Preventing Plantar Fasciitis For Hikers

In this episode, I interview expert podiatrist Damian Gough, and he dives deep into the common hiking problem of plantar fasciitis. Inside he explains what it actually is, and the proven ways a hiker can overcome it.

 
Plantar fasciitis is the bane of many hikers existence. We have all experienced it. And it is terrible. 
 
All too often I see hikers reaching out for help with this issue, but getting some incredibly poor information in return. 
 
So with this in mind, I invited Damian Gough, an experienced hiker and expert podiatrist on the show,to have a detailed exploration of the common issue of plantar foot pain for hikers. 
 
So if you are currently suffering from some type of plantar foot pain, if you have dealt with it in the past or even if you want to be prepared for it in the future, this episode will be a fantastic resource for you. 
 
You will learn:

• A clear explanation and breakdown of over 25 commonly recommended 'solutions' to plantar fasciitis
• What hikers should to look for in recovery footwear when dealing with plantar heel pain
• One of the most important areas to look for in regards to preventing any type of foot pain
• The 'green light' approaches which are proven to work for reducing plantar heel pain
• Some great tips to ensure you get the right fit for you when buying boots

 
Mentioned in the episode:

• Archies thongs 
• Scholl orthaheel 
• Vionic 
• Fasciitis fighter
• Low-Dye strapping
  

You can find Damien and Umina Podiatry here:

https://uminapodiatry.com.au/yourfootpain/

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Episode Transcript:

Rowan:
So welcome to the show, Damien. Thanks for coming on.
Damien:
No problem, Rowan. It's great to be here to have the opportunity to talk about a common problem. Yeah.

Rowan:
I'm so glad you took the time to come on this podcast because as we're saying before we hopped on, you know, the subject around plantar fasciitis is just so misunderstood and there's so much terrible information out there and so many hikers need help. So hopefully we can dive into it a little bit deeper and sort of maybe explain a few of the common myths. So hopefully we'll have some hikers we get some good value out of today.

Damien:
Yep. I so, yes, I mean, I've, I'm a podiatrist, I should say that number one. I know you, you sort of describe yourself as a coach first and a hiker second and, and I kind of think that's what I am. Haven't done a great deal of long or multi-day type hikes except a few years ago when I was involved with the Scouts. But my role now is much more about supporting people through things like the Oxfam trail walks. And my wife and friends who do multi-day hikes and I tend to be the the driver and the first aid and the foot fixer.

Rowan:
Yeah. Fantastic. And for, for people who we know in the past we've had other PO, another podiatrist on the show, but for people who are not 100% sure what a podiatrist does, do you want to break that down just in some general terms?

Damien:
Okay. so we're generally degree, you know, a bachelor or master's degree trained in university. We specialize in treating sort of foot and lower leg conditions, everything from skin and nail conditions to muscle and bone problems, sports injuries, workplace injuries. We do minor surgery, skin and nail type surgery. And some podiatrists have advanced training in in bone surgery. So pretty much podiatry is you kind of go to number one, professions for foot, ankle and walking, running problems, anything to do with the lower limb. Does that sound fair enough? Fair enough.

Rowan:
And I think that's exactly what we need to cover this subject. So to get into it then, so we're talking all about plantar fasciitis today. Do you, would you mind describing what plantar fasciitis actually is and why is it such a common thing for hikers?

Damien:
Okay. Plantar fasciitis is a term that's sort of been used commonly to describe pain underneath your heel. Now, planter is anatomical term, which refers to the sole of your foot and fasciitis. It means inflammation of the fasciitis. So anything with itis at the end means inflammation. Now it's a bit of a misnomer. It's a common name for what has also been referred to as heel spur syndrome or plantar fasciitis. Some people have called it a much more general term this, these days, which we call plantar heel pain because there are so many different reasons why you get this same pain. Now, plantar fasciitis as a condition is, is a very common cause, but it's one of over 30 different causes of this pain underneath your heel. It's typically where this plant a fattier, which is a tissue similar to tendon or ligament attaches to your heel bone.

