Theme 1: patient values | ||
Subtheme Findings Illustrative quotes | ||
Thoughts on condition cause | Foot arch height; age; activity pattern; new load increase; long periods weight bearing; standing on hard surfaces; minimally supportive footwear; limb length asymmetry; rapidly changing load; altered gait; altered movement due to other conditions. | Q: Walking on the outside edge of my foot when I was having pain in my second toe (PN). Q: Heel spurs, arthritis. Q: Long shifts on my feet in facilities with hard floors. Q: Excess loads with inadequate progression. Q: A number of contributory factors which is why is occurred now. |
Thoughts on pathology | Tissue irritation; degeneration; inflammation; tearing; inadequate tissue capacity; contracture. | Q: Tissue band has become irritated through age/overuse. Q: It feels like it is tearing. I think I have torn a ligament. Q: Inflamed damaged PF which needs to heal/repair. Q: Struggling to cope with the demand and non adapted tissue. Q: Tendon contracture is wanting to happen all the time. |
Expectations | More information; quick recovery-unrealised; exercise programme, especially foot strengthening; pain elimination; access to orthoses; specific treatments; better explanation of treatment/condition and causes. | Q: Expected to get a steroid shot and was hoping for deep tissue manipulation to break down the scaring or thickening tissue. Wasn’t offered. Q: I assumed wrongly I would need insoles. I expected to be back on my feet within a few weeks (very optimistic). Q: As swift a recovery as possible, relief from the pain and programme of exercises to treat. |
Needed improvements | Facilitation of earlier recognition by patients; better communication as adherence promotion. Intervention strategy for pain; easier access to, and more information on, specific treatments; standardised treatment across sectors; clarity of treatment and expectations; reduced waiting times. | Q: Better understanding of symptoms and types of patients prone to PHP. Q: More explanation for the mechanism of the symptoms in order to motivate me to do the exercise. Q: Get rid of the pain forever. Q: Standardised treatment from NHS across the country. I’ve gone private as Dr can’t refer. |
Strengths of management | From no strengths to positive experiences; fast decisions; specific interventions; clear plan; individual preferences accounted for; detailed explanation; specific interventions. | Q: Range of options considered and clearly explained. Q: Spent time explaining in detail the condition/cause/treatment. |
Experience | Restricted activity; intermittent severe pain; reduced exercise; altered activity; morning pain; painful; emotionally affected; large impact on ADL; long, uncertain recovery. | Q: It restricted the activities I wished to carry out. Q: It’s very painful under my heel when I get up in the morning. Q: Miserable 6 months. Had a huge impact on daily activities. Q: Very long process and uncertain outcome. |
Key information | Time course of recovery; self-management advice; how pain relief works; long-term effects; explanation of what was not done; unsure; statistics on usual timescales for effects. | Q: What can I do to reduce my pain and improve function? Q: Will pain reliever actually address the issue or just mask the pain? Q: When they could make the pain go away? Q: Expected outcome at the end of rehab. |
Sources of information | Range of online methods predominated; clinicians, friends, magazines; lack of clear guidance. | Q: I can google it all day, and there isn’t much out there. Q: Patient groups on Facebook aren’t even very helpful, because everyone using them hasn’t found relief. Q: Online forums, confusing as everyone’s cause is different therefore treatment different. |
NHS, National Health Service; PHP, plantar heel pain.