestions and heel pad as in the link
>>
>> I wonder how many of me agree and how many disagree with the line of management tailored for her at this stage and thought of sharing the ongoing experience as a learning tool from various perspectives after my mother gave me the consent to share this with august medical fraternity on these forums.
>>
>> She coined the term that there is a sin (cine) in Medicine and also laughed when I asked if there is Crocin at home saying that there is a Sin (cin) in Crocin as well which i was persuading her to start off with and hence the subject of this mail.
>>
>> I look forward to all comments and criticisms to help me learn more and wonder if we are ready to take over the sins of medicine as this patient who happens to be my mother has expressly wished and consented gracefully this Sunday morning?
>>
>> I will look forward to keeping the forum aware how she responds to treatment designed for her including compliance to same.

The useful link is http://www.patient.co.uk/health/Plantar-Fasciitis.htm

Date: Tue, 16 Oct 2012, 11:34

One more therapy I have realised is contrast fomentation which many colleagues wrote back and the best one is putting feet in warm water for 4 min and then cold water 1 min and again warm then cold - total 4 times in each - time duration 20 min - each night - strangely missing in EBM

Of course exercises to stretch TA as in uk patient website in my 1st mail

Though i will try my best regarding patient centred queries as will help me learn more I will not promise success every time as lots depends on dynamics and incidences going around me, however I will try my best 

On 16 Oct, 2012, at 4:05 AM, cm> wrote:
This will definitely help one of my current patients who had visited us all the way from 1500 Kms and we couldn't do much except provide an insole for his shoes that didn't seem to work once he reached home.

Can i send you some of our patient centered queries from rural India so that you can provide us such excellent EBM answers that can help our patients?

best,

On Mon, Oct 15, 2012 at 9:56 PM, patient advocate 70F > wrote:

Dear All,

Many thanks to all who mailed with various non-invasive measures rightly needed to treat plantar fascitis in a sensible manner.

I wish to share 2 snippets from latest article on this subject published this week in BMJ.

I hope our orthopaedic colleagues will also reflect on indiscriminate use of steroids and anti-oxidants in their practice which is nowhere mentioned in evidence based literature and be safe to their patients and design therapy for individual patients rather than trying the formula of same size fitting all.

Thanks again,

 
Summary points (So : BMJ 13 Oct 2012)

• Plantar fasciitis is a condition which generally resolves over time with minimally-invasive management
• There is no one treatment with the highest level of evidence, but several with moderate levels of evidence, including stretching, orthotics, shock wave therapy, and injections
• The secondary cost of prolonged immobility can be severe (and can also worsen plantar fasciitis), so it is worth treating plantar fasciitis actively rather than with neglect
• Choice of treatments should be tailored to the individual patient’s circumstances and likelihood of response

Summary of individual selection for various treatments (So : BMJ 13 Oct 2012)

Management	Who it might help	Who might not benefit	Relative cost
Orthotics	Those with a longitudinal arch that is flattening in middle age	Those who don’t get any relief from low-dye taping	Low for tape and prefabricated orthotics, moderate for custom made orthotics
Night splints	Those with morning pain who are good sleepers	Those who struggle to sleep	Low
Extracorporeal shock wave treatment	Those with a heel spur on x ray	Those who don’t quickly respond to initial treatment	Moderate
Cortisone injection	Those who have had success with NSAIDs or cortisone injections elsewhere	Those with diabetes; those with thin fat pads or who have had previous injections	Low-moderate
Ultrasound guided cortisone injection	Those who need diagnostic confirmation	Those with poor pain tolerance (as slower technique under ultrasound)	Moderate
Rocker sole shoes	Those with pain on walking	Those who stand or run a lot or have coexisting knee or hip pathology	Low-moderate
Platelet-rich plasma injections	Athletes	Those with poor venous access (such as obese patients)	Moderate
Botox injections	Possibly those with cavus feet	Athletes or those who walk heavily at work (as side effects of muscle paralysis are poorly studied)	Moderate-high
Immobilisation	Those who refuse to reduce loading	Any overweight patient	Low (but high secondary cost)
Surgery	Those with longstanding pain who have been unable to unload the heel	Those who have not exhausted conservative treatment	High

NSAID=non-steroidal anti-inflammatory drug

From patient advocate of another patient from another location 65F 

6/9/15- 8/9/15 bartoman poristhiti -  betha nei tabe khichuni majhe majhei hochhe.Sorirer dan side ektu obosh obosh lagche.Thigh er nich thekei khuchuni suru hoy.Tab Ultracet plain newar por theke buk dharfor o matha khanik khaner jonno ghure jachhe. Ultracet 1/ 2  dine dui bar o Paracetemol 500 mg dine 4 bar dewa hoyeche.

