Shockwave therapy for heel pain – does it work to help Plantar Fasciitis?

You’ve tried conventional treatments for heel pain? You’re an expert in the ins and outs of taking rest? You’ve filled your freezer with ice packs? Your bathroom cabinet is bursting with pain relief and anti-flammatory meds? You’ve slipped on the support devices more often than you’d care to remember? You feel all physio’d out with all kinds of physical exercise? If this sounds like “my life with plantar fasciitis so far” and it’s all been to no avail, you might want to read on, ready to try something shocking!

You might have heard about Shockwave treatment for plantar fasciitis, referred to by NICE (National Institute for Health and Clinical Excellence) as Extracorporeal Shockwave Therapy For Refactory Plantar Fasciitis. Let’s break down its meaning;

Extracorporeal – outside the body

Refractory – (as above) it doesn’t respond to conventional treatments

Shockwave – high energy inaudible sound waves directed through the skin

What is Extracorporeal Shockwave Therapy For Refactory Plantar Fasciitis?

Shockwaves are passed through the skin to the affected area using a special device where ultrasound guidance might be used in a clinical setting to get to the place in need of treatment. Here the soft tissues and tendons are stimulated into healing and regeneration in one or more sessions that reduce the pain at the time and afterwards.
The process is like a non-surgical version of standard operative procedures for tennis elbow, where tiny holes are burned into the site of pain and strain to cause blood to flood the injury zone and start the body’s own process of healing. The advent of shockwave therapy has replicated this process using vibration instead of surgical tools so all the inconvenience, expense and risk of surgery are eliminated.

Does it work?

In one study cited in the NICE guidelines 25 more patients than those receiving the placebo treatment reported less pain after 3 months and didn’t need medication.

In a further study 56 more patients receiving the shockwave therapy reported a reduction in pain relief 3 months into their treatment than those receiving a placebo.

What’s more, the NICE procedure guidance leaflet details a study of 149 patients with 69% of patients who had the procedure reporting “an excellent result” (no heel pain) whereas those who had received conventional treatments – you know the ice, the rest, the exercise, the meds – reported some pain after an average of 64 months.

Overall therefore it seems that assessment on Extracorporeal Shockwave Therapy appears positive. NICE’s own go-to expert advisors say the main success is the relief of symptoms. For long term sufferers that offers hope and a way forward.

Will my GP prescribe it?

Realistically what are the chances of your doctor offering you ESWT on the NHS? As we’ve discussed in previous articles, this is pretty unlikely due to budget constraints. This kind of treatment is often only available privately costing upwards of £300 per session as it must be delivered in a hospital setting with all associated costs.

As a result, plantar fasciitis sufferers are now seeking low cost alternative shockwave treatments that they can try themselves at home or work.

Next week: Going under the knife – when is it time to think about surgery?

(sign-up using your email address below to never miss another article)

Plantar Fasciitis– 3 Basic Exercises to Ease the Pain

“Walking is the best possible exercise” if you’ve heard that phrase as a plantar fasciitis sufferer it probably makes you wince. But exercising your way out of pain might be worth looking into. What top 3 exercises do experts consider to be the best way to ease away the pain of chronic heel discomfort?

Early on in the diagnosis of plantar fasciitis it’s vital to get the balance right between light exercise to stretch and strengthen your inflamed plantar fascia ligament and rest which will allow the tears and strains to heal. So, with that in mind, start your exercise regime lightly and be gentle on yourself and your inflamed feet.

We tend to think of exercise as vigorous activity, but that may be what has caused the condition in the first place, if you’ve done too much running, power walking, jogging or ball court sports. Instead opt for our top 3 basic stretch and flex exercises that avoid weight bearing altogether and can be carried out in a seated or supported position in the comfort and privacy of your own home.

Exercise 1

Sit comfortably on a chair and place your foot on a tennis ball or rolling pin, some find a chilled bottle of wine does the job for arch rolling! You want something curved that will support the shape of the arch of your foot as you gently move it back and forward to ease the pain. Repeat as necessary. If you are able to progress to standing then do so – but gently. It’s probably best to use a tennis ball for this.

Exercise 2

You may want to follow this exercise with a gentle toe stretch. Simply place each heel in turn on the floor, reach forward and pull your big toe up and towards you holding for approximately 20 seconds. Aim for 4 reps on each foot, several times a day.

Exercise 3

Another great seated activity is the towel stretch. You can do this by sitting on the floor with your legs outstretch in front of you. Place a lightweight flexible towel under the ball of your foot. Pull the towel gently towards you without bending your knee to allow the foot to gently flex for approximately 30 seconds. Aim for 4 reps on each foot. Try to do this daily and feel the give in your calf and foot.

Any more activities?

