PRACTITIONER VOICE
The common patient and psychosocial impact of PHP
Let ’ s face it , living with PHP isn ’ t just about hobbling around and wincing every time your heel hits the floor . It gets into your head too . Patients with PHP tend to experience more than just foot pain - they ’ re often dealing with heightened levels of anxiety , depression , and stress .( 14 ) Not to mention that some develop kinesiophobia , which is a fancy way of saying they ’ re scared of moving because , well , movement hurts .( 15 ) It ’ s like your feet are holding the rest of your mental health hostage . Fun , right ?
Risk factors and long-term prognosis of PHP
PHP is that friend who refuses to leave long after the party ’ s over . If you ’ ve had it for more than seven months , it ’ s probably time to dig deeper and come up with a battle plan .( 16 ) And here ’ s the kicker - about 60 % of people recover within two years , but for some unlucky souls , PHP can persist for up to a decade . ( 17 ) Risk factors include all the usual suspects : high BMI , flat feet , thickened plantar fascia , heel spurs , and conditions like Baxter ’ s neuropathy .( 18 ) Oh , and if you ’ re a woman over 40 with bilateral foot pain , your odds of shaking it off aren ’ t great , especially if you ’ ve got a heightened BMI and your plantar fascia is thickening like an overgrown shrub . Not to mention runners . I don ’ t think Forrest Gump had an issue but 8 % of all running injuries are from PHP .( 19 ) Bottom line ? Keep an eye on your feet - they can be surprisingly stubborn to feel and understand . Creating a processdriven assessment is ideal to prevent most foot conditions , as the research indicates treatment outcomes are poor .
The lowdown on fixing your heel without losing your footing
When it comes to managing PHP , we need to take a step-by-step approach – pun intended ! Let ’ s ease into the process , starting with the least invasive methods . Trust me , no need to dust off your “ Sell Your Feet on eBay ” business plan just yet . Evidence-based approaches typically involve a combination of heavy-slow resistance training ( HSR ), stretching , foot orthoses ( those fancy shoe inserts ), heel cups ( a little love for your heels ), tape ( think foot duct tape ), and electrophysical agents such as a combination of ultrasound and iontophoresis .( 20 ) Yes , that last one sounds like something from a sci-fi flick , but it ’ s a legitimate treatment method . ( 21 , 22 )
Best practice , according to research , involves a mix of methods : taping , stretching , education , and , most importantly , listening to patient feedback . We adjust your load - static and dynamic – and work on pain education ( because , let ’ s be real , pain and panic are best friends forever but they don ’ t need to be ). Add a sprinkle of footwear advice , and boom , you ’ re on your way to happy feet . If none of this works , we can always bring in shockwave therapy or orthotics , though not everyone agrees on their effectiveness .( 23 )
Let ’ s get serious : injections and surgery
If all the taping , stretching , and ducttaping your feet to oblivion isn ’ t cutting it , we might need to escalate things . Enter injections . Ah yes , corticosteroid injections – the foot equivalent of turning the volume down on your plantar fascia ’ s temper tantrum .( 24 ) Just be careful not to overdo it , or your fascia might stage a rebellion ( and trust me , you don ’ t want that ). Feeling fancy ? There ’ s Botulinum toxin A – yes , Botox for your feet . Because why should your face get all the fun ? This can relax your overworked foot muscles and give your fascia a much-needed vacation .( 25 ) But the idea of silencing some muscles in a foot that ’ s already crying for help needs further investigation . After all , once the Botox takes effect , what compensates for the now-relaxed muscles over the next 8 to 12 weeks ?( 26 )
If that ’ s still not enough , let ’ s talk Platelet-Rich Plasma ( PRP ) injections , where your own blood becomes the superhero that kicks your heel pain to the kerb .( 27 )
And if the injections still don ’ t work , don ’ t go selling your feet just yet . Surgery is the SWAT team of the PHP world . You ’ ve got endoscopic fascial release – a super stealthy way to cut that fascia tension – or gastrocnemius recession to lengthen your calf muscle and give your plantar fascia a break .( 28-30 ) But remember , surgery should be your absolute last resort . It ’ s like calling in a professional cleaner after you ’ ve tried scrubbing with baking soda and vinegar for weeks - good , but only when nothing else works .
Patient education : because knowledge is power
One of the most underrated tools in managing PHP is education . I believe the best way to relieve plantar fascia pressure is restoring function in the foot , and that involves the entire functional limb . More on this to come . Runners , listen up : you need to reduce your training volume . Yes , I know you love those 5am jogs , but PHP doesn ’ t care about your runner ’ s high . You ’ ve got to run less and rebuild your strength before you ramp things up again . And a little pain during exercise ? That ’ s not necessarily a bad thing . In fact , research says pain during exercise doesn ’ t equal harm .( 31 , 32 ) So , don ’ t freak out if your heel screams at you a little – tendons like progressive loads !
Now , if you ’ re carrying some extra weight the hard truth is that losing some can really help reduce PHP . Studies show that dropping your BMI - even through bariatric surgery - can reduce the chances of developing PHP .( 33 ) It ’ s not the easiest conversation , but your heels will thank you in the long run ( pun intended ).
Orthoses , taping , and stretching : your foot ’ s new best friends
Let ’ s talk about orthoses - those fancy insoles that look like they were designed by NASA but really just support your arches . Research says prefabricated orthoses , the ones you can buy at the chemist , are just as good as custom-made
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