Date: Sun, Sep 6, 2015 at 11:04 AM
Subject: Re: 66yrs.F swelling in right leg

Hain half tablet. 

On Sun, Sep 6, 2015 at 10:58 AM, patient advocate 65F wrote:

Ultracet Semi pawa na gele ultracet plain ki dewa jete pare !

On Sep 6, 2015 9:58 AM, "cm wrote:

Shune mone hocche plantar fascitis 

Local daktarer jonye suggestion. 

Kichu diner jonye mild pain killer nite paren.

Tablet Ultracet Semi dine char bar ebong Tablet Paracetamol 500 mg dine char bar.

On Sat, Sep 5, 2015 at 9:28 PM, patient advocate 65F wrote:

Exactly  goto 7 din theke sudhu payer patay betha chilo.Kichuni shuru hoyeche goto kal theke.Bichana theke namar somoy , hatte gele  khichuni shuru hochhe , 1-2 minute thake, darate gelei problem hochhe.Mone hochhe pore gie paa venge jabe.

On Sep 5, 2015 9:20 PM, "cm wrote:  Kotokkhone thake?

On Sat, Sep 5, 2015 at 9:08 PM, patient advocate 65F wrote:

Goto 7 din theke dan payer thigh theke payer pata porjonto prochondo khichuni.Majhe majhe mone hochhe paa obosh hoye asche.Khichunir somoy betha hochhe.Paye support dite osubidha hochhe.                              Please need your help !                 

41F from another location 

Date: Tue, 30 Jun 2015, 09:31
Subject: Re: New Patient Name - Zingiber Montanum( Koenig ) Age - 41 y Sex - F

Local daktarer saathe poramorsher jonye:

Gastritis/Gastric ulcer ebong kidney failure beshi din khele. 

On Tue, Jun 30, 2015 at 9:22 AM, patient advocate 41F wrote:

Dakthar  babu   Ai   Osud  guli    Khala   ke   Osubedha  Dakha  Dethay  paray

Aktuk  Janaben.

2015-06-29 21:01 GMT+05:30 cm wrote>:

Unar pathano payer chobi ta dekhlam. 

Unar daktarer saathe poramorsher por Tablet Ultracet semi dine 4 bar ebong Cap Indocap SR 75 mg raate ek bar ek saptaho nite paren.

regards, 

2015-06-28 17:50 GMT+05:30 cm wrote

>:

Dekhlaam. 

Local daktarer jonye suggestion:

Plantar fascitis howar sombhabona ache. Dorkar hole ekhane aro details a dekha jete pare. Ae chara ekta payer image (jekhane byatha hocche) whatsapp kore dite paren. 

On Sun, Jun 28, 2015 at 5:45 PM, patient advocate 41F wrote:

Dakthar  Babu      Patient  Tar   Payar   Gorale   Fula  Gachay  Hatacola  korthay

Ba   Aknagaray    bosay thakthay    para na Ai  Deka    Aonk  Chhekethsa  koray  chay   kenthu  kono    Upokar  hochay   Na  Tai  Sob  Repot  Gule   Dakha  Akta 

Replay   Deban   WhatsApp  A  Pateayche  Aktuk  Dakben

52M from another location:

Date: Sun, 21 Jun 2015, 11:39
Subject: Re: Old Patient Name - Terminalia Billereca ( Gaertn ) Roxb Age - 52 y Sex -M

Unar sampoorno record ta upload korun.