Damien:
It tends to be a mechanical problem to do with strain or damage. To that tissue and is more of a chronic inflammation rather than an acute inflammation. Now, chronic inflammation is something that's been lasting for weeks or months rather than something that's happened very recently. There are lots of different factors such as vascular, metabolic or genetic factors, which are all linked to the a degenerative change in this, this fascia tissue. And it usually presents as typically pain. When you stand up and get out of bed first thing in the morning, it tends to feel better as you get moving or you get warmed up. But later in the day you will notice that your heels are getting sore, particularly if you sit down and have a cup of tea or watch the TV and then get up again later in the day, you'll feel that pain. So it's common in people in the fifth decade of their lives. It's common in people with a high body mass index. So if they're a bit overweight it's also common in people who have limited ankle joint movement. So there are tests that you can do to, to check on that. So they're the three sort of big red flag things where we tend to see an increased incidence in the general population. The covers off some of the basics was exactly what we need. So the next thing I want to explore is on the internet you always see people reaching out saying, look, I have plantar fasciitis. How can it help? And they might not have seen a professional would actually get diagnosed. So why would it be a problem if so people do try to, you know, heel pain. And then what are some other conditions which might be causing this type of pain?

Damien:
Okay. The, yeah, let's start talking about plantar heel pain rather than plantar fasciitis because that's the accuracy is one of the causes of plantar heel pain. Like I said, they, they can be as many as 30 different reasons, but some of the most common are actually pathology of the fat pad onto your heel. So that might be bruised, swollen or it could even be wearing out as you get older. So you've got more of a bruising or an irritation of the fat pad. The next most common thing that we see is where there's nerve entrapment or irritation. So the small nerves that travel behind your ankle bones and down either side of your heel to give you the, the sensation and the feeling underneath your heel. Those nerves are trapped or irritated and they can cause similar sorts of sensations. And this plantar heel pain a rare condition is, is, is actually something that they call a lovers fracture.

Damien:
So you might actually get a crack in your heel bone. It was called a lover's fracture because it happened to people when they jumped out of windows if they were caught having an affair and other metabolic problems which can cause changes to your bone density. So osteomalasia is a, a lack of bone density in the heel and it can cause, you know, stress fractures and pain. There are other sort of more systemic conditions like for instance, inflammatory bowel diseases, a reactive arthritis that will likely to cause heel pain, plantar heel pain problems. So you've have other things going on with your general health that could be a reason why you're suffering with, with these heel pain as well. One of the, you know, some of the much more rarer things are when you've got a spinal problems, say your lower lumbar and sacral areas of your spine.

Damien:
If there's a pinched nerve, there are what they call a radicular apathy. That can refer pain down to your heels and other parts of your feet. So you need to be aware of you've suffered with lower back problems and heel pain. There could be a connection. Finally and unfortunately we do see this occasionally, you know, bone tumors in your heel bone can cause this sort of pain. And that's why we need to check things carefully. We'll very often get scans and or x-rays to check state of your heels before we commence treatment, just to be sure we're on the right track.

Rowan:
Okay. And would it be safe to say with such a big array of different things that can potentially cause heel pain, that they'd each require some different type of treatment? To help them.

Damien:
The law was be a slightly different approach to treatment because what we want to do is reduce the strain or the load on the tissue that's that's damaged or inflamed, so it may not actually be the fascia. For instance, you might have a small muscle tear or a muscle strain which is swollen and saw perhaps pressing on one of the nerves or crowding the area where the fascia attaches to the heel bone and causing that sort of pain. So we'll always, we need to identify the structure that's causing the pain and then do what we can to firstly relieve the pain and then allow proper healing of that structure so that you can get back to the the things you love to do. I suppose the one, one thing that I didn't mention, which is like almost the elephant in the room is is the heel spur. Heel spurs are a small shelf of bone which grows out from the heel bone and are rarely the actual cause of the pain. It's usually inflammation of the tissues in that area that are the cause of the pain. So you can't simply remove the bony spur to, to solve the problem. So to ask for, for treatment for a spur you're sort of barking up the wrong tree there.

Rowan:
Another point I'd like to make, or question I'd like to ask you is quite often people that reach out to me, they're repairing for their tracks that prepare them for the hikes and they pull up with some type of foot pain or heel pain and they say their first point of call is they go to their GP to get a diagnosis and the GP says to do X, Y, and Zed. Now, if people were looking for diagnosis for heel pain, would they be potentially better going straight to a podiatrist as PR as opposed to straight to their GP or doctor? And if so, why would that be

Damien:
Feta? What we do all day every day and, and it's our speciality. It's is our area of special interest. So certainly that, you know, if you had a problem with your teeth, you wouldn't go to the GP, you'd go to the dentist and I'd like you to think about your feet in the same way. I think that that's probably the best way of putting it. Certainly JPS can point you in the right direction, but I suppose the kind of knowledge that we have around specifically around heel pain is going to be much more than your GP usually who will, might send you for an x-ray and eventually refer you to a podiatrist anyway. If you're already seeing somebody like a physio or a chiropractor or a coach of some description, they may have some knowledge in the area and they might be able to help you out. But I think eventually if your heel pain is not getting better after say a month or six weeks, then you need to be seeing a podiatrist.

