Background
“What are the experiences, thoughts and concerns of patients with persistent plantar fasciopathy, and how do they cope with everyday life?”
Material and methods
Design
1. Background |
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⁃ Please start by telling us about yourself and the reason why you came to our department |
2. Debut of heel pain |
⁃ When and how did you first notice that your heel was bothersome? Special episodes? |
3. Heel pain development and experiences |
⁃ How has the heel pain developed? |
⁃ How do you experience the heel pain in your everyday life? |
⁃ How do you experience the heel pain compared to other previous pain? |
⁃ If you were to picture the heel pain, what do you see? |
⁃ If you did not experience this pain, how would your life have been different? |
⁃ If you were to describe your heel pain to somebody who has not experienced such pain, what would you say? |
4. Cause of the heel pain |
⁃ What do you believe caused your heel pain? |
5. Coping |
⁃ How do you think you have coped with your heel pain? |
⁃ What do you consider the most challenging part of living with heel pain? |
⁃ Do you avoid anything because of the pain? Examples? |
⁃ What have you tried to do to decrease your foot pain? |
⁃ What advice would you give to a friend with the same heel pain? |
⁃ What challenges do you think you have overcome in spite of your heel pain? |
6. The future |
⁃ What are your thoughts about your heel pain in the future? |
Setting, recruitment and participants
Names | Age | Work status | Physical activity level | BMI | Duration symptoms | NRS |
---|---|---|---|---|---|---|
Anne | 57 | 100% work | walking/ biking ≥ 4 h/w | 27.4 | 12–24 months | 6 |
Beate | 33 | unemployed | walking/ biking ≥ 4 h/w | 26.8 | > 24 months | 5 |
Kristin | 48 | 100% work | walking/ biking ≥ 4 h/w | 30.7 | 6–12- months | 7 |
Elisabeth | 46 | 100% work | recreational sport ≥ 4 h/w | 24.3 | 3–6 months | 5 |
Fredrik | 51 | 100% work | walking/ biking ≥ 4 h/w | 31.9 | 3–6 months | 7 |
Hanna | 54 | 70% sick leave | walking/ biking ≥ 4 h/w | 27.5 | 3–6 months | 5 |
Julia | 65 | 50% disabled | walking/ biking ≥ 4 h/w | 26.2 | 6–12 months | 10 |
Kine | 43 | 50% sick leave | walking/ biking ≥ 4 h/w | 25.2 | 12–24 months | 9 |
Mary | 47 | 100% disabled | walking/ biking ≥ 4 h/w | 33,4 | 12–24 months | 10 |
Naomi | 41 | 100% work | walking/ biking ≥ 4 h/w | 27 | 3–6 months | 9 |
Oda | 31 | 100% work | walking/ biking ≥ 4 h/w | 27.4 | > 24 months | 7 |
Pernille | 38 | 20% sick leave | walking/ biking ≥ 4 h/w | 33.5 | 12–24 months | 7 |
Robert | 54 | 100% work | exercise/competition | 27 | 6–12 months | 8 |
Thomas | 58 | 100% work | walking/ biking ≥ 4 h/w | 26.8 | 3–6 months | 7 |
Victor | 49 | 100% work | walking/ biking ≥ 4 h/w | 33.1 | 12–24 months | 8 |
Data collection
Analysis
Theoretical framework
Results
Theme 1. Struggling to stay active
Sub-theme 1. Struggling with pain and how to adjust it
“Yes, I avoid going out. Because I know that when I get home after walking for a bit, I will be in a lot of pain and then it's ruined. When I go shopping, I do it late in the day because when I get home it’s evening and then I go to bed. I'm not afraid, or actually, in a way, I am. Because I know that when I get home I will be in a lot of pain and I won't be able to do anything else. I have friends who have cars, they drive me sometimes, but I don't go if I have to take the bus, just the thought that I have to walk from there to there, no, then I stay at home, but what should I do?”
“But it hurt when I ran, really hurt. It was probably a month when I stopped doing everything, no exercise at all.”
Sub-theme 2. Finding alternative activities
“I spent the summer cycling. Luckily, it has been summer, otherwise I would have gone crazy a long time ago because I don't have the patience to not be able to walk. I've never been that sporty, but I've always liked walking. And that's what I can't do. That bike saved my mental health.”
“But I've been quite good at finding alternatives. So, for example, I've taken a kayaking course, so now I've sort of become a kayaker.”
Sub-theme 3. Longing for the experience of walking
“Walking as exercise is really the best. It's the best for me mentally too. I actually love to walk. So, I think that walking is the best because then you are physically active at the same time as you are meditating inside, in a way.”
“You get to clear your head and thoughts when you walk.”
“Because I really love going for walks, I really love being outside.... I don't know how to explain it, getting fresh air. I feel like I get so much energy, and I feel like I've been reborn and I'm ready to do lots of good things.... I get stiff in my pelvis and back if I don't walk. And then I comfort eat a lot too.”
“To be able to go jogging and to be able to smell the spring and things like that. It was just such a completely wonderful feeling of freedom.”
Theme 2. Emotional challenges
Sub-theme 1. Feelings of frustration and self-blame
“What exactly is the problem, why can't I fix this? I always, like, wear trainers and have always been good at being careful, I don't wear high heels, I just don't understand why …no, it’s more that I'm more frustrated with – and can't I just do the right things so I can get well? What am I doing wrong now? Something is expected of you all the time, the children and my husband ask; are you okay now? It's better now, right? You know, I would like to answer, YES now I'm done (laughs) it’s not bothering me anymore, but it is. Oh, extremely stressed, very stressed, I feel that now I'm not achieving, now I should have delivered.”