On Sun, Jun 21, 2015 at 11:35 AM, 

Patient advocate 52M wrote:

Dakthar babu Ai  Guli  tek  Ame  bujthay  parche Na Patient  Akhan  ke  korbay

Janaban Indocap 25 mg  Kala  Akden  Kom  Thaka   Ke  Korlay  AKTUK  Aram pabay

Seta  Aktuk  Janaben.

On Sun, Jun 21, 2015 at 9:31 AM, cm> wrote:

Unar record ta aekhono website a uploaded hoyni (amar Feb 9, 2015 er email ta niche dekhun). Sampoorno history samet upload korte parle bhalo hoto. Uni ki recently paralysis rugi tike niye aeshechilen tini? Unar ki payer X ray o amra koriyechilaam ebong Dr ... keo dekhate bolechilaam (jodi unei hoye thaken)?

Aekhonkar bortoman crisis er jonye local daktarer er saathe poramorshser por uni Cap Indomethacin 75 mg at bedtime 3 days khete paren (ebong Indocap 25 mg dine du bar sakal theke khete paren 3 days er jonye) kintu unar samporrno record ta dorkar. Aekhono poryonto shab shune rogtar naam mone hocche 'Plantar fascitis.' best, 


Date: Mon, Feb 9, 2015 at 10:34 PM
Subject: Re: Old Patient Name - Terminalia Billereca Age - 51 Sex - M

Local Daktarer jonye suggestion:

Complete history ebong discharge summary ta dekha dorkar. Upload kore dile bhalo hoi.

Cap Indopcap SR 75 mg at bedtime for two days.

On Mon, Feb 9, 2015 at 9:57 PM, 

Patient advocate 52M wrote:

Dakther Babu  Amar Bondhu  Aponar Kachay  Geaychlo   Or  Payar

Goraler Nechay  Kub  Batha  Hochay  Bortho Manay    Nechay  Ar

Osud  Guli  Kachay  Kenthu  Kono Kag  Hochay Na Ke  Osud  Kabay

Aktuk  Janalay  Kub  Valo Hoay.

1) Matesnal  Psy --

2) Finuncicel Crinin        

Ai Guli  Kachay.

On Sun, Jun 21, 2015 at 8:18 AM,

Patient advocate 52M wrote:

Dakthar  Babu   Nomoskar  Naben  Ai  patient   ta    2  times    Aponaka  Dakheaycha    payar  Gorale   thay   kub  batha    Akta  Capsul  deaycelan

Sata  khala   24  hours    Aram  thakay     Abar   batha hoay   2 den jaboth

akdom    Hatthay   parcha na  ke  korbay   aktuk   janalay   valo hoay, Akta

Replay  deban.

58M April 2025

[20/04, 14:52] 58M Patient Advocate Left Heel Pain 6 Months: Sir

I have a problem in my health

[20/04, 14:53] 58M Patient Advocate Left Heel Pain 6 Months: Left leg heel pains

When i went to orthopedic doctor he did x-ray said spur

And prescribed pain killer and soft shoe 

But thats not giving relief

I feel its linked to some major body disorder

[20/04, 14:54] 58M Patient Advocate Left Heel Pain 6 Months: How to connect 

Which body or organ disorder is giving this pain

[20/04, 14:54] 58M Patient Advocate Left Heel Pain 6 Months: In left leg heel

[20/04, 14:54] 58M Patient Advocate Left Heel Pain 6 Months: Throbbing pain

[20/04, 14:55]cm: It's more likely to be plantar fascitis which is a subset of spondyloarthropathy

[20/04, 14:55] 58M Patient Advocate Left Heel Pain 6 Months: Ok sir

[20/04, 14:56] 58M Patient Advocate Left Heel Pain 6 Months: My CBC report recent

[20/04, 14:57]cm: Please describe your patient's sequence of events that led to the current problems.

Please begin the sequence of events from the time your patient had absolutely no problems at all. 

Please describe your patient's hourly  routine over 24 hours when he was perfectly alright 

Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life 

Please mention specifically which part of the patient's hourly routine was disrupted 

What are the patient's current requirements from us like if we had to give him a single medicine which problem would they prefer it to address?

Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here:

https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html?m=1

[20/04, 14:59] 58M Patient Advocate Left Heel Pain 6 Months: Left heel pain persistent from last six months

[20/04, 15:02]cm: Take your time to slowly answer the other questions like:

Please describe your patient's hourly  routine over 24 hours when he was perfectly alright 

Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life 

Please mention specifically which part of the patient's hourly routine was disrupted 

Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here

[20/04, 15:02] 58M Patient Advocate Left Heel Pain 6 Months: For 2 weeks i am having left leg heel pain mostly in night time

Throbbing and shooting pain last for half an hour to one hour

[20/04, 15:04]cm: Don't share any reports. I'm assuming they are alll normal

[20/04, 15:05]cm: Tell us how it was 6 months back

[20/04, 15:06]cm: What time exactly? Yesterday at what time? What was the patient doing at that time?

[20/04, 15:06]cm: Please don't share any patient identifiers in social media even on pm

[20/04, 15:09]cm: Please describe your patient's hourly  routine over 24 hours when he was perfectly alright and didn't have the following complaints:

1. Left leg heel pain

2. No sound sleep of 6-7 hours

3. Mild continuous headache 

4. Burning sensation in urethra. Burning micturition sometimes

Next please describe what happened to his hourly 24 hour routine once the above complaints took hold on his life

Please mention specifically which part of the patient's hourly routine was disrupted by which complaint at what time 

Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here

https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html?m=1

[20/04, 15:11] 58M Patient Advocate Left Heel Pain 6 Months: Ok sir

Will do

[24/05, 17:08]cm: We need a better history with regular informational continuity.

Have asked my team members if they can connect with you synchronously to explain how our solution works

After a conversational gap from May to August 2025

[17/08, 10:38]cm: How's the heel pain?

[17/08, 10:59] 58M Patient Advocate Left Heel Pain 6 Months: Sir 

As I was traveling abroad 

I had to take steroid injection and go

[17/08, 10:59] 58M Patient Advocate Left Heel Pain 6 Months: So now it's no pain

[17/08, 11:00] 58M Patient Advocate Left Heel Pain 6 Months: But 

Not sure what's the prognosis

[17/08, 12:03]cm: Let's hope it won't recur.

@⁨Meta AI⁩ what's the epidemiological evidence for recurrence of plantar fascitis after local steroid injections? Please support your statements with single best RCTs in a PICO format taking care not to use any percentages

[17/08, 12:03] Meta AI: *PICO Format Analysis*

- *Population (P):* Adults diagnosed with plantar fasciitis, particularly those who have not responded to conservative treatments like stretching, orthotics, or physical therapy.

- *Intervention (I):* Local corticosteroid injections administered into the plantar fascia.

- *Comparison (C):* Placebo, other injections (e.g., platelet-rich plasma [PRP]), or non-invasive treatments like physical therapy or custom orthotics.

- *Outcome (O):* Recurrence of plantar fasciitis symptoms after a period of symptomatic relief.

*Key Evidence from RCTs:*

One high-quality randomized controlled trial compared *local corticosteroid injections* to *placebo injections* and *platelet-rich plasma (PRP)* for plantar fasciitis.

- *Findings:* Corticosteroids provided significant short-term pain relief and functional improvement (typically a few weeks to months). However, recurrence of symptoms was commonly observed in the long-term follow-up, particularly when the underlying biomechanical or inflammatory causes were not addressed. PRP, while slower to show benefits, demonstrated longer-lasting symptom control and lower recurrence rates compared to corticosteroids.¹ ²

Another RCT evaluated corticosteroid injections versus physical therapy (e.g., stretching and strengthening).

- *Findings:* While corticosteroids offered a faster reduction in pain, patients receiving physical therapy had better long-term outcomes with lower recurrence rates. This highlights that while corticosteroids may address inflammation temporarily, they do not resolve the root cause of plantar fasciitis.³ ⁴

*Conclusion:*

The epidemiological evidence suggests that corticosteroid injections are effective for short-term symptom relief but are associated with a higher likelihood of recurrence when used as a standalone treatment. Combining injections with physical therapy or addressing biomechanical factors may reduce recurrence rates. Would you like me to elaborate on alternative treatments or dive deeper into PRP evidence?