Rowan:
Yeah, absolutely. So now I want to get into the meat of the episode. And this is sort of the inspiration around what I wanted to bring you on to talk about today. So more often than not, when you're on the internet, you see people recommending their own remedies for heel pain online. And I thought it'd be really, really cool if we could break down a range of these common recommendations, whether we always see and then sort of talk through each remedy, you know, and what it's actually trying to do, where it might be useful and where potentially might be counterproductive. So what I'm going to do right now is just, we're just going to go through a big list of remedies that I often see on the internet just being thrown around. And then I'd love if you could just break them down a little bit and we could arm just explore them.

Rowan:
So to start things off, is splints now, what might they be useful for? What are they trying to do and when might it be counterproductive?

Damien:
Okay. usually splints that are specific for plantar fasciitis or heel pain are known as night splints. They tend to hold your foot at a a kind of a 90 degree angle to your leg as if you were standing up and they hold the foot in that position while you're in bed and while you're asleep. Now I think the idea of that is that any healing that takes place while you're in bed or asleep, it heals with the plantar fascia. So with the tissue stretched already in a position that they're going to be in when you're standing. Now the scientific evidence is a bit sort of a bit gray around the area of night splints. So we would say that splints might work. And for us as podiatrists, it's sense it tends to be something that we recommend when you know, first line treatments haven't been successful. So yes, they're out there and they have been found to be effective. There's some, some good evidence about their effectiveness, but there are also research papers we say that they don't make any difference.

Rowan:
So next one up then is probably the most common recommendation I always see is rolling with a bowl underneath your arm here. So do you want to break that down?

Damien:
Yeah. Rolling with a ball. There's various things I've even seen at a conference in the U K a kind of stainless steel bowl, which is filled in with some kind of liquid and you kept it in the freezer so it wasn't just rolling a ball, but it was icy cold as well. Now what the stars, even if it's just rolling a tennis ball or a golf ball, simply massages and gently stretches the structures underneath your feet. So it might provide you with some pain relief while you're doing it, but they are actually much better ways of stretching or loading the tissues to help them to heal properly. And that tends to involve actually sort of semi weight bearing or weight bearing and putting something underneath your toes to give a really good stretch to the fresher rather than just massaging or rolling it. So it might make you feel better, but it's certainly not going to heal your your heel pain or your plantar fasciitis.

Rowan:
And next one, touching off what we just talked about is cold cold therapy. Okay.

Damien:
Cold therapy. So I seen or yeah, are putting a bottle of water in the, in the freezer and getting it out and rolling your foot over it. And now at the end of the day, if you've been on your feet, maybe you've been on a long hike and you don't have the opportunity to plunge your feet into an icy cold Creek, that kind of thing is good for sort of reducing hate and a bit of localized inflammation. It's not going to help fix your plantar fasciitis or your heel pain, but it will make your feet feel better. I feel I've been on a long hike or I've been on your feet all day. If you think about sports teams and what you see them doing for recovery after a big game, you know, they're going for, for ice bobs and swims in the ocean, that kind of thing. So, cold therapy can be helpful for recovery after, you know, a big hike, lot of exercise, but I'm afraid there's no evidence to show it helps. Curing plantar fasciitis.

Rowan:
Alright, next up is acupuncture. What do you think about that?

Damien:
Mmm.
Damien:
If we're talking about actually a puncture, we're talking about sticking needles into your feet. So there are two ways or two forms if you like, of of this needle therapy. So traditional Chinese medicine, acupuncture has been around for years and years and a lot of people find it very effective in treating all kinds conditions. The other approaches is something called dry needling, which tends to be used by musculoskeletal therapists. So podiatrists, physios, chiropractors, and there's not very much good scientific evidence. However, most people who say who've had it done the dry needling or the acupuncture will say it really helped. And lots of people, there's lots of anecdotal evidence that say getting people are getting really positive results with dry needling, trigger point therapy into the muscles in your carves and into the areas that are painful. But again, it's more about pain relief rather than actually curing the damaged tissue underneath your heel. So yeah, it's, I suppose the jury's out. It's something that might work, but it's not going to cure the problem as far as we know.

