Heel pain not improving?

Heel pain/ plantar fasciitis still not improving?

Have you tried treating plantar fasciitis at home? Been seeing health practitioners and still not getting better?

As stated in the previous blog post this is a chronic condition and will take time to resolve, the longer you have had it the longer it will take to improve.

Here is our approach to what should be the next steps if you haven’t seen good improvement after 8-10 weeks.

Have you addressed the causative factors?

Have you reduced the negative stress on the plantar fascia?

Have you been undertaking positive healing response exercises regularly? (at least daily)

These are all spoken about in the last blog post.

If you answered yes to all of these then we need to look at the next steps.

Healthcare clinicians- This can be a bit of a tricky situation in regards to treating heel pain and treating plantar fasciitis.

Who do you see? GP? Podiatrist? Physio? Osteopath? Chiropractor?

Each have their strengths but also have restrictions.

GP’s- This is most peoples normal go to. They can diagnose based on symptoms and can also utilise imaging for an accurate diagnoses. They can undertake X-rays, Ultrasound, CT scans and bone scans and these can normally all be bulk billed or rebated along with their visits.

Apart from a diagnosis their treatment may be limited- you may be lucky and get a hand out but apart from that the options they have available are anti-inflammatory medication or cortisone injections. But saying that if you have been trying to treat your pain but after scans everything in your foot and ankle looks normal they may be able to scan your lower back and find that your pain actually is referred from your back and not caused by your foot. So this can save a lot of time, effort and money.

Podiatrist- These are foot health professionals and would have a fantastic understanding of heel pain and it is something they will see regularly. They have access to X-ray and US scans to get a diagnosis. They will be able to explain the condition, give exercises to help heal the damaged tissue and may be able to perform treatments like shockwave therapy, therapeutic ultrasound, dry needling and offer prefabricated orthotics or custom orthotics.

Physio- Are normally a hands on profession in treating heel pain. They will have a good understanding of the condition but do not have rebatable access to scans to diagnoses plantar fasciitis. They will often utilise treatments like massage, therapeutic ultrasound and dry needling. They may be able to assess if the pain is coming from other sources.

Osteopath- Are normally a hands on profession in treating heel pain. They treat the whole body and know the whole body.They will have a good understanding of the condition but do not have rebatable access to scans to diagnoses plantar fasciitis. They will often utilise treatments like massage, therapeutic ultrasound and dry needling. They may be able to assess if the pain is coming from other sources.

Chiropractors- These are back specialists but do deal with other aspects of the body. They often utilise hands on mobilisation techniques. Again they do not have rebatable access to scans to diagnoses plantar fasciitis. If the pain is referred from the back they are a good option for consultation.

So that is a quick overview of what health practitioners are out there. NOT all are created equal- some will be more caring, some may offer more treatments and some may push you to do your best.

What to do if you are seeing a health clinician and still not improving? The best thing is to start asking questions.

Is this really plantar fasciitis? Should we have a scan to confirm we are treating the right condition? Is there something else we can look at to treat the condition?

Can we utilise a number of treatments at once?

What is the treatment plan? How long do we give it before trying something else?

Is it worth while being referred to see someone else to have a different opinion on treating this?

Don’t lose hope if you get to the point and you aren’t improving after seeing one clinician, another may offer services more suited to you!

If you are seeing another clinician the best thing to do is be open of what you have tried, how often you tried it and how well you stuck to the previous plan.

If they want you treat it similar do ask why are we doing this if it hasn’t helped before? There may be a very good reason why the want you to do it. Like stretches the GP gave you in combination with trying out orthotics from the podiatrist for the first time, if the stretches didn’t help originally. Often one treatment will rely on other treatment options to further assist.

Summary:

This condition takes time to improve.

If you have tried sticking to a treatment plan and addressing the factors mentioned earlier it is best to get seen in person by a health clinician.

Ask questions to as why this will help, and how this will help.

Don’t lose hope if you aren’t getting better straight away.

Be open with your clinician if you aren’t getting better.

Ask what else can be done to improve it? can scans be done to confirm plantar fasciitis?

If you aren’t improving with one clinician then it may be worthwhile consulting with another.