Put yourself in this position; your job requires that you walk between 10-15 miles, every day, in every kind of weather, in all sorts of terrain, and throughout you have to control a minimum of 6 monstrous, wild animals (monstrous, wild animals including household trained Labradoodles and Cockapoos).
One day you wake up and find when placing your right foot on the floor you have a shooting pain that goes right through your heel, to the point where you can barely put weight on it. Slowly the pain eases off, but it’s still very noticeable when working, particularly when trying to prevent the Golden Retriever from eating a child…’s sandwich. In the evening the pain worsens and affects sleep. Painkillers don’t help, even the liquid sort served in a wine glass.
The pain lasts for days, which leads into weeks, which leads into months, with seemingly no change in symptoms. Your livelihood requires that you use your foot, which right now is in agonising pain, what do you do?
This was the issue facing one of our clients. She had been a self-employed Dog Walker who had built her business up for over 5 years. She had been to see a doctor who diagnosed her with Plantar Fasciitis (PF). She received some stretches to try with vague recommendations on how and when to use them. Unfortunately, she found no difference and the pain continued to stay the same.
PF a common condition that happens to 1 in 10 people in the UK. It occurs at the bottom of the foot at a structure called the plantar fascia, which runs from the base of the toes to the heel. PF affects the general population as well as sportsmen and women, especially runners. Symptoms can come on suddenly without any apparent trauma.
Due to similarities in structure, PF has been compared to tendinopathy, which refers to a disease of the tendon (the tissue attaching muscle to bone). Just as with PF, tendinopathies can happen suddenly without warning and has long healing times. A higher BMI has been shown to correlate with both conditions, but unfortunately, no other evidence has found exact causes. The consensus as to how PF and tendinopathies occur appear to be due to acute increases in activity, e.g. a runner increasing their mileage too quickly, or a Dog Walker wearing less-supportive shoes than usual for a long duration.
The literature on tendinopathy has found that applying a load to the area of pain (strength training) helps improve the condition. This appears to be due to a change in the actual structure of the tissue. This is opposite to what many people think should be done when injured: rest. However, at best resting can only maintain the current structure, at worst degeneration can occur.
With that being said, why then don’t loads of load improve PF? The answer refers back to why the injury happened in the first place; too much weight which the foot can’t handle. So how do we make sure the foot can handle it; we build up the load gradually.
This is obviously easier said than done. There a few things to consider; 1) how painful is the foot currently, 2) how do you decide how much to do, and 3) how do you know when you’ve done too much?
- Firstly, if the pain is so great that you can’t do anything (say 8-9 out of 10), then short-term rest would be appropriate. Other short-term options could be painkillers or orthotics. These will allow the pain to decrease so that you are able to begin exercising to add load.
- Once the pain is more tolerable (say less than a 7 out of 10), you can begin to add exercise. This can be done in many different ways. However, the focus of the exercises should be to return to the activities which PF affected. So if a runner can perform heavy calf raises but is still unable to run without pain, the rehab would need improving. The single-leg calf raise with a towel under the toes is a great exercise to start with.
- Knowing if you’ve done too much is arguably the most critical point. This should be assessed within 24 hours following exercise. So if a runner decided to try and run 5 miles in the morning, but the pain was higher than usual in the evening, this would suggest too much load on the foot. However, if 2 miles found no difference in pain, this could be viewed as an appropriate load. It becomes trial and error to see what works best. It’s important to select fewer exercises to help determine the culprit for any change. The time frame can vary hugely, however, a minimum of 3 months is to be expected.
The steps above aren’t a guarantee to eliminate the pain. However, what they do is allow you to be in control of your recovery. If in 3 months the pain is still the same, but you are capable of performing your previous activity, then surely that’s a better alternative than having the same pain and not being able to do much of anything!
This is what our Dog Walking client had to go through. In the beginning, she struggled to do calf raises, but over time she built up to walking long distances. There were setbacks she would push too much and have high amounts of pain, but she learned from this and what she was capable of. She is now able to work normally, covering the amount of distance she did before. She isn’t entirely pain-free, and she has good and bad days. However, she understands how to manage the pain, which has helped give her back control of her body, and her life.