Rowan:
And then next up is the really common and contradictory recommendations around either barefoot walking or never been barefoot and always wearing a thick shoe.

Damien:
Okay. So treatments are that we know to help plantar fasciitis or plantar heel pain are are strapping or taping the feet and supporting the feet. Either we're with orthotics or arch supports or even just wedging in the shoe. So these are things that we know work and that there are scientific evidence to show that they improve plantar heel pain or plantar fasciitis over, you know, weeks and months. So there's good scientific evidence around those things. That's, that sort of contradicts the notion that the going barefoot is better because strapping and support or recommended treatments. So being barefoot really doesn't sort of go along with, with those ideas. So walking barefoot is not going to help. I'm afraid it might feel better, but it's not going to help. I will sort of qualify that in some ways is that if you're doing loading or stretching exercises, you will be doing them barefoot because you need to get a lot of extension or you know, stretching underneath your toes to pull your toes back. So don't walk around barefoot if you can avoid it. And, but you do need to be barefoot for your exercises.

Rowan:
I've said it, they go, you might get a bit of hate mail from that one. We go. Next one is Birkenstocks, Birkenstocks. So they've been around for, for years.

Damien:
And that, that German company that made the cork sandals that had a bit of an arch support in them and a, an a molded kind of foot bed. The thing about Birkenstocks is, apart from their colors, they really haven't changed very much over the years. I think you can do a lot better than Birkenstocks if you want some kind of footwear that's got a molded foot bed. Some kind of arch support built into them. The first thing about Birkenstocks is they're quite flat and we tend to recommend people have a little bit of a heel raise. It changes the, what we call the ankle joint moments are the forces that are going through the foot and the heel when you have a little bit of a heel race. So Birkenstocks, some people find very comfortable. I'd prefer you look for something similar that's got a little bit higher in the heel or more of a wedge, some arch support. And there are a number of brands that have thongs and slides that will, will provide those features. That I would favor over Birkenstocks. However, you know, people have been wearing them for years and they love them and they did have a bit of a sort of a comeback a few years ago in the in the summer, didn't they? The w with those fashionable young people. Yup.

Rowan:
That's a, that's my girlfriend Allie She's never leaves the house without a Birkenstocks. You can't tear away from them. Well, that's good. And she'll probably tell you she, she, that's the reason she never has any heel pain. Yeah, that's it. I wouldn't mind off the top of your head, can you think of any of the brands that do have a little bit of a, a heel raise in, in that type of shoe put where it's really probably this is your

Damien:
Casual footwear. So from the bottom end of the price range, there's a brand called archies. They're thongs. They come in lots of different colors and , they've got arch support and a bit of a heel lift. They're designed by a physio, a lot of us podiatrists loving. And then you move up through sort of the Shoal author heel brands which again are arch support, thumbs and slides. There's another brand via Vionic, which again, you're getting up sort of towards the a hundred dollar figure for those sorts of things. Their phones and slides, which have good arch support and good heel lift in them. Some of your, your sort of sports shoe stores also stock different brands of, you know, arch support and what they call recovery sandals or footwear. So the things that I suggest you look for just that the heel is a bit higher than sort of underneath your toes. I know that the barefoot and the minimalist people will be cursing me, but we're talking about really sort of what you can do to change the forces and change the ankle joint moment so that you reduce the stress on the damaged tissues.

Rowan:
Well, that, thank you for sharing that because it's always interesting to get a little bit more specific in those things and I'm sure a few people can check those things out. And for the U S listeners, we're talking about flip flops and.

Damien:
Oh, yes, yes. Right.
Rowan:

You mentioned before that you were saying orthotics do have some strong evidence behind helping this type of issue. How about quite often you see on the internet and people recommending just generic pharmacy or supermarket bought orthotics?

