Category Archives for Recovery

Hand me some tissues

I enjoy talking to people. Really, I do. You should see what I do for a hobby. But when I talk during the day, I have a lot of similar conversations and I promise, it’s not because of you. It’s not you at all. It’s me. I’m a podiatrist. And the conversation goes something like this…

“It still hurts. It’s not as bad as it was but I thought it would be better by now”

And there it is. The great dissonance between what you expected and what I knew beforehand was going to happen. Like I said, it’s not you, it’s me. When you do something long enough, you can forget that people who don’t do what you’re doing are not always so casually aware of what to expect. I should know. I was the same not so long ago…

About half my lifetime ago, I used to try and make people happy and of course, which can be a problem when dealing with people in pain. What I didn’t understand until much later, after I started my practical surgical training, is that different types of tissue within your body heal at different rates. It revolves around a couple of things but I’ll summarise for you so you can get a few sneaky tips to help the process along.

To give you a basic idea, in a healthy young adult, skin heals in about 10-15 days. Bone takes 8 weeks to get full strength. Muscle fibres take three weeks, but muscle tendon, as well as ligaments can take 14 weeks. Seriously, 14 weeks! And nerves can take up to two years. It’s crazy, isn’t it?

So when you have a newly minted practitioner, as I was late last millennium, you can feel like a failure if the person’s foot still hurts two weeks after they got their orthotics. I often did in fact, made worse by the juxtaposed success stories of patients I’d “cured”, largely because they were probably less acute to start with. The reason tissues heal at different rates is largely due to four key things. Tweak any of these and you’ll either help yourself tremendously, or wreck it for months.

  1. Blood supply is crucial for healing. Your circulatory system transports everything that has any relevance in your body, from oxygen to sugar to inflammatory markers, so if you want something to heal, blood supply is crucial. Did you know there are nine separate tiny blood vessels inserting into the head of your first metatarsal? (It’s true. They go in through little channels called Volkmann Canals. You are so going to clean up if Trivial Pursuit makes a comeback…). Key lesson: bone heals quickly.Now, your tendons and ligaments have much less active blood supply. Much of what they need has to diffuse in from surrounding tissues in the same compartment. Suddenly, not healing so quickly…If you want to speed up the process, get more blood there. You can do this using heat, massage, rubefacients like Deep Heat and Metsal (things that make the skin go pink when you rub them on).. the list is extensive and being a blog, I shouldn’t really give you definitive advice, but you get the general idea.
  1. Tissue stress. This one is actually much simpler than it sounds. The more pressure on the injured tissue, the harder it is for the body to heal it. Imagine a bucket with a leak. You can keep pouring water in, but the leak will still be there until you stop adding more water and patch the hole. Then you can start to fill it again. It’s the same if you have ankle pain but you love running, so you keep exercising on it without actually allowing time to heal. I know it’s my job to help you, but only to help. We’re partners in this part.. So if you want to run faster, longer and more often for years to come, dial back the frequency, distance and intensity now so your body’s maintenance crew has some time to catch up. Comprende? Excellent.. Rest. You’ll feel better and you’ll perform better later. That’s just how it works.
  1. How long you’ve had the problem. A funny thing happens when you injure yourself. Your body tries to heal up, whether you like it or not. It does this in different ways, but mostly it tries to get you out of your own way. It’s a bit like diplomacy and like diplomacy, it’s rarely recognised by the person it’s used on. Namely you. The longer you try and heal, the more your body will tend to scar. If you immediately deal with a small problem, it has a much better chance of healing quicker and cleaner, a bit like when you stitch a wound together. Contrast this with a wound you leave open and you’ll have some idea of what I mean. It still heals, only much messier, uglier and longer before the process is finished. Essentially, the longer you leave something, the more scar tissue will be laid down inside as your body attempts to settle the problem down. This falls into the category or “you should probably come in for a chat”, but it at least outlines that if you’ve had the problem for 3 years, expecting it gone in 3 weeks might be ever so slightly unrealistic. 4 weeks maybe…
  1. What you do about the problem. Some people immediately come in for a consult. Others pop off to yoga, pilates, osteopathy, the anti-inflammatory aisle, acupuncture, the GP… everything will have some effect, but target it wisely and you’ll get better quicker. It’s just that simple. None of you would see a chiropractor about your toothache. You need a dentist. So why wouldn’t you see a lower limb person about your ankle/knee/heel pain? The current research suggests that patients have better outcomes, at a lower long term financial and emotional cost when they see people who are more like machines. This doesn’t mean no bedside manner. What it means is someone who does the same small group of things, over and over and over again, perfecting them, understanding them and gradually racking up mastery of them.