“Because you are so dependent on the feet to transport you. I have noticed that it is easier to take a car to places I would normally walk or cycle to. And that makes you get lazy and then you get annoyed with yourself because you are lazy.”
“You simply become a bit defensive, whether it effects the brain, I don't know. But at least it does something to you mentally that you give up a little. I also think that no, no, that was how it should be, and you don't deal with it like you might have done otherwise.”
Sub-theme 2. Worries of weight gain and related consequences
“Yes, I can't walk, like, from February until May, I've barely moved, I've just been sitting. I feel like my body is swelling up, I feel sluggish, I'm also worried about my health, you know? I'm a little overweight. I borrowed a rowing machine from some friends. But everything hurt, so I haven't managed to get my heart rate up. At least to get my heart rate up and be a bit active, then I get a little worried about my health, then I think that's my menopause, so now it's like everything is falling apart.”
“I've put on weight too, a lot and that's the worst thing to me. I was a bit overweight for a while, so I tried to work on it and lose weight. For many years I have been very active, been very good at eating and exercising a lot and running with my dog for 1 hour, going to the gym for 1 hour after that. So, I've been very strong and worked very hard, so it should be the body you feel happy with. It's even more depressing when I'm not happy with myself, then I don't have so much to give to other people.”
“No, like, I depend on being able to exercise regularly in order to somehow maintain my mood, fitness and weight. If I stop doing it, I'm afraid that, yeah, I think it will go downhill, that is, it will go downhill in all those areas. I have very few options these days, I feel. A bit high risk and a lot of uncertainty. Yeah, last week those who had been to the gym between then and then had to quarantine, but it didn't happen after all. Then I actually panicked a bit. Then life gets very boring and now I have sort of been on a roll where I have exercised regularly. And if, like, it doesn't work out, I'm afraid that it will be hard to get back into it again. No, then I get a bit worried. Like, it sounds so trivial.”
“I've heard that a lot of people who don't exercise get high blood pressure, there are lots of people I hear about who die … yeah, I'm a bit scared. My father died from cardiac arrest. I have to be fit, I don't like being sick and staying home... I’m never sick, not on sick leave. I'm healthy … no, it's sad, that's why I'm going to the doctor and have to hurry up and get well. Because some say one year or two years. TWO YEARS.”
Theme 3. Relations to others
Sub-theme 1. Participation in family- and social life
“So, I just have to tell my son, he says: Mum, can't you run with me? Because he is used to his mum running with him and going for long walks and us having fun in the forest and things like that, but we don't do that anymore. He asks me all the time and I have to keep telling him I'm in so much pain, I'm in so much pain.”
“I was very annoyed at home because I had been looking forward to being able to start jogging again. Then I was in a really bad mood when I couldn't jog because I had thought that I could jog with my daughter.”
“We were a whole group of friends who were going to go to the mountains, but I couldn't. I walked a bit, then I had to turn back. And it's things like that that I find tiresome. Not being able to walk, because then it hurt so much that it was very uncomfortable to walk. A little less social, there are certain things I haven't been too keen on joining. It is this type of physical activity because I know it has been painful for me.”
Sub-theme 2. Visible in new ways
“I also think it's so embarrassing at work because it can look like I'm limping, and it's only at the start, and it can happen that I walk across the school yard, but by then I've sort of got the hang of it so that I'm able to walk almost apparently without being affected by pain. I feel so stupid.”
“It annoys me that people question me when they see that I'm limping. I say, but it's fine. At that time I had to walk with crutches because it was so painful. Oh, so it was, like, that if I saw someone I knew, I tried to wait until they had passed to avoid them.”
“I walk very slowly, I take a very long time, I have the speed of a turtle. I see people coming and I can't even walk. Very depressing, sometimes when my colleagues stand there and greet me, I say now you just have to go, you know?”
Sub-theme 3. Striving to avoid sick leave
“As long as I have enough to do at work, I don't really think about it too much, so it's fine. I'm at work every day, so, I have to say, I handle it pretty well. I could have laid down or called in sick and said that this isn’t going to work. It's not coping, is it? I’ve decided that I would have to be quite sick to not make it to work, so to speak.”
“I think it's very good to be at work. I enjoy being at work and I don't like being at home, so it’s, like, psychological help. And what can you do at home? Then you only think about pain, when you can't be very active. I think that going to work is the best for me, then I don't think. Then I am with the people I love. We have such a great time, fantastic. Yeah, that I’m able to go to work, yeah, I’m proud of that”.
“I went a long time without mentioning it, I don't really know why. If you just pretend things aren't there, then they go away. I think it has gotten better, because I get relief when I'm on sick leave? It worked very badly to just keep stomping around and pretending that there wasn’t anything to make allowances for. No, it really hurt during the evening and into the night at its worst.”
“And it's tough. I don't think I'm being kind to myself when I go home every day and don't manage to go for a walk and sit alone. Ugh, to look people in the eye, I feel it’s negative that I'm on sick leave. Patience, I wish you had, like, a pink pill that you take it and then you’re free of the problem. I know I'm impatient, but there's a lot behind being on sick leave, you feel like you're a burden, being on sick leave they have to have substitutes and things like that ... Yeah, also I’m impatient now I'm also tired and have a bit of a shorter fuse because I sleep a little badly.”
Sub-theme 4. Bothering others
“So, I try not to let my pain affect anyone else. Of course, you have to talk about it with someone else because it's tiring, but you don't, like, complain about it all the time. I’m not really a complainer.”
“No, it is not comfortable being a complainer. You also do everything anyway because it takes less time to do things yourself than to explain to people, right? I'm not the patient type. Obviously, it didn’t make the burden any lighter that I walked terribly much anyways.”