[17/08, 14:30] 58M Patient Advocate Left Heel Pain 6 Months: Yes sir

I hope so

[17/08, 14:31] 58M Patient Advocate Left Heel Pain 6 Months: The contrast is

I need to walk a lots for my health 

And if plantar fasciitis pain is there I can't do that

[17/08, 14:40]cm: @⁨Meta AI⁩ Can walking become a solution for plantar fascitis pain?

[17/08, 14:40] Meta AI: Walking can sometimes help alleviate plantar fasciitis pain, but its effectiveness depends on how it’s approached and the severity of the condition.

*Potential Benefits of Walking:*

- *Improved circulation:* Gentle walking can increase blood flow to the plantar fascia, aiding in healing and reducing stiffness.

- *Stretching effect:* Walking can help stretch the fascia and Achilles tendon, promoting flexibility and reducing tension on the heel.

*Risks or Limitations:*

- *Excessive pressure:* If walking is done without proper footwear or while the fascia is inflamed, it can worsen the pain and delay healing.

- *Biomechanics:* Poor walking posture or gait can exacerbate the condition, especially if the underlying cause is related to foot alignment or overuse.

Supportive footwear, orthotics, or walking on softer surfaces can make walking a more viable solution. Are you considering specific walking routines or seeking advice on footwear?

[17/08, 14:41]cm: @⁨Meta AI⁩ please provide specific walking routines and advice on footwear for Plantar fascitis

[17/08, 14:41] Meta AI: Certainly! Walking routines and footwear advice can be tailored to alleviate plantar fasciitis pain while promoting healing. Below are specific recommendations:

Walking Routines for Plantar Fasciitis Relief

1. *Start Slowly*

    - Begin with short walks (5–10 minutes) on even, soft surfaces (e.g., grass or a track). Avoid hard surfaces like concrete or asphalt, which can increase impact stress on the heel.

    - Gradually increase the duration and intensity as pain improves.

2. *Warm-Up Before Walking*

    - Perform gentle stretches to loosen the plantar fascia and Achilles tendon before walking. Examples include:

        - *Towel Stretch:* Sit with your legs extended and loop a towel around your foot. Gently pull the towel to stretch the foot and calf.

        - *Wall Stretch:* Stand facing a wall, place your hands on it, and stretch your calves by leaning forward while keeping your heels on the ground.

3. *Focus on Proper Walking Technique*

    - Maintain a neutral gait: Avoid overstriding or rolling inward/outward excessively.

    - Keep your steps short and controlled to reduce strain on the fascia.

    - Land softly on your heel and roll through to your toes.

4. *Incorporate Rest Periods*

    - If pain starts to increase during walking, stop and rest. Gradual progression is key to avoiding aggravation of the fascia.

    - Alternate walking days with non-weight-bearing exercises like swimming or cycling to reduce stress on the heel.

5. *Use Walking Intervals*

    - For beginners, alternate walking with rest periods (e.g., walk for 5 minutes, rest for 2 minutes). Over time, increase walking intervals as pain decreases.

---

Footwear Advice for Plantar Fasciitis

Wearing the right footwear is crucial for reducing strain on the plantar fascia and promoting healing.

1. *Key Features to Look For in Footwear:*

    - *Arch Support:* Choose shoes with adequate built-in arch support to reduce stress on the plantar fascia.

    - *Cushioned Heel:* A well-cushioned heel helps absorb shock and minimizes pressure on the heel bone.

    - *Firm Midsole:* A firm yet flexible midsole offers stability and prevents overpronation (excessive inward rolling of the foot).

    - *Deep Heel Cup:* Shoes with a deep heel cup provide better support and alignment for the heel.

2. *Recommended Types of Footwear:*

    - *Walking Shoes:* Look for walking shoes designed for plantar fasciitis, such as those from brands like Brooks, New Balance, or ASICS.

    - *Running Shoes:* Many running shoes provide excellent arch support and cushioning, which can be beneficial for walking routines.

    - *Orthopedic Sandals:* For casual use, consider sandals with arch support (e.g., Birkenstock or Vionic).

3. *Avoid These Types of Shoes:*

    - Flat shoes (e.g., flip-flops or ballet flats): Lack arch support and cushioning.

    - High heels: Increase strain on the fascia and Achilles tendon.

