Heel Pain – Dalen Friesen

Mark: Hi, it’s Mark from TLR. I’m here with Dalen Friesen from Body Works Physiotherapy in North Vancouver, multi time award-winning physiotherapy clinic. And today we’re going to talk about heel pain. How are you doing Dalen?

Dalen: Hi Mark. I’m doing very well. Thank you. Good to be here.

Mark: So what’s the typical cause of the kind of heel pain that you’re seeing in your clinic?

Dalen: Well, it very much depends, I think on a number of things, but quite often, people will come in and they’ll be a reporting kind of an ongoing history or that it’s been going on for some time. Describing pain at the back of the heel, maybe within the achilles tendon. Sometimes it’s located down near the bone of the heel, or oftentimes we’ll find that it’s within the tendon or in the middle of the tendon.

They’ll typically describe pain with activity, maybe going upstairs, pushing off, walking uphill. But one of the hallmarks quite often is waking up with heel pain or tendon pain in the morning. So first steps of the day being very, very painful.

Mark: And what kind of treatment protocol do you go through after you’ve diagnosed it and determined that it’s the achilles?

Dalen: Yeah the key thing is in the getting a good history during the assessment. So sometimes they don’t know you know, how long ago it started. Cause quite often what we find is that it has been going on for maybe longer than they even realized or beyond their symptoms.

And part of that relates to the fact that we now understand that there’s more going on than simply an itis, which refers to as inflammation. It typically is something that has become more chronic. In fact, we’ve now coined a term with it or put it under the category of an opathy or a pathology of the tendon.

So the collagen tissue, the way that it’s all made up, it’s actually changed over time. And so we need to understand what state the the condition is in and that’ll help direct our treatment. So if it’s something that’s very much on the early onset, then modifying activities, giving very specific instruction, can change that very quickly.

If it’s something that has been much more prolonged, ongoing. It can be measured more in months in terms of recovery, but again, very much education specific. We look at what have they been doing maybe differently of recent. Maybe they’ve been doing a lot of something. Maybe they’ve had changes in, let’s say footwear and things like that. So it’s very specific to each case, to see where it is within the stage of the condition.

Mark: And what would the typical treatment be?

Dalen: Well, again, the first part would be the education understanding what it is that they’ve been doing and making changes and modification around that, giving specific guidelines. Within the clinic, there would be some manual therapy techniques, some dry needling perhaps, within some of the tight muscles.

And then giving a very prescriptive exercise plan for them. That is the new research that has been conducted on that and within this area, some of it being done here at UBC. Some of it with some Australian leaders and finding that because of the the reorganized collagen tissue, the type of exercises must be very specific. We need to load this tendon and giving specific exercises through that. So it could involve, for example, some calf raises and being held in what we call an isometric position, or you’re just simply holding your body in a position and then loading that tendon through more advanced type of of exercises and ultimately getting back to function.

So understanding is this a return to, you know, a jumping sport, like a volleyball player that would involve treatment progressions that would be quite advanced. Compared to someone who maybe is you know, working in an office environment, doing stairs occasionally and going for some simple walks in the neighbourhood. So education, some clinic therapeutic modalities and things like that. And then also a home exercise program that is very progressive either over weeks or months, perhaps.

Mark: Depending on what, how long the pain has been there essentially.

Dalen: Very much. Yeah. Back to the first point of the assessment. Understanding what stage within the condition we’re at. Is this something very early or not? And one of the hallmarks I forgot to mention there in the assessment is quite often, we know that it’s become much more advanced when we see thickening nodules. Painful thickness within the tendon. And when you’re comparing one to the other, it’ll often be very, very noticeable how distinctly different those two tendons are. Of course, if it’s something that’s happening in both, that would be even more significant. And at that time we’re also strongly considering what may be going on in the low back.

Mark: So there you go. If you’ve got some heel pain, call Body Works. You can reach them at (604) 983-6616 to book your appointment, or you can book online on their website, body-works.ca. They’re in North Vancouver. Get Dalen to work on your achilles. He’ll get you running, walking as fast as it’s been around for basically. Thanks, Dalen.

Dalen: Thank you, Mark.