Treating plantar fasciitis can be challenging. It is thought that a ligament in the foot causes pain with weight bearing. Classically walking is painful. Scanning the ligament may reveal a thickening of the tissue. However is this really the source of pain?
The case study
A patient recently attended the clinic with a six month history of foot pain. His pain began without injury and walking had become difficult. Unfortunately his symptoms did not resolve with treatment under a specialist which had included ‘shockwave therapy’. Two separate injections into his foot and lower leg gave him only temporary relief.
After listening to his story it was evident he had developed a number of fears around his pain. This had unfortunately been reinforced by the imaging he had received and explanation he had been given for his condition. He now felt there was a structural problem with his foot. The pain meant damage to him. The result was he had become increasingly protective of his foot. Leading ultimately to deconditioning and weakness over the 6 month period.
So I put this question to him – ‘do you think a thickened tendon is stronger or weaker?’. He said ‘stronger’… to which I agreed. ‘So if the tendons strong why are you not loading it?’…he said ‘Because its painful. I don’t want to hurt myself’.
The change of mindset
By getting him to understand how pain was due to sensitivity of the tissues rather than damage. How his behaviour around pain was actually contribuing to the problem. He was then able to make some real progress. This change in mindset made such an impact on his symptoms that they were effectively better in 2 weeks. Thickened ligaments are often seen in pain free individuals. Therefore it is not a good indicator of a painful structure.
Removing the Threat
Often it is not the structure that creates the problem but the threat. Which unfortunately can be exacerbated by healthcare professionals.
Treating plantar fasciitis can be challenging but it will always resolve if managed well.