    - Worn-out shoes: Shoes with worn soles or inadequate support can exacerbate symptoms.

4. *Consider Orthotics:*

    - Custom or over-the-counter orthotics can be inserted into your shoes to provide additional arch support and heel cushioning. Brands like Superfeet, PowerStep, or Dr. Scholl’s plantar fasciitis insoles are popular choices.

---

Additional Tips for Walking with Plantar Fasciitis

- *Stretch After Walking:* Stretch your calves and plantar fascia after each walking session to prevent tightness.

- *Apply Ice:* If pain increases after walking, apply ice to the heel for 15–20 minutes to reduce inflammation.

- *Night Splints:* Consider using night splints to keep the fascia stretched overnight, which can reduce morning pain and improve walking comfort.

- *Monitor Pain Levels:* If walking causes sharp or worsening pain, consult a healthcare provider for evaluation and guidance.

---

By combining proper walking routines with supportive footwear, plantar fasciitis pain can be managed effectively. Would you like detailed instructions on specific stretches or exercises to complement your walking routine?

From 35F August 2025:

[17/08, 09:50] Patient Advocate 35F Plantar Fascitis: I am in trouble, please help me

[17/08, 09:56] Patient Advocate 35F Plantar Fascitis: Sent voice msg 👆🏻

[17/08, 09:58]cm: Please text if possible

[17/08, 10:11] Patient Advocate 35F Plantar Fascitis: Ok

[17/08, 10:16] Patient Advocate 35F Plantar Fascitis: আমার বাম পায়ের গোড়ালি তে হঠাৎ করে কয়েকদিন আগে থেকে খুব ব্যথা হচ্ছিল, গোড়ালির একটু উপরের দিকে এবং নিচ অব্দিও ব্যাথাটা হচ্ছিল এবং হাঁটতে খুব অসুবিধা হচ্ছিল। আমি একটা পেইনকিলার ওষুধের দোকানে জিজ্ঞেস করে পাঁচ দিন দুবেলা খাই। এবং তাতে যেহেতু আমি একটা ট্রিপে গেছিলাম ব্যথা কিছুটা বেড়েছিল এবং পরবর্তীকালে কমে। 

আজ সকাল থেকে আবার পা ফেলতে পারছি না এত যন্ত্রণা করছে বা পায়ের নিচের দিকে ভীষণ বেশি ব্যথা হচ্ছে। বিশেষ করে বাঁ দিকটা।

 আমি সাধারণত এখানে ঢাকা জুতো পড়ে চলাফেরা করি কারণ বেশ উঁচু-নিচু পাথরের উপর দিয়ে আমাকে হাঁটাচলা করতে হয়, কিন্তু বর্ষার জন্য শেষ কয়েকদিন আমি কিটো পড়ে হাঁটছিলাম তো হতে পারে যে আমার পা কোনভাবে এদিক ওদিক পড়েছে বা মোচকে ছে যেটা আমার খেয়াল নেই।

[17/08, 10:20]cm: Looks like plantar fascitis. 

@⁨Meta AI⁩ what would be the best management for plantar fascitis affecting the left heel of the foot for a few days.

No past history of similar pain

[17/08, 10:20] Meta AI: Plantar fasciitis is often managed conservatively, especially in the early stages. Here are some common approaches:

1. *Rest and Activity Modification*: Avoid activities that aggravate the pain, like prolonged standing or running.

2. *Stretching and Strengthening*: Perform gentle stretches for the calf muscles and plantar fascia. Toe stretches, calf stretches, and rolling a ball under the arch can be helpful.

3. *Ice Therapy*: Apply ice to the affected area for 15-20 minutes, several times a day, to reduce inflammation.

4. *Footwear*: Use supportive shoes with good arch support and cushioning. Avoid walking barefoot or wearing unsupportive footwear like flip-flops.

5. *Orthotics*: Consider over-the-counter arch supports or heel cups to reduce strain on the plantar fascia.

6. *Pain Relief*: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can help with pain and inflammation if needed.

If the pain persists or worsens after trying these measures for a couple of weeks, consulting a healthcare provider might be necessary. They could recommend physical therapy, night splints, or other interventions.