If you’re keen to keep your entire body active as part of general health and wellbeing but can’t stand the pain of walking or running, consider swimming or gentle cycling. Both forms of exercise, if undertaken gently, will allow you to flex and stretch your feet without having to bear the weight of your body. This should help you feel lifted.

If for whatever reason you’re unable to undertake exercise, maybe through injury or disability, you might consider a device for shockwave therapy to the injured area.

Next week: Shockwave therapy for heel pain – does it work?

(Sign up using the form below to never miss a weekly article.)

Are you flare aware? What causes Plantar Fasciitis to flare up?

If you’re a diagnosed sufferer of the debilitating foot and heel pain condition that is plantar fasciitis do you know 6 key ways to avoid a flare up? Lifestyle issues can trigger a new episode, prevent your treatment working or even make you take a step back on the road to recovery. Let’s walk you…ever so gently, through the common mistakes that could be making your condition worse.

Old Shoes

If your shoes are well worn and have too much ‘play’ in them either side your foot will not be adequately supported and can cause strain to the plantar fascia which will lack support. Similarly, if you use inserts to help your plantar fasciitis and buy a new pair of new shoes, then be sure to replace your old inserts at the same time. Ill-fitting inserts can do more harm than good.

New Shoes

Just as old shoes lack support, new shoes may have too much and require ‘breaking in’ for your foot to feel comfortable. Avoid this if you can and try to choose a pair that offers comfort and cradling from day one, especially a shoe with arch support.

Bare Feet

Don’t fall into the trap of thinking that going bare foot is natural and therefore best. Take it very easy doing yoga or Pilates as feet prone to strain are easy to overstretch and cause you problems and pain.

Everyday Injury

It may sound obvious but going over on your foot or ankle can trigger an old strain in the ligament and start a new bout of plantar fasciitis. It doesn’t need to be a sports injury or strain caused by exercise, a simple slip on the ice or cockling over a curb can put you right back to square one, so take care, especially in winter time.

Becoming Overweight

Gaining weight through overeating, inactivity, injury or even pregnancy can put additional strain on your foot and cause an episode of chronic heel and foot pain. Carrying excess body fat can also change the way you walk and weight-bear so can have knock on effect for plantar fasciitis sufferers.

Quest for Fitness

It’s possible that if you overdo it in trying to lose weight with a vigorous new exercise regime or cardiovascular fitness class you might cause a flare up of foot pain which might be plantar fasciitis. If you’re already sporty and active try to ensure you pick the right footwear for whatever sport you’re undertaking. Good running shoes for your 5K, netball trainers for court time and robust walking boots for a day on the fells will all protect your feet.

Next week: Plantar Fasciitis– Exercises to Ease the Pain

(Sign up using the form below to never miss a weekly article.)

Plantar Fasciitis; what your GP should offer you but doesn’t have the time

With the average length of a GP appointment sitting at 7 minutes, how is your doctor ever going to have enough time to listen to your symptoms let alone make an accurate diagnosis of plantar fasciitis? And, if you’ve reached out for help, the chances are you are already desperate for practical advice on what you can do to deal with the debilitating effects that you’re experiencing.

So, let’s fast track you to some of the things that your GP might walk you through if only there he or she had time. The most common cause of heel pain in both men and women is plantar fasciitis caused by a strain to the plantar fascia. There are at least 8 possible treatments that may be on your doctor’s radar to explore in depth with you;

1. Anti-inflammatory drugs

Drugs are prescribed to ease pain and reduce swelling. Ibuprofen or other anti-inflammatories are commonly used to manage plantar fasciitis. Prolonged and regular use of pain relief drugs is something you may wish to avoid as it can be accompanied by complications and side effects.

2. Orthotic support

Poor quality shoes that lack adequate arch support can cause plantar fasciitis so finding an insert with cushioning in the heel and soft tissue support under the foot can give relief. Custom inserts can be expensive while off-the-shelf inserts may offer only temporary relief or too little too late.

3. Splints

You may be advised to try a splint or a brace designed to gently stretch the calf and the foot bringing some relief to the fascia. Splints are often a boot-like device, recommended to be worn at night. They are cumbersome to wear so can cause difficulty sleeping and add to your sense of discomfort.

4. Steroid injections

Many healthy adults who jog or run are desperate for a quick fix to the plantar fasciitis preventing them enjoying their passion. A quick read around online running forums reveals very little success from cortisone injections, even as the last resort.

5. Athletic taping & physical therapy

Some physios will apply intricate narrow loops and figures of 8 under the arch and around the back of the heel to offer the support to prevent further swelling. It can be tricky to master yourself and be aware that some people are allergic to the zinc oxide tape used. Regular physiotherapy can be lengthy, costly and often only available privately.

6, ESWT Shockwave therapy

National Institute for Health and Care Excellence (NICE) has recommended Extracorporeal Shockwave therapy for refractory tendinopathies like plantar fasciitis but this is often only available privately costing upwards of £300 per session in a hospital setting.

