Chronic heel pain

As a PT, plantarfasciitis is the most common diagnosis associated with the foot that I have evaluated in my previous 14 years as a PT. This article added to the evidence, at least for me, because I operated in the narrow view of 1. foot pain is/isn’t coming from the spine and 2. if it isn’t coming from the spine, then it must be coming from the foot. Duuhh.

How wrong was I…very. After having read Annie O’Connor and Melissa Kolski’s book “A World of Hurt”, which I highly recommend by the way, my mind was opened far beyond just the biomechanical issues that could create pain. We understand that pain is more than just a nociceptive input, meaning a nerve gets irritated by an outside or inside force and therefore causes pain.

This article adds to the fact that there are other factors, that I rarely consider for heel pain, that could also play a part in the patient’s complaints.

To summarize the study results: Waist girth, multi-site pain, and pain catastrophizing were all independently associated with chronic heel pain. Ankle plantarflexion strength was also associated with chronic heel pain.

As a longstanding clinician, I like to play with puzzles. This first part of the puzzle is still hard for me to discuss with patients. It ain’t easy telling a patient that “you have a big belly”. When looking at the study deeper, the “belly-fat” was more associated with heel pain moreso than simply increased body fat percentage.

This conversation is harder for some PTs than others because; “hi pot…I’m kettle” (I chuckle when I say this). If you’ve seen pictures of me…I ain’t got room to talk in my size XXL. One has to “read the room” when having these conversations, because it could go so many ways:

  1. This guy’s a freaking hypocrite…look at his belly.
  2. for those clinicians that are less “fluffy” and more “Brad Pitt”, the patient may have some resentment to these comments

Big picture, we have to have a method of having the hard conversations. I have a very strong blue collar background, so I only know how to “come out with it”. I state the facts and then let the patient lead the discussion from there.

When having these conversations, we need to employ empathy and compassion. Answer questions from patients and be comfortable answering “I don’t know” if a patient is asking a question that I truly don’t know the answer to, but it is always followed up with “but I’ll look into it for your next visit”.

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