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What is the Plan of attack for Heel pain?
We rarely don’t see this get better. Being a specialised injury clinic we see this more than anyone.
Plantar heel pain (PHP) affects up to 10% of the whole population. Understanding this is important. As it is so common, so are the suggested therapies proposed to get it better.
This blog is written by Blake Withers who is a Podiatrist, Researcher and University Lecturer here at Achieve Podiatry.
Most PHP is diagnosed as Plantar fasciitis. However, the plantar fascia (the structure that is always thought the be the culprit) is one of many structures that live within the heel and arch. It isn’t aways the cause of the pain. Its common, but as common as you think. There are muscles, bones, tendons, ligament, fat pads and several other structures that can be the driver of the pain. It is important that you see a Podiatrist that is experienced in dealing with injuries and pain. Here at Achieve Podiatry, our caseload is all pain, sporting injuries and rehab. This means we see these conditions a lot more than anyone else. We are also uniquely positioned working alongside GP’s and Sport Doctors which means if we need to refer on, we have good relationships to do so.
So how do we work out the cause of the pain?
We take a thorough history and head into the gym to assess the capacity of your tissues such as your heel and calf. We are the only Newcastle Podiatrists to have access to a full functioning gym and running track. It’s important this testing gets done as without it, the rehab and treatment can’t be tailored to you.
Once we have an understanding on what structure is causing the pain, we can begin to work out a treatment plan. There aren’t any treatment plans that are the same as each person is different. Some of the treatments may include:
Rehab – This is incredibly important. The tissue that is injured is generally that way because it has a reduced capacity. This means it was, for either a short or long period of time, unable to tolerate the force/load/stress through it. So, knowing this, we can increase the capacity by engaging in exercise therapy. It is like doing squats to get strong legs. We need to find the ‘squats’ off the foot.
Offloading – this is just as important as the rehab. If the tissue is injured, angry or inflamed, we need to somehow reduce the stress through it so it has time to recover. We do this many ways. We can use compression, custom orthosis, pre-made orthosis, footwear, brace and much more. They aren’t all used but do sometimes get used in conjunction. We are lucky at Achieve Podiatry, we can make everything here at the clinic so you can go home with them whichever therapy suits best.
Shockwave therapy – There is a lot of evidence now for the use of Shockwave therapy for plantar heel pain. We have seen incredible response in the clinic.
Its proposed mechanisms of action are:
Stimulation of free nerve endings to the point of desensitisation. This is the analgesic affect that we find almost everyone initially gets. It can last up to several weeks
Increase in neovascularization which is the growth of new blood vessels and increase in blood flow to the local tissue. This aids the healing process.
There are plenty of other therapies that work for some people. The previous mentioned the mainstays of any treatment and should always be considered first. It’s important to understand that although these treatments work, knowing when to use them is important.