For some time now I’ve had a puzzling minor problem with my right heel, just a temporary internal pain that jarred when I put my weight on it first thing in the morning or after sitting for a while. It always disappeared quickly and I thought little of it, until the recent Pumlumon backpack: something happened on that walk that tipped the balance and aggravated it. I felt it as usual on getting out of the tent on the last day but this time it didn’t go away, and although it improved as I started walking it later flared up again and I walked the last few miles with the help of painkillers.
I suspected that the culprit was a variant of Plantar Fasciitis, and although the pain diminished considerably over the next few days it did persist. I booked an appointment at a sports physiotherapist, one I hadn’t tried before in Handforth located on the first floor of a fitness centre. There is a purpose built road leading to this complex, a gigantic place full of gym machines of every kind, hydrotherapy facilities, you name it (actually some joker did name it:- the road sign says ‘Fitness and Rehab Centre’ but a while ago someone had crossed out and rewritten two letters so that it read ‘Fatness and Kebab Centre’).
The physio confirmed my suspicions after poking around and applying pressure points on my foot. To probe further she made me do various walking, bending and posturing exercises to assess the problem from a more holistic viewpoint and concluded that overall my ‘frame’ was out of kilter, very probably the main contributory factor taking into account the many miles of backpacking I do. Years ago my previous physio was impressed that the muscles at the base of my back and bum were as hard as Sylvester Stallone’s from all that backpacking but, as he said, ‘your flexilblity in that area is pretty crap!”. This one agreed, and she printed off a sheet describing 4 stretching exercises to loosen up this region and gain some pliability.
She took me through them on the bench, almost constantly telling me to relax and loosen up, and I think they were designed by the Devil himself:- ‘…can you feel that stretch in the whatever…?’ to which I grunted ‘I sure can, but I can feel the hips a lot more, they’re about to crack!’. ‘Right’ she said, ‘do 3 repetitions (per leg) of all 4 exercises 3 times a day and I’ll see you next week for a follow up half-session - and no more yomping up hills for a few days at least’. I’m booked in for Monday.
For those interested, the stretches she prescribed were for:-
- Lower back and glute stretch (illustrated right)
- Piriformis stretch (illustrated above)
- Gluteus Medius stretch
- Hamstring Muscle stretch
Another exercise she prescribed was foot rolling: I had to freeze a tin of something in the freezer and roll my foot over it as hard as I could, giving it a good massage and ice treatment in one go. So I end up sitting in the kitchen with an old folded piece of underlay on the floor and rolling a frozen can of tomatoes backwards and forwards for a few minutes at a time, and it’s damned hard work after a while!.
She was very interested in my rigid custom orthotics, which I had taken along with my Berghaus Pro Rush Mids in anticipation of her questions about the footwear I use for backpacking. Apparently their podiatrist favours the other type which have the very important firm cupped heel but are flexible along their length. Her view was that the rigid ones are great provided your feet don’t change significantly, but my right foot was no longer a good fit and had a gap along one side, possibly another factor in the development of the problem.
The follow up is tomorrow, if my hips can move at all!. In the meantime, and by way of consolation, we’ve added to our repertoire of fine single malts with our first bottle of Isle of Jura to sample: mmmm, nice!.
11 Comments
Interesting read Geoff. I have a permanent bad foot and should see a sport physiotherapist to see how it could be helped to improve. I hope you heal quick and I will look for updates on the foot bed issues.
Hi Geoff,Sorry to hear about your heel problems.Never had a pro blem myself despite playing lots of football in my younger days and hillwalking since the age of 17(now age 54)However,the last 18 months have been spent trying to find a cure for my Son’s heel pains.He is age 15 and a keen footballer but for the last 2 seasons he gets severe pain in his heels when running.We have tried everything without success but have now made several visits to the Podiatry Clinic at Salford University.The students there will examine you as part of their training and for the sum of £35 you can have a cast of your foot done and special custom inserts made for your shoes.This is all undertaken under the supervision of a chap named Neil who seems to really know his stuff.Anyway,this has resulted in a big improvement in my Son’s heel pain.The left heel is completely cured and the right one shows a big improvement.We are going back again in Sept for another consultation when the Students return from their break.Anyway,if your problems persist,it may be worth giving them a try.