Damien:
Yep. There's a number of research papers which have have shown, you know, a few different types of results. Certainly pharmacy, sports store supermarket, both orthotics are a good start. Their effectiveness will really depend on, again, the nature of your heel pain. So what's causing it the, the type of footwear that you wear and also how long you use them for. Some of the materials that they're made from are not really very durable or long lasting. So you'll find after a month or so, you'll notice the [inaudible] is in the sides of the orthotics where the foam has compressed and they're not providing you with the support that perhaps they did when you bought them. The, I suppose the next step on from that is whether or not you'd get orthotics that are ready made or whether they're custom made, made to measure for you. And, and again, that that's going to depend really on how, how we can fit things to your feet and whether your feet are symmetrical, they rarely ever are. And again, the, your sort of foot shape, your foot type and the type of foot wear that you're using, but certainly orthotics that have a heel cup and an arch support or a good start before you get to see a podiatrist. But if you're going to spend that 40 or $50 put it towards a consultation fee. That's my, yes,

Rowan:
Fair enough. Fair enough. Next one anti-inflammatories

Damien:
I'd seen fire trees. So your things like your ibuprofen, so you knew roof, you know, that type of medicine. If it's a very acute, just happened injury and I'm talking about the first few days it might help with a bit of pain relief, but more and more studies are now suggesting that those types of anti-inflammatories actually adversely affect healing because they reduce the blood flow to the area and, and you need blood flow to take away all the damaged tissue to provide all the nutrients for, for healing and for recovery. So I, if you feel like you need to take something to reduce the pain, then we would usually suggest that you don't use these anti-inflammatories like ibuprofen. And look for an alternative form of pain relief. It might just be paracetamol, Panadol, that sort of thing. Unfortunately there, you know, those sorts of medications also affect your stomach and you've got to take them after food. The anti-inflammatory my, one of one of my children actually had bone surgery he'd had a couple of years ago and then he was also told to avoid anti inflammatory medications again cause it slows down bone recovery, bone healing. So certainly while we used to think it was a great idea, not so much anymore.

Damien:
Then next one up cortisone injections. There's something that's been commonly used over many years and they're still sort of still commonly used. Unfortunately. the evidence now is showing that the, it's quite poor and the pain relief that people tend to get is, is more than likely, you know, very short lived and dependent on how accurate the injection is. And probably also on the local anesthetic that's mixed with the court zone. There are many more risks than people previously understood. So they're finding now that the cortisone might reduce the inflammation, but it'll also weakened tissues. So for instance, you know, used to be common place to inject tendons with cortisone to, to get a faster recovery. They're finding now that it also massively increases your risk of a, of a full rupture of a tendon. So cortisone injections used to be a kind of go to finger JP and stick a needle in your hail in, in, in, in the surgery. And it's a very, very painful let me tell you but unfortunately now, yet it's something that you should avoid at all costs.

Rowan:
The next one and one that I really know nothing about is Mini-Tran patches, if I said that right,

Damien:
Right. So these are patches which contain drugs that are used to treat heart disease or angina. People commonly know as people sometimes would have a little pill had put under their tongue or a spray if they got an angina tech, which is where, where the blood vessels in your heart are not working well. So they found that these patches would, if they were stuck on an area where there was an injury, would help to increase blood flow in the area. And the idea was that it might help with a recovery or curing, you know, tendonitis and also heel pain. Excuse me. There was a research study done in 2013, which was in Iraq. All the, there were 50 odd subjects in the research. They were all overweight for two weeks. They stuck these angina patches on their heels to try and help to reduce their plantar fasciitis. At the end of the two weeks, 13% had had a greater than 50% reduction in the pain. So they're not, they're not fantastic results. It's certainly not something that's licensed or used in that way here in Australia. I'm not sure that anywhere in the world for sorts of patches licensed for use in the management of heel pain. And what can I say? There are better treatments with a lot more evidence behind them. That's my answer. That makes sense.

Rowan:
That makes complete sense. And I threw that in there cause I saw that the other day and I never heard anything about it. So I'm glad you, you know, thank you for breaking that down. Next one we've got is plantar fasciitis socks.

Damien:
Now there were a number of companies coming out with these sorts of things and I found them to be really helpful. I don't think there's a lot of research you know, evidence based research out there behind them. However, anecdotally it, it makes a lot of sense because taping and strapping helps to sort of compress and support the area and there's good evidence for taping and strapping these compression socks or compression garments. And we're seeing a lot more of those sorts of compression type things. You know, you watch any, any even sort of professional sport on the TV now and you'll see people wearing things on their arms and on their legs. In the, the longest shot of it, it compression reduces inflammation in the area, so it's effective in reducing pain and getting your moving. So I'm a bit of a fan of these so-called plantar fasciitis socks as, as long as they're providing compression in the right places. And just be careful about taking them off when you go to bed. I mean, some of them say they're, they're good to be used overnight, but mostly, you know, I, I'd suggest taking them off when you go to bed. You should be careful if you've got any circulatory problems because if the, there's too much compression, you know, you're cutting off the blood supply and that's not going to be good. Not for your hiking Korea.