Have you noticed if the pain is worst in the morning or after long periods of inactivity?

[17/08, 10:21] Patient Advocate 35F Plantar Fascitis: যেদিন প্রথম ব্যথা হয়েছিল সেদিনকে বাড়িতে ফিরে অফিস থেকে আমি অনেকক্ষণ বরফ জলে পা ডুবিয়ে রেখেছিলাম তাতে সাময়িক ব্যথা কমেছিল পরে আবার ব্যথা হয়।

[17/08, 10:23]cm: Prothom kabe hoi.

Aer aageo kokhono hoyechilo?

Komore kono byatha aer aage?

[17/08, 10:23] Patient Advocate 35F Plantar Fascitis: এখন হাঁটাচলা খুবই কম হচ্ছে কারণ অফিসের কাজের সেরকম দায়িত্ব অনেক কম, বেশিরভাগ সময়টা চেয়ারে বসেই সময় কাটছে। সেটা কি কোন কারণ হতে পারে?

[17/08, 10:24] Patient Advocate 35F Plantar Fascitis: দু সপ্তাহ আগে প্রথম হয়। অফিসের বাসটা এখন চেঞ্জ হয়েছে তাতে বসার সিট টা খুব অদ্ভুত মানে পা টা মাটি অব্দি পৌছয় না। পাটাকে একটু বেঁকে বসতে হয় তো সেটার জন্য মাঝেমধ্যে কোমর এবং পায়ে একটু স্ট্রেস হয়

[17/08, 10:25]cm: Hain

[17/08, 10:28] Patient Advocate 35F Plantar Fascitis: এর আগে কখনো এই ধরনের ব্যথা হয়নি। এই প্রথম হলো দু সপ্তাহ আগে

[17/08, 10:28] Patient Advocate 35F Plantar Fascitis: কিভাবে কমবে ব্যথা?

[17/08, 10:42] Patient Advocate 35F Plantar Fascitis: কি ওষুধ খাবো? Pain killer ছাড়া অন্য কোনো উপায় এ কমতে কত সময় লাগবে?

[17/08, 12:08] Rakesh Biswas: Sharing a similar patient who had to eventually get injected inside his heel 👇

58M April 2025

[20/04, 14:52] 58M Patient Advocate Left Heel Pain 6 Months: Sir

I have a problem in my health

[20/04, 14:53] 58M Patient Advocate Left Heel Pain 6 Months: Left leg heel pains

When i went to orthopedic doctor he did x-ray said spur

And prescribed pain killer and soft shoe 

But thats not giving relief

I feel its linked to some major body disorder

[20/04, 14:54] 58M Patient Advocate Left Heel Pain 6 Months: How to connect 

Which body or organ disorder is giving this pain

[20/04, 14:54] 58M Patient Advocate Left Heel Pain 6 Months: In left leg heel

[20/04, 14:54] 58M Patient Advocate Left Heel Pain 6 Months: Throbbing pain

[20/04, 14:55]cm: It's more likely to be plantar fascitis which is a subset of spondyloarthropathy

[20/04, 14:55] 58M Patient Advocate Left Heel Pain 6 Months: Ok sir

[20/04, 14:56] 58M Patient Advocate Left Heel Pain 6 Months: My CBC report recent

[20/04, 14:57]cm: Please describe your patient's sequence of events that led to the current problems.

Please begin the sequence of events from the time your patient had absolutely no problems at all. 

Please describe your patient's hourly  routine over 24 hours when he was perfectly alright 

Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life 

Please mention specifically which part of the patient's hourly routine was disrupted 

What are the patient's current requirements from us like if we had to give him a single medicine which problem would they prefer it to address?

Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here:

https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html?m=1

[20/04, 14:59] 58M Patient Advocate Left Heel Pain 6 Months: Left heel pain persistent from last six months

[20/04, 15:02]cm: Take your time to slowly answer the other questions like:

Please describe your patient's hourly  routine over 24 hours when he was perfectly alright 

Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life 

Please mention specifically which part of the patient's hourly routine was disrupted 

Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here

[20/04, 15:02] 58M Patient Advocate Left Heel Pain 6 Months: For 2 weeks i am having left leg heel pain mostly in night time

Throbbing and shooting pain last for half an hour to one hour

[20/04, 15:04]cm: Don't share any reports. I'm assuming they are alll normal

[20/04, 15:05]cm: Tell us how it was 6 months back

[20/04, 15:06]cm: What time exactly? Yesterday at what time? What was the patient doing at that time?

