This article will challenge the conventional view of what CAUSES heel pain. If we keep on doing the same old treatment, we are going to keep getting the same old results, so time for a new perspective.
Wow … There has been so much change in this space since Alana and I finished university many moons ago. The research is coming in so thick and fast, it can be hard to keep up. The internet has been a real game changer in our field, making information available to everyone. On the last count a quick Google search for “heel pain” came up with 222 000 000 results in 0.65 seconds … incredible! Some of the search results are trying to sell you some why my heels hurt when I get out of bed type of gadget, many promise a cure and there are an awful lot of differing opinions. So usually when our patients come in to see us, they are very well-researched and slightly confused.
In the past, this is how a Podiatrist would have treated plantar fasciitis: strapping, encouraging rest, prescribing anti-inflammatory drugs, making orthotics for your shoes, sending for injection, and if nothing works we send you for surgery, in that order. This was the best evidence-based practice and definitely how Alana and I were taught to treat this condition in our 4 years of university training.
In many cases, people seem to improve with these conventional treatments but good is not the same as BEST. We see many frustrated patients who have had painful injections, a bag full of orthotics, and expensive shoes and they are still in pain.
This was a signal to us that we needed to revisit the treatment options for “Plantar Fasciitis”.
Here in Maroochydore, on the SUNSHINE Coast in Queensland, I think I speak for the majority when I say we prefer to wear no shoes or thongs (flip flops/jandals/flippy floppies). Mainly because of the HOT Sunshine and we also love sand between our toes!
There are many popular sports where participants don’t wear a shoe that could fit any kind of orthotic, or they don’t wear shoes at all. Think kickboxing, dancing, martial arts, surf lifesaving, etc.
So let us go back to the drawing board together.
Imagine you are going shopping. You put 4 cans of tomatoes and a carton of eggs in a paper bag, and you feel the strain on the bag, but you think it is ok, just a few more things go in the bag… you try to get to the car quickly and then BAM!
The bag has broken, your eggs are broken all over the carpark and you can have rolled off in all directions. There is no fixing the bag, it is busted. DISASTER.
What could you have done differently to avoid this scene?
- The double bag trick? But there is still a breaking point isn’t there.
- Spread the load out over a few bags, but can you carry them?
- Use a different type of bag?
- Get fewer groceries?
I want you to think of this analogy when we think of the problem of your foot pain. Your heel hurts, not working properly, it is busted. The body’s soft tissue has a breaking point just like your shopping bag. Increased load or stress to the collagenous tissues in your heel can CAUSE your problem.
- Is that because the bag (tissues) are weaker because of illness, medication, smoking, age or nutrition/dehydration, or hormone changes?
- Is your body not functioning properly because of other problems i.e tight calves, weak ankles, dodgy hip, poor posture, increase in weight, or high emotional stress?
- Have you gone too hard too soon with your get-fit-for-summer plans and overfilled the bag (overstretched/strained your body’s soft tissues)?
- Have you ignored the initial niggle before your bag metaphorically broke and spilled your metaphorical shopping EVERYWHERE? (read torn your plantar fascia)
- Is it just the wrong type of bag (shoes) for your shopping (foot type)?
Depending on where you are along this continuum of damage to your bag/body, the treatment and healing time can be very different.
We found one study presented in the Journal of American Podiatric Medicine Association in 2003 by Lemount et al. in which 50 patients with chronic heel pain (over 2 years) had had their heel spurs surgically removed (ouch!). They sent the spurs and plantar facial fibres they had cut out into a lab to be tested. The results were astonishing…
There were no signs of inflammation on the plantar fascia…in ANY of the 50 samples. Rather, they all were showing breakdown and degeneration. Anti-inflammatory medication and injections had not worked in these people and now we know why.
They might have helped in the early stages, however by the time things got this bad and the inflammation has turned into destruction, pills, and needles were useless. The needle could have caused the damaged plantar fascia to rupture.
But this is about getting the CAUSE of your pain right to get the TREATMENT right. If the cause was inflammation then anti-inflammatory medications and a bit of rest from the provocative activity for a few days would have you right back on track. If they don’t help, you have moved down the continuum OR you have the wrong diagnosis and it is time to get help.
If you have heel pain, we can help. Feel free to give us a call and book an appointment today.
Thanks for stopping by and feel free to share this info with your friends 😊
Podiatrist at Sports and Structural Podiatry
202/2 Emporio Place, Maroochydore Qld 4558
Ph: (07) 54791211 | Fax: (07) 54791227