Rowan:
Yeah. I made the mistake and I was a on Kokoda of, I was wearing my compression tights over night, but then all of a sudden, one day I was like, yeah, I'll, I'll wear my girlfriend's compression socks as well. And after an hour or so, not a good way. We're in there a little bit too small for me, so I can speak from experience there. Yeah. So you've mentioned a couple of times that taping and strapping have some good evidence around it. If you are looking at taping and strapping, what are you specifically trying to do? What we're trying to do

Damien:
IT, is put some compression onto that fat pad on your heel and also to support the arch of your foot. So there's a technique known as low dye, D, Y, E taping, so low, low DUI E and, and this was after di was the guy that first sort of described these taping techniques. Get on YouTube, there's, there'll be a thousand videos showing you low die taping. What's worthwhile is using the the rigid sports tape. So if you've got a, rather than the multicolored stretchy what they call like Kinesio tape or rock tape, which again, you, you know, you see on a lot of sports people on TV, but then no, the rigid sports strapping tape, the, the Brown stuff that you see is, is the best sort of type for that. Generally you gotta leave it on for up to a week and you should continue with that taping for, for up to four weeks after four weeks. Yeah. If you haven't experienced a sort of a 50% reduction in pain, then we need to review you. But certainly the taping is got good evidence behind it. It helps to give you fate more support and or being, well, your skin couldn't tolerate the adhesive. That's the other problem. Some people need to find a hypo allergenic tape, but it's certainly worth doing as a first line treatment and something that you can do at home.

Rowan:
Yeah. Fantastic. And you beat my follow up question there cause I was going to talk about the if you're allergic to tape, cause I know a few people I've worked with previously have been in that situation. So when you're leaving the tape on, you said for about four weeks as this for through day to day while you're sleeping, while you're training, is there any times you would take it off or you just leave it on as much as you,

Damien:
You can or you can you can take it off overnight if you need to let your skin recover. Usually if it's, if it's applied well and you're careful, it'll stay on in the shower. Obviously you, he gets dirty or it starts peeling off or it gets soaking wet and it doesn't dry out, then it needs to be replaced. The, the issues are, I think around you, you're actually getting yet, you know, your skin damaged and becoming moist and masqueraded and then breaking out. Unfortunately, we've, I've seen people taped up a couple of times and we come to take the tape off and we take the skin off with it and that's not pleasant.

Rowan:
So next one is soaking your feet in Epsom salt.

Damien:
Magnesium sulfate is what makes Epsom salts. Now there's been a fair bit of sort of talk if you read around the internet about magnesium and how it can help with various conditions. If you put Epsom salts in warm water and soak your feet in it, there's a very minimal amount that's actually absorbed through your skin. I think probably the main benefit is from just soaking your feet in warm water and sitting still for, for 20 minutes. Some people recommend actually drinking solutions of Epsom salts. As far as treating plantar fasciitis or plantar heel pain, I don't think there's any good scientific evidence behind using Epsom salts and I don't have much else to say about that.

Rowan:
Fair enough. Whoa. In the same vein the next one is essential oils.

Damien:
Again, this is an area where there's not a lot of great evidence. Now there are some oils that are recommended for people with arthritic complaints. They particularly the kind of the menthol, the minty type things. They tend to encourage some circulation in the area and give you some pain relief and, and sort of, I've put alongside essential oils, the pain relief creams, like physio cream and athletes gel. They're both available in Australia, I'm not sure about overseas, but they're popular because they, you know, when they're rubbed into a painful area, they seem to encourage a bit of local circulation and and, and provide some pain relief. But that's what they are. They're pen belief. There's something that makes things feel better, but they're not actually going to heal or resolve your plantar fasciitis or heel pain.

Rowan:
And then the last one from this list, something again I have absolutely zero knowledge about is CBD cream or CBD oil.

