By: Gareth Sneath, PT, MCPA, Grad Dip Man Ther, MScCH
There is nothing like personal experience of symptoms to give you a better perspective of what our clients go through. On a recent trip abroad I developed a severe case of foot pain, specifically in the heel, on weight bearing in the morning, features classically associated with a heel spur/plantar fasciitis. Why did this suddenly occur? I believe it had to be a combination of a sudden increase in walking and using two different types of footwear.
At the beginning of the trip I spent a lot of time wearing my favorite Birkenstock sandals. I also bought myself a new pair of New Balance (NB) sneakers in anticipation of doing a lot of walking. In the past I have done well with this brand because NB seem to be one of the few sports shoes that fits my wide foot as it comes in a triple E!
Comfort was fine and on one of the days I walked several miles seeing the sights of London without any pain. The next day I did a short run for about thirty minutes with no pain but the day after, as I got out of bed, I felt severe heel pain. 10/10 intensity. The heel bone felt as if it was going to break and I limped into the shower on my tip-toes, complete with a healthy dose of cursing, as I tried to offset the load to get relief.
What I found curious was that prior to the onset of pain despite loads of walking I felt no pain. Even more odd was that although the morning pain was extremely painful, when I palpated the heel later in the day looking to find the focus of the pain, it was hard to find and when I did find the tender spot it really was not that bad. As I crept around gingerly, helped considerably by the sneakers plus an added drug store heel cushion the pain subsided and as the day progressed walking became easier. At that point you would not think anything was wrong.
Like clockwork, the next few days demonstrated the same pattern of pain, excruciating morning pain associated with heel weight bearing and then after about ½ hour it would subside enough to walk without too much guarding. Complete rest was not an option, each day of the holiday had something planned which typically meant walking. After about 10 days of this pattern the morning pain subsided to the point where I could get out of bed and put some weight through the heel with only a mild discomfort, almost a “good” pain feeling, indicating the start of resolution.
What strategies did I use to manage the pain? I used the same strategies that I advise for many of my clients who are in pain. I used a variety of self-directed treatments to get relief and being “on the road” and without access to clinic equipment at times had to be resourceful in finding ice (hotel ice machine, can of cold pop). The new sneakers and the added heel insoles undoubtedly helped facilitate walking comfort and function along with a combination of Advil, heat and ice.
It was also enlightening for me as a physiotherapist to experience both calf pain (straining/overusing the calf muscle when maintaining a tip toe position in the morning) and pain down the outside border of my foot (tendonitis) because of overloading the compensating peroneal muscle/tendon. I hear these stories frequently from patients who feel that they are falling apart as they develop a series of additional symptoms (calf pain and foot pain remote from the original heel problem). Here was a logical explanation for these symptoms related to an altered way of walking which I adopted as a means of protection.
As I head into the third week, the heel pain has subsided and I am experiencing no significant pain in the morning, no calf pain and only a lingering feeling of pain on the outside of the foot. I expect these to continue to resolve, helped by pursuing a normal gait pattern and continuing to move the tissues modestly even when in pain which I believe has helped, not hindered, tissue healing. This is sometimes a hard course to follow when you are in pain however biological studies have shown that carefully applied movement stimulates tissue to heal more efficiently. In another week I’ll probably try some gentle running, just a few minutes to assess the foot’s response and if OK, gradually and carefully increase the loading. If symptoms persist and prevent me from functional activities I’ll follow up and seek the expertise of one of my PT colleagues.