7. Fasciotomy

Your GP, orthopedic surgeon or podiatric physician would only recommend this surgical procedure for chronic plantar fasciitis when all other stretching, taping, orthotics and anti-inflammatories have failed to release the fascia. It should only be considered as the very last resort, due to all the risks of surgery and slow recovery.

8. Heelease

A small device that you strap to the site of pain for proven, quick, painless and inexpensive treatment for the relief of plantar fasciitis. It offers ESWT that you can control yourself, flexible and easy to use at home or work, supported by a wealth of real-life case studies and a money back guarantee.

Next week: Are you flare aware? What causes Plantar Fasciitis to flare up?

Sign up using the form below to never miss a weekly article.

What is plantar fasciitis?

If you’re arrived at this article, there’s every chance you’ve been to see your GP because of pain in your feet, or more specifically pain in your heel or heels. You may have been diagnosed with a common and painful condition called plantar fasciitis.

So, let’s start with some basic definitions like what it is and how to pronounce it. The plantar fasciitis (phonetically pronounced – with emphasis on the bold text as plan-ter fash-ee-eye-tus) is the most common cause of heel pain in both men and women.

The condition is named from the plantar fascia which is a ligament flat on the base of the foot that connects the ball of the foot and the toes to your heel bone. You can think of it as a band of tissue that holds the bones of your foot together, expanding and contracting when working properly to allow the foot to flex, thus supporting walking and movement.

When we experience pain in our feet, and especially in the heel, it is often due to a strain of the plantar fascia. That strain manifests as pain, maybe at the front or centre of the heel bone, or it may be across the whole base of your foot. The connective tissue that is the plantar fascia has very little stretch and therefore can become inflamed, swollen and thus weakened. This pain can be experienced as an uncomfortable ache or a crippling pain, depending on the severity of the swelling of the plantar fascia, hence the term plantar fasciitis.

The condition is often felt most acutely first thing in the morning on waking when we try to take our first steps or after walking or light exercise. The heel pain may be more extremely if walking or running. The condition will be aggravated for those who have to spend all day on their feet at work or who are used to taking exercise or doing sport that involves running or jumping.

If the heel pain you’re experiencing is severe enough, your GP, who will probably have examined your foot to look out for any bruising and redness, may also send you for an X-ray or even an MRI scan. The reason for this is to rule out any other causes of pain such as a broken bone or a trapped nerve. Your doctor may also look at whether you are flat footed and what sort of support you have within the structure of your shoes. He or she may ask you if you often wear flat shoes or go barefoot. All of these aspects may contribute or point towards a diagnosis of plantar fasciitis.

Based on your answers to the above questions, diagnosis is often made without the need for further investigation, especially if you are able to recognise the following key symptoms yourself:

  • Waking up with pain on taking your first step in the morning
  • Feeling of an ache or bruising in the foot
  • Increased pain after walking or exercise
  • Radiated pain into the ankle
  • Easing of pain after rest or gentle stretching

Next week:  What your GP should offer you but doesn’t have the time! 
Sign up using the form below to never miss a weekly article.

Avoiding painful feet – or – How not to get plantar fasciitis!

Believe me, you do not want this condition, not under any circumstances at any time. It is agony, agony to get out of bed in the morning, to walk, to run, to cook dinner at the end of the working day, to enjoy a day on the beach with the children.

If you don’t mind hobbling around like a very old person walking on broken glass, then ignore what I say. But if you have a job where you stand most of the time, especially in high heels, or if you spend long hours walking on hard pavements in soft ill-fitting shoes or if you are a jogger or athlete who allows his or her running shoes to wear out then take heed. Plantar fasciitis is absolute hell.

So what is the first symptom of this painful foot problem? You happily carry on with your usual activities until one day your heel feels very sore. Or maybe it is the ball of your foot. (or both of them – woe betide you if you get it in both feet at once). You notice the pain is very bad when getting out of bed. If you walk any distance the pain gets worse and soon it is the sole of your foot that hurts and sends stabbing shooting pains up your leg. If you have flat feet or fallen arches you might be tempted to blame these. You might even wonder if the bunion you inherited from your mother is the cause but don’t be fooled.

Now is the time to take measures to prevent the condition worsening because if the offending ligament in the sole of your foot weakens and tears you are in big trouble. At the moment you merely have inflammation, which is bad enough, as a result of overdoing the wear and tear on your poor tootsies. To begin with I would suggest resting with your feet up as much as possible. Scour the internet for some well made supportive shoes and junk the worn ones. If standing for long periods try a rubber mat to relieve the stress and spend a few moments before you get out of bed in the morning massaging the Achilles tendon above your ankles and stretching your feet forward and back.