Damien:
It's a very on trend at the moment, CBD in different parts of the world. In Australia there's still a very complex scheme which you need to go through to get prescription. It's only available legally on prescription. I haven't found it clinical trials or a sort of proper research papers relating to heel pain, but there are lots of anecdotal stories and evidence about general wellbeing and people all of a sudden being able to get up and move around after using cannabis products, whether it's CBD or whether it's the actual sort of more potent capsules that are available. So at the moment it's very much something that we wouldn't be recommending, but I, it's one of those things where you'd say, watch this space because I'm sure in the next 10 years there'll be a lot more information one way or the other. About how effective it really is.

Rowan:
Yeah. Fantastic. And then to sum all of this up, like taking all of these things we've talked about and maybe some things we haven't talked about, if someone was experiencing heel pain, what would you recommend as their sort of best course of action?

Damien:
Okay, there's, there's gotta be two approaches. If it's, if it's something that's very acute, so it's something that's very new that's only happened in the last few days, then you've got to, first of all, you don't try and reduce the pain. So reduce the load on the damaged tissues, reduce work you're doing. So get off your feet, get some rest, do some gentle stretching, weightbearing stretching, stretching to your calf muscles with, and also pulling your toes back towards you while you're doing that. So you might, there are, there were there's a product called a fasc itis fighter, which is a little tool to help you stretching and it sits underneath your toes. You'll, if you search for that online, you'll find it. So that's, that's the approach. It's a very, it's a very new injury. The other thing you'll need to do is make sure you're get into some supportive footwear.

Damien:
So a good job, a running shoe, even your hiking shoes with a little bit of a higher heel. So the high heel needs to be higher than the toe. And this is if it's a very acute thing. So if it's just happened, the other thing is taping and compression. So reducing the inflammation and supporting your foot. That's a very important part. If it's been present for more than a couple of weeks or if it's been months that you've been putting up with this heel pain, then we need to look at those things. The same things. So taping, compression, supportive foot, bear with a bit of a heel lift, stretching exercises. The other things that we need to look at probably more closely things like your ankle joint, range of motion and for everybody. It's a bit of a longterm, much more longer term thing, but most people that get plantar fasciitis in the general population are overweight.

Damien:
So weight loss is a really, really good thing to make. Part of your I suppose approach to heel pain. Now I know a lot of hikers, you know, they tend to be fit active anyway and it might not be effective for them. But certainly the statistics with people that need to lose a bit of weight. So the, I suppose the green light things that we know definitely help and definitely work for plantar heel pain or plantar fasciitis, a number one, weight loss taping with that low dye strapping or taping or compression type socks orthotics or some kind of wedging into your shoes. Your podiatrist can help with that. There's actually good evidence for surgery, but that is the absolute dead set. Last resort. If you can't get rid of your heel pain and that would be something that you wouldn't consider, I would say for, you know, 12 months.

Damien:
There's a lot more sort of good evidence shockwave therapy where they use sort of concentrated radio sound waves. So you might see it, see some practitioners using shockwave, which it's a sort of a tapping, banging kind of a sound that the machine makes that sends shockwaves into the tissues that helps with pain relief, stimulates healing and blood flow in the area. There's a growing body of evidence for manual therapies like stretching, strengthening and mobilization of the joints around your ankle and the small bones in front of your heel bone. Definitely stretching the tissues, so stretching the plantar fascia and the tissues underneath your feet and also your calf muscles. So what you need to be able to do and it's something that you can, again, another thing you can look up online or look up on YouTube is, is a lunge test.

Damien:
So you should be able to carry out a lunge test where you stand with your foot pointing at a wall and your toes should be at least 10 centimeters from the wall and you should be able to bend your knee and stretch your ankle forward until you need touches the wall. If you can't do that, then you need to do some work on stretching those calf muscles. Might splints. Like I said, I've got a bit of a, a mixed report with the, with the evidence, but some people are finding them them helpful and also strengthening the small muscles in your feet. So doing exercises like I'm picking up marbles and pencils with your toes and things to help them little muscles in your feet. Most podiatrists be able to advise you physios and other trainers and coaches advise you on strengthening the small intrinsic muscles in your feet.