Thanks for describing those stretches, Geoff, and I’m sorry to hear that PF has struck.
I’ve had a problem that I’ve been unable ever to completely shake off with achilles tendonitis, which set in about 6 years ago when I did too much running, too fast. It really helps to find a good physio, but I found that surprisingly difficult, considering that I was in a running club. Lots of people just press on without advice, which of course tends to make things worse in the long-term. Hopefully you’ve caught it in time.
That clinic mentioned by Trenthamwalker sounds excellent!
Martin,
It’s already improved a lot. I’ll have to see about the orthotics, I’m not surprised that my feet have changed from the original prescription. It’s definitely worth a consultation with a sports physio for a bad foot, the problems might be building up slowly to the point where they are hard to correct (my 1-hour consultation session was £48). The older you are, the harder it is to treat and the more slowly injuries heal.
Jeff,
The Salford clinic is a good idea to keep in mind, I keep forgetting about the possibilities at the universities - a great deal cheaper than doing it through a private podiatrist if the inserts sound good.
PW,
I might add those stretches to the main site as a reference along with the written instructions, I’ll continue to do them regularly from now on. It is hard to know which are the best physios, it would help to know one who is a regular backpacker and understands hiking with a pack on rough terrain.
Try to track down a copy of ‘Running - Fitness & Injuries’ by Vivian Grisogono. Full of self-help and proactive exercises to assist & prevent
John,
Should be useful, I’ll bear that one in mind.
Boy, do I know these stretches well! After a visit to the physio last week, I’ve had a few new ones added to my routine to ease my sciatica… my new favourite being the ’sun warrior’ (bit hard to describe, but seems to do the trick!) Hope all sorts itself out, anyway.
I can recomend the Jura, by the way. This is classified by my malt-drinking circle as a ‘party whisky’ as it is a little lighter and more quaffable than our favourtie dark, smoky Islas. Enjoy!
Plantar, sciatica, tendonitis… we’re all falling apart!.Still, I’m sure we’re in far better shape than most.
I agree on the Jura, a nice light one. Haven’t tried the Islay yet.
As a podiatrist, I see plenty of plantar fasciitis (as opposed to calcaneal apophysitis that is prevalent in early adolescence). Many of the treatments are ineffective since they don’t address the primary problem - excessive traction pull on the plantar fascia (PF) when standing / walking / running. If you calculate the daily traction force on the plantar fascia (body weight x 10,000 steps), it figures out to be millions of pounds for all of us.
If you look at a diagram of the PF from the bottom with an engineering perspective, the greatest tension is at the heel where the PF is narrowest. Tension is also higher along the medial edge (the big toe side). The combination gives the characteristic pain site of the bottom of the heel, somewhat towards the medial side. Orthotics are the best way to lessen this PF tension, and any type can be effective, though I tend to favor softer ones that are more easily modifiable.
Other modalities - icing, anti-inflammatories, cortisone injections, etc. help relieve inflammation, but they do nothing to address the primary biomechanical cause of PF tension. I recommend and utilize these methods, where appropriate, but only if the patient agrees to use their orthotics nearly all of the time. My success rate is fairly high - usually pain free in 1-3 visits.
There are plenty of other modalities that I don’t agree with - ultrasound, night splints, or surgical intervention, but I’ll spare the lengthy explanations.
Doug,
Thank you for such a detailed answer, most interesting. My symptoms match your description perfectly: the pain is at the bottom of the heel and a little towards the medial side.
I was looking at those night splints on the Sports Injury Clinic website and wondering if they were worth buying, but I decided to proceed with the physio first.
My orthotics are getting old now and the physio said one didn’t fit well any more, maybe it’s time for a new pair.
Where are you based - anywhere near Cheshire?.
Geoff,
I may have appeared to be in the UK, but I’m acually in the US. Sorry.
My knock on night splints is that they theoretically stretch out the plantar fascia. I contend that walking barefoot to the bathroom provides more stretch to the plantar fascia than wearing a splint all night. The mechanism of injury is plantar fascia stretching, so adding to this doesn’t make physiologic sense to me. Plus, the splints are a pain to wear, and patients tend not to be compliant.