I’m thinking from next year, I might only do the right foot. Any questions…?

So you’re not a morning person…?

A friend of mine is a poker player. Not the Saturday night beer kind, but the World Series, minimum buy-in, weeks a year in Vegas kind. The sort who’s more interested in people than cards, because the cards are hard to control, but people.. people are another story entirely. People have their habits, their giveaways, their little, seemingly individual quirks of behaviour.. their “tells”.

Tells exist outside of poker too and you’d be surprised how attuned you can be to them. Think about it the next time you get a sense that the person you’re talking to at a barbecue isn’t really into your pet subject, but still smiles politely and says “tell me more” with zero conviction.

Tells are why I know with a reasonable degree of certainty that when a Google printout unfolds from one of my patients’ handbags, there’s a better than reasonable chance that we’re discussing heel pain after we’re done with the pleasantries.

The most popular search result is usually plantar fasciitis, an inflammatory, painful, hugely frustrating condition that seems to strike out of nowhere and overstay its welcome like an uninvited guest who saps your energy and monopolises your time. And it just seems like it isn’t going anywhere. Ever.

There can be a couple of reasons for this, but if you take nothing else away from this article, know this. You will feel better. When and how.. well, you’ll need to read slightly more and, you know, perhaps also do some stuff about it as well. Sorry about that. I’d do it for you if I could.

So as I was about to say, the first and perhaps most important aspect to your healing process is knowing what’s actually wrong. It sounds overly simplistic, but a couple of years ago I started counting the different causes of heel pain, so I could use them as an example. It was meant to be a harmless exercise. Until I gave up at 35… That’s right.. there are more than 35 possible reasons why your heel could be hurting and only one of them is plantar fasciitis. Also, don’t be too fussed if you have an x-ray and see a nice pointy spur on the base of your heel. This is very, very, very rarely the cause of your problem. Allow me to explain what it’s doing there.

There is a principle known as Wolf’s Law, whereby bone will lay down new bone in areas where it’s under pressure. It’s the exact opposite if there is no pressure, which is why every space station has had a gym. What’s the link? Weightlessness for long periods means that astronauts, normally some of the fittest humans from Earth, progressively lose bone density because there is so little pressure on them. At the base of your heel, the opposite problem is depositing calcium.

The spur itself is simply a ledge of sorts, but seen from the side. When you have excessive stress on the tissue, usually around the origin point of some of the foot’s small muscles, the bone lays down extra reinforcement to protect itself from the muscle trying to pull away. That reinforcement, projecting out from the underside of the heel is what looks spur-like on your fetching new black and whites.. Remember, you can’t see muscle on an x-ray, but you can see the bone lying on top of them. The only time a heel spur is causing pain is if it’s actually broken (making it a fracture), or so gigantic it’s squashing other things.

So now that we know it’s not the spur sticking in, why does it hurt so much in the morning? As it turns out, the calcaneus, your heel bone, has a number of things attached to it, foremost amongst these your Achilles tendon. Your calf muscle, like all muscles really, shortens when it’s not under tension, so when you get out of bed, or get up after sitting for ages (because reality tv always goes overtime. Always.) By shortening the calves attaching to the back of your heel, the smaller, weaker tissues on the other side of it are placed under tension. If it was a workplace, we’d call it a power imbalance and union reps would be called in but for now, you’ve had your first big clue about how to ease this off.

Stretch. Specifically, stretch your calves, not your foot. Now of course, you do still need to see a professional and make sure that’s what you have, for the sake of not missing the big, important, nasty things, but if it feels better after stretching there’s a good chance you don’t have one of those. Also I’m not suggesting that stretching will make it better. It won’t replace proper long term strategies like orthotics, footwear changes and so forth.. but I am suggesting it will make you FEEL better. And like my poker playing friend and the reality tv you were watching when it started to hurt as you went for the fridge in the ad break, it’s how you feel that counts right now.