Damien:
There are some treatments for which there is not a lot of good evidence but they are new and showing a bit of promise. So things like STEM cell therapy, PRP and autologous blood injection. So this is when they they'll take some blood from you. They'll either put it in a centrifuge and take out the platelet rich plasma or they will take blood from, from you and run it through some kind of processing and then it's injected back into the painful area. For some conditions there's really good good evidence that there, that it's helping. And there's a lot of research going on at the moment. There's nothing that's saying that it's good for heel pain, but mixed results, like I said, I think it's gonna look, it's gonna look at one way or the other.

Damien:
We're going to be more certain in the coming years. Ultrasound has been around for years and it's been found to be fairly useless. Low level laser therapy is something that is, we're seeing a lot more with some therapists, but again, the evidence is not quite there yet. We've mentioned corticosteroid injections of them if at all possible. So there's, yeah, there's your run down of all the kinds of treatments that are available from, from from what you can get at the, at the chemist to right, what you can get from podiatrists, physios, trainers, coaches, and even from surgeons.

Rowan:
Perfect. And I think that is a great rundown of everything. So I appreciate you going into so much detail because that is a really, really good resource. You've just sort of put together for people to understand a little bit more about this. So that's amazing. Now before we wrap things up today, is there anything else you'd like to add? Anything we haven't covered or any other points you wanted to make?

Damien:
Okay. I suppose one last thing, which is something that we see mentioned in a lot of the forums online is about, you know, shoe fitting boot fitting. You know, someone's got an a pair of old favorites that have finally given up on them and they don't make that model anymore and they don't know where to go, what to do. So there's a few things that you need to consider is, you know, as you know, when you're hiking or walking for a long distance or a long time, your feet do tend to swell and grow. So try and go shopping for boots or shoes later in the day when your feed of at least while then up a little bit and take the socks that you would usually wear with you to try them on. Of course, if you've got any kind of orthotics, Archibald's inserts in souls, you know, make sure you've got them with you as well.

Damien:
Now when you're trying on your shoes, unfortunately manufacturers have got all different sizing systems, so you can't just go along and say I'm a size eight or a seven or whatever anymore. You might find that you're trying on a seven in one brand and a nine in another. Because they can be a couple of sizes difference. Even though they're actually the same shape, same length, whatever you don't be afraid to pull out the foot bed or the inner sole that's in the shoe that you're trying and stand on it because then you can see where your toes a lie in the toe box. Most of the problems people have are around the term box because of the shoes, just not the right shape for their toe area. So if you know, if any party your foot's hanging over the edge of that inner soul, then you might need to consider a different brand or a different style.

Damien:
It's got a different shape toebox or are a bit of extra width. And so there's a few things that you know, really when you're out there, go and go and try them on in a shop, whether you actually they actually fit them for you and you have the opportunity to walk over perhaps different surfaces. I know some of the bigger outdoorsy type shops all have some steps or some rocks for you to walk over just to see how they feel sort of on the uphill and on uneven ground. It's well worth making the journey to make sure your shoes get fitted properly. That's probably all I've got to say on that ride.

Rowan:
Perfect. And then just to finish things off today, if someone was trying to find you, whether it's online or work with you in person, like where are you based, how could they reach you? Is there any information you'd like to share around that?

Damien:
Okay. Yeah, that's fine. I'm where you're at. You might podiatry, which is about an hour North of Sydney on the central coast. And if you look up your mind, a podiatry, U, M I N a podiatry.com. Dot. AU websites there. My name is Damian Gough and you can find me on Facebook and Instagram and Twitter and all those usual places if you need to connect with me personally. And I think that one of the resources that we have that particularly can help with hail pain is on the Yamana podiatry website. There's a button to click to find your foot pain and there's also basically there were pictures of you and it tells you what could be wrong cause like through the Umina podiatry website.

Rowan:
Perfect. Well I'll put a couple of links below in the Shanine so people can find the website and find that little find your foot pain thing as well. But thank you so much for comment on Damian. This has been an absolutely fantastic episode. You've delivered so much value, you've cleared up so much information, which I'm sure would have written. A lot of it was new to me and I'm sure a lot of our listeners I'm listening in will be getting a lot of value out of this, so I really appreciate you coming on.

Damien:

Oh, you're welcome. It's great. I mean, yeah, I know I might've started some arguments as well. But all I can comment on is, is either on the evidence or, you know, my own opinion. I've got 30 years under my belt looking after people's feet and we get good results and they can get out there and do what they wanna do.

Rowan:
Well, beautiful. Well, thank you very much, mate.

Damien:
You're welcome. Bye for now.
 

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