You may have to give up the jogging or at least alternate your running with other sports. Stretch your Achilles tendon before exercise and lose some weight if you pound round the track like an elephant. If all this advice fails and the agony becomes more intense you will give up smiling and consider going to the doctor.

First though, you might try some of those insoles that are designed to support the feet. Then look for some simple exercises on the web, like rolling the foot backwards and forwards on a tin can or a bottle of water. Your family will wonder what you are up to but hey, they don’t have the pain. Any stretching exercise would be good too, with a long stretchy length of material like a towel. The stretching will loosen the tight ligament. Even pulling your foot forward with your hands will help.

These are things you can do yourself but if you are unlucky enough to need the advice of a doctor your interview might go in several ways. He will diagnose the problem and begin by recommending all the measures described above. In a few months, depending on your determination to persist with the exercises the inflammation will subside, the tears will heal and you will be free of the pain.

On the other hand, if you are elderly, he may tell you that growing older inevitably brings a few aches and pains, that you probably have a touch of arthritis and you should take more exercise. He might conclude his nine and a half minutes with you by writing a prescription for painkillers. If this happens you must visit the surgery again and practice your assertion skills because every older person deserves to sail into their declining years as fit as they can possibly be without the curse of chronic pain if it can be avoided. And that is what you will get if plantar fasciitis is left untreated for long years.

Let me tell you of a friend of mine. She is in her seventies and has had foot problems for many years, assuming the pain to be part of growing old. She can no longer enjoy a morning window-shopping in the town. She can drive but must not park too far from her destination because the walk is difficult. She stays mostly at home as going anywhere has become problematic. The rest of her is in pretty good shape but she’s philosophical and accepts what her doctor tells her.

It’s probably too late now. It is likely the ligaments and muscles in her feet and ankles have become stiff and tight with multiple small tears and there probably is some arthritis too. Had she been aware in those early years and taken good advice, even nagged her doctor, she might have been tripping around like a teenager now.

So you’ve been told you have plantar fasciitis? Be warned, 23% of doctors misdiagnose the condition.

A recent study of 310 patients in the University of California research department showed a surprising statistic. Although all patients in the study had joined because they suffered from plantar fasciitis pain, a painful disorder of the plantar fascia fibres, nearly a quarter had been misdiagnosed. That’s 71 people who turned up on day one to be studied, and left the first day.

So you thought doctors were never wrong? So did we. The general understanding of the condition by the medical community in the UK is comprehensive and it is rare for doctors to get their diagnosis significantly wrong unless it is a rare and complex issue. If you’re sitting here reading this with plantar fasciitis and have been diagnosed with a simple examination of the foot then read on.

We looked at similar studies in the UK to see if the effect was replicated here. Initially there didn’t seem to be much data on misdiagnosis until we looked at Pub Med, the collection of medical research available to doctors and medical professionals. What we saw was startling. A chochrane review, that’s a review of a large number of clinical trials, showed that it was fairly common for people in medical research to start with a group of people, a cohort if you want to use the correct name, and immediately remove those who don’t suffer from the condition the researchers recruit for. In fact, over 28% of trials we looked at suffered from this early bias. That’s over a quarter who’ve been misdiagnosed. So what’s going on? We looked further into the data.

5% of the studies contained people initially withdrawn because they had flat feet or bunions. These people were originally diagnosed with heel pain and their GP reported their condition as plantar fasciitis, but on further investigation they were found to have the symptoms but not the cause. An overwhelming majority (54%) had plantar fasciitis but combined with pain in the ball of the foot. A podiatrist referral had suggested PF as the main cause of painful feet but further investigation had shown that the source of the pain was muscoskeletal rather than the plantar fascia itself. So that’s well over half already. 19% were wearing orthotics, no problem at all there, plantar fasciitis sufferers often wear orthotics and heel cushions to help with the pain. Except here, it seems the orthotics were causing the pain. In essence, misdiagnosis was wide ranging with no specific cause but significant.

So, what have we learnt? It is a fact that NHS doctors have on average 7 minutes per consultation. This includes time to meet and greet and say goodby. In between they have to diagnose the condition accurately and make a recommendation for treatment. This is particularly problematic with foot problems. Painful feet can have a number of differing causes and it seems that plantar fasciitis has become a simple catchall for doctors to use as a generic diagnosis. It is only later when a foot specialist looks into the problem, as happened with the clinical trials, that painful feet are diagnosed as something else, often a heel spur or bone spur or something which can be easily be treated with orthotics.

So the next time you’re in the doctors surgery with painful feet, remember, if you’re not convinced get a 2nd opinion. Or start with a podiatrist who specialises in foot pain. It may help save time and effort.

Have you been misdiagnosed or struggled to get your doctor to come up with a treatment plan? Let us know. We’d like to hear from you.

Doug Finnie,
Pharmacist.