[20/04, 15:06]cm: Please don't share any patient identifiers in social media even on pm

[20/04, 15:09]cm: Please describe your patient's hourly  routine over 24 hours when he was perfectly alright and didn't have the following complaints:

1. Left leg heel pain

2. No sound sleep of 6-7 hours

3. Mild continuous headache 

4. Burning sensation in urethra. Burning micturition sometimes

Next please describe what happened to his hourly 24 hour routine once the above complaints took hold on his life

Please mention specifically which part of the patient's hourly routine was disrupted by which complaint at what time 

Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here

https://userdrivenhealthcare.blogspot.com/2024/08/template-for-pajr-user-driven-history.html?m=1

[20/04, 15:11] 58M Patient Advocate Left Heel Pain 6 Months: Ok sir

Will do

[24/05, 17:08]cm: We need a better history with regular informational continuity.

Have asked my team members if they can connect with you synchronously to explain how our solution works

After a conversational gap from May to August 2025

[17/08, 10:38]cm: How's the heel pain?

[17/08, 10:59] 58M Patient Advocate Left Heel Pain 6 Months: Sir 

As I was traveling abroad 

I had to take steroid injection and go

[17/08, 10:59] 58M Patient Advocate Left Heel Pain 6 Months: So now it's no pain

[17/08, 11:00] 58M Patient Advocate Left Heel Pain 6 Months: But 

Not sure what's the prognosis

[17/08, 12:03]cm: Let's hope it won't recur.

@⁨Meta AI⁩ what's the epidemiological evidence for recurrence of plantar fascitis after local steroid injections? Please support your statements with single best RCTs in a PICO format taking care not to use any percentages

[17/08, 12:03] Meta AI: *PICO Format Analysis*

- *Population (P):* Adults diagnosed with plantar fasciitis, particularly those who have not responded to conservative treatments like stretching, orthotics, or physical therapy.

- *Intervention (I):* Local corticosteroid injections administered into the plantar fascia.

- *Comparison (C):* Placebo, other injections (e.g., platelet-rich plasma [PRP]), or non-invasive treatments like physical therapy or custom orthotics.

- *Outcome (O):* Recurrence of plantar fasciitis symptoms after a period of symptomatic relief.

*Key Evidence from RCTs:*

One high-quality randomized controlled trial compared *local corticosteroid injections* to *placebo injections* and *platelet-rich plasma (PRP)* for plantar fasciitis.

- *Findings:* Corticosteroids provided significant short-term pain relief and functional improvement (typically a few weeks to months). However, recurrence of symptoms was commonly observed in the long-term follow-up, particularly when the underlying biomechanical or inflammatory causes were not addressed. PRP, while slower to show benefits, demonstrated longer-lasting symptom control and lower recurrence rates compared to corticosteroids.¹ ²

Another RCT evaluated corticosteroid injections versus physical therapy (e.g., stretching and strengthening).

- *Findings:* While corticosteroids offered a faster reduction in pain, patients receiving physical therapy had better long-term outcomes with lower recurrence rates. This highlights that while corticosteroids may address inflammation temporarily, they do not resolve the root cause of plantar fasciitis.³ ⁴

*Conclusion:*

The epidemiological evidence suggests that corticosteroid injections are effective for short-term symptom relief but are associated with a higher likelihood of recurrence when used as a standalone treatment. Combining injections with physical therapy or addressing biomechanical factors may reduce recurrence rates. Would you like me to elaborate on alternative treatments or dive deeper into PRP evidence?

[17/08, 12:08] Patient Advocate 35F Plantar Fascitis: Omg 🙏🏻

[17/08, 12:09] Patient Advocate 35F Plantar Fascitis: I am not willing for any injection if not emergency

[17/08, 12:10] cm : Ice ee choluk tabe

[17/08, 12:10] Patient Advocate 35F Plantar Fascitis: আচ্ছা 😊