Tag: foot pain

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”.

Link to article: https://www.jospt.org/doi/10.2519/jospt.2021.10018

Ankle strength

Some people have lost strength in the ankle due to a litany of issues such as:

Nerve damage

Muscle strain

Shin splints

Ankle fracture

Etc

Getting a stronger ankle joint doesn’t have to be complicated.

Some people have the ability to get stronger, but others may not have that ability.

Check with a licensed professional to see if the nerves are working properly before starting a structured exercise program for the ankle.

This is a basic exercise and is intended for general education.

Plantar Fasciitis and Ultrasound: questionable at best

“The plantarfascia is a thick, nonelastic, multilayered connective tissue crossing the plantar part of the foot. Plantar fasciitis is the main cause of pain in the plantar surface of the heel.”

The plantarfascia is located at the bottom of the foot, between the heel and the toes.   It is very thick and a tough band.

A part of physical therapy school includes dissecting the human body.  Some people find this disgusting, but it is actually an honor.  We were told that only 5% of college students will ever be able to dissect the human.  The bottom of the foot is very intricate. There are multiple layers of muscles, but the plantar fascia is a very taut band that requires a scalpel in order to tear.  In other words, it is very strong tissue.

“In the United States, more than 2 million people are treated for plantar fasciitis every year…the most common signs for identifying plantar fasciitis are pain and tenderness in the medial …heel bone, as well as an increase in pain when taking first steps in the morning and pain in prolonged weight bearing.”

First, plantar fasciitis is mostly diagnosed through a patient’s history.

Second, there are a lot of people with plantar fasciitis that seek out treatment.

This leads us to the next statement from the article

“…researchers have not determined the most effective combination of treatments due to the dearth of high quality research in this area.”

Feel good about this condition yet? So many treatment options are available, but few with solid research to back them up.

If you are interested in learning more, check out this  Link

“One of the most widely used electrical devices among physical therapists in Israel and worldwide is therapeutic ultrasound…Yet there is insufficient high quality scientific evidence to support the clinical use of therapeutic ultrasound in treating musculoskeletal problems.”

I find it funny that PT’s should know this information and yet they act opposite of what the evidence indicates.  There are running jokes that using ultrasound may be just as effective turned off as when turned on.

If your PT continues to utilize ultrasound, ask why?

Sometimes the answer may simply be: it is easy, it can be charged and it will do no harm.

Treatment:

Both groups were given stretches for the Achilles/calf and the plantar fascia.  One group was issued ultrasound at a higher intensity in order to create a thermal effect and the other group was given ultrasound that was low intensity and not postulated to have any physiological effect, as the intensity was low and the depth of treatment was considered more superficial.

There was no significant difference in the number of treatments per group.

Result: There was no additive effect of ultrasound on the treatment of plantar fasciitis for pain, function or quality of life.

There are reasons to use ultrasound from a business perspective, but the more and more that I read research I find fewer reasons to perform the intervention medically.

Reference:

Yigal K, Haidukov M, Berland OM et al. Additive Effect of Therapeutic Ultrasound in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial. J Orthop Sports Phys. 2018;48(11):847-855.