What to do when your heel pain/ plantar fasciitis isn’t improving
We will break this up into 2 different blogs.
1. Looking at factors you can manage
2. What to do and where to go when you still aren’t getting better
Background: Plantar fasciitis is the most common form of heel pain. As mentioned in previous posts it is a chronic breakdown of the fascia at the insertion of heel bone.
This breakdown causes pain, tightness and you may even develop a heel spur.
As it is a chronic condition, it means it did take time to develop… this means it will take time to heal. Studies say that most people will get better in 12-18 months without treatment. The good thing is by treating plantar fasciitis and heel pain you can get better a lot quicker.
We can see that in treating this condition early, it may only take a number of weeks to improve if treating it correctly.
If you have had this condition for a long time, it means it may take longer for it to improve. This may mean a number of months.
So what can you do if you are treating this condition but still not getting results?
We need to look at 3 main things.
1. Addressing causative or aggravating factors
2. Reducing negative stresses
3. Improving healing responses
Addressing causative factors
These are the reason why we develop heel pain or plantar fasciitis.
If we are trying to treat the condition but we haven’t addressed what has caused our injury to begin with it will be very difficult for it to improve.
The most causative factors include:
· Increase in body weight- more weight for the plantar fascia to deal with
· Use of ladders of shovel- an increased stress placed on the plantar fascia
· Flatter/ hypermobile feet- this refers to excess movement of your foot, the more it moves the more the plantar fascia has to work to limit it to where it should really be
· High heels- large stress by the angle of the foot and ankle
· Non supportive footwear- if the shoes have lost their support or don’t contain support it increases the work the plantar fascia has to do to help support your foot. If the shoe is supportive this can help reduce the work the plantar fascia has to do.
· Uptake of new activities- our bodies are great at dealing with what it is use to, but new activities place a lot of stress and strain on the plantar fascia it self, the more on going stress the more likely it is to develop into plantar fasciitis and heel pain.
Reducing negative stress
There are two types of stress of body tissues
Helpful stress ie weight bearing exercise to improve bone strength in those with osteoporosis and muscle response following a structured gym program.
Negative stress- this can slow down the rate of healing as the body has systems to try repair damage itself but if there is ongoing negative stress this does not occur, and it can also slow down your treatment of heel pain.
Examples include: Repetitive micro trauma from long periods of standing Tightness through the plantar fascia - as a result of caustic or factors discussed previously Pull of the plantar fascia on the heel bone- tightness of the plantar fascia oiling on the attachment of the heel bone leads to a breakdown of the plantar fascia thus the pain and structural damage. Reducing these negative stresses will enable healing and provide a faster recovering.
To combat these stresses there are a number of items that can help! Foot orthotics- the simple explanation of how these work is as follows. If the foot is supported by the orthotic the muscles of the feet that normally help support the feet end up doing less work… thus less stress going into them. The duper comfortable gel heel and forefoot also help reduce the ground reaction force. Plantar fascia stretch band- by reducing the tightness of the calf muscles and improving the 1st MTPJ motion it reduces the stress on the plantar fascia- again less negative stress = improved healing. The stretch band also helps give the perfect stretch to help reduce the tightness in the plantar fascia. Night splint- this works in a similar way to the stretch band but provides a gentler stretch of the same structures but over a longer period of time. Once again, less stress = improved healing. Peanut roller- The peanut roller is used to help massage out the tired, sore right muscles of the feet. Again the less tightness through the muscle the less stress there is on the attachment to the heel bone the less pain is experienced. The other benefit of the peanut roller massage apart from loosening off the plantar fascia is the increased blood flow to the area we get from the massage. This increased blood flow helps heal up the damaged painful area by increasing the body’s natural healing properties.
Improving healing responses
In order to achieve this all the above factors need to be addressed. There is no use trying to make something better if at the same time damage is reoccurring. This is often why this condition lasts so long.
The more often we implement these positive healing factors the more likely we are to improve.
So what can we do? Your body has a great system to heal damaged tissue, but there are ways we can speed this process up. Heat- improves blood flow to the area to remove nasty waste products and increases the rate of healing. Massage- like heat this improves blood flow to the area, removed toxins and improves healing- wee suggest you do both. Strengthening exercises- like going to the gym and increasing the size of your muscles, strengthening exercises can actually help with healing and improve the strength and resilience of the structures in the foot. Shockwave therapy- This increases the bodies release of natural chemicals which promote healing along with increases blood flow and reducing your perception of the pain (though it is very painful to receive) PRP injections- Injection of the special goodies from your own blood (which is taken from your arm, spun and certain aspects retrieved) into the damaged area has been shown to improve the rate of healing. Other treatments- A wide range of other modalities have been found to be helpful in clinic settings but research hasn’t fully supported these treatments. This doesn’t mean they don’t work, it just means that it may not work one everyone. Laser Dry needling Cupping Therapeutic Ultrasound Utilising the treatments listed above are aimed at improving the healing of the damaged area but as stated, healing won’t occur effectively if the causative factors are still at play and the negative stress is still present.
Review
1. In order to get better we need to address what has cause this and try reduce it.
2. Stress on the plantar fascia will slow down the rates of healing, so reducing negative stress will help.
3. Our bodies can improve when negative stress is remove, but we can treat heel pain and treat plantar fasciitis more effectively by increasing the rate of healing.
4. If we undertake the treatment more often, we will see faster healing.
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