In this study, we aimed to explore the experiences of individuals with longstanding PF. To address our research question, we will discuss our findings with reference to the body from a phenomenological theoretical perspective, supplemented with previous research.

A major finding in the study was that participants regarded pain during and after walking as the most problematic aspect of living with PF. They experienced fear of pain and uncertainty as they struggled to find a balance between challenging their pain and trying not to aggravate it. The participants expressed how their foot pain became the focus of their attention, which can be interpreted following Drew Leder’s notion of the dys-appearing body. They could not take their body for granted anymore, and experienced their body as an obstacle in everyday life. Our participants felt uncertainty and were constantly negotiating with themselves about weather to participate in painful activities or not. These doubts led them to continuously monitor their pain, and dominated their decisions regarding avoiding painful physical activities, limiting their freedom to move. These experiences are consonant with the ideas of Carel [31], who suggests that consciously planning everyday activities leads to bodily uncertainty and limitations.

Our study highlights the participants’ challenges with having to adjust their physical activity. While some expressed negative emotions associated with becoming significantly less active, others elaborated on the importance of finding alternatives to weight-bearing activities when coping with PF. Participants felt that swimming, biking, rowing and strengthening exercises were all feasible activities that contributed to positive experiences. According to Leder, individuals dealing with longstanding pain will alternate between being productive and in control and out of control when pain dominates, which will in tern determine their feelings and actions [27].

In line with our results, Cotchett et al. found that PF had a negative impact, in particular in limiting the ability to walk, run and stand for long periods of time [17]. In a recent mixed-methods systematic review on psychological factors associated with foot and ankle pain, the same researcher found that experiencing foot pain influenced emotions and function, which they associated with pain-related fear [10]. These results support the findings in our study concerning fear of foot pain and uncertainty about how to handle it.

Participants in our study emphasised the importance of walking prior to being diagnosed with PF. Elaborating on these prior experiences, they used phrases like ventilation for the mind. Many participants experienced better mood, more energy and the feeling of happiness when walking. Prevented from walking as they had before, participants described a longing for the experiences of eu-appearance when walking, a bodily awareness in which mind and body work harmoniously together. According to Zeiler, “The body can eu-appear to me as something that I am aware of as positive without this being an explicit focus for my attention and without its disrupting my way of being or acting” ([29], p.341).

Participants in our study described how their heel pain led to a limping gait, the need for crutches or being unable to maintain the same pace as others which made them feel embarrassed and uncomfortable. The body became thematised as a problem disrupting communication with others, giving rise to social dys-appearance [26]. As far as we are aware, these findings are the first to touch upon the theme of how a limping gait or being unable to walk at a normal pace are experienced by individuals with heel pain.

In line with our findings, previous research has highlighted the negative impacts of being unable to walk and stay physically active. Cotchett et al. documented reduced ability to walk, negative emotions and social isolation as impacts of plantar heel pain [17]. Turner et al. described how individuals with Achilles tendinopathy experienced a restricted ability to walk and run leading to frustration and annoyance [32].

The participants in our study experienced their heel pain at present as severe and overriding, giving rise to feelings of powerlessness regarding how to influence or speed up the healing process. Leder describes the temporality of pain with the presence of the pain as endless and projective impacting hopes, dreams and aspirations of the future. He argues that pain can create a feeling of imprisonment that limits freedom of movement and leads to disconnection with the surrounding world. Although the future may appear uncertain for people with pain, it may also present possibilities and the search for a pain-free future can represent hope. According to Leder “… the chronic pain is truly the time itself (khronos), unless and until the sufferer can make peace with this three-faced god of past, present and future” ([27], p.32). Our results show that the participants experienced frustration and psychological distress due to their present pain and being unable to stay as physically active as they used to as well as, sadness for what they missed out on, but, at the same time, many had hope for the future, albeit with some uncertainty.

In line with our findings, Turner et al. documented similar results of frustration, impatience and feelings of hopelessness when exploring the experiences of people living with Achilles tendinopathy [32]. In a similar vein, Cotchett et al. found comparable results in their qualitative study with patients with PF, describing the frustration with the metaphor of a mouse stuck on a wheel [17].

According to our findings, participants experienced that heel pain limited their participation in social activities. Being unable to join friends and family in physical activities like they used to, such as walks in the woods or hiking in the mountains, triggered feelings of loneliness and distanced them from those closest to them. They experienced guilt for not being able to contribute to family life as they had before, and increasing the burden on others. Leder argues that chronic pain may dis-place and pull the sufferer away from their usual place in the world and from their routines and their fellows [27]. According to Svenaeus [33], chronic pain alienates the sufferer both from themselves and from the outside world. These ideas tally with the feelings of loneliness and guilt expressed by the participants in our study. Participants felt separated from their families and friends because they could not take part in shared activities anymore.

The negative impacts on social life caused by living with foot pain have also been demonstrated in previous qualitative research with patients suffering from PF [17], and among those with foot pain due to rheumatoid arthritis and Achilles tendinopathy [34,35,36].

According to our findings, concerns regarding being overweight, in the sense that their BMI was classified as overweight or obese (BMI range from 24–33), predominanted. Participants commonly feared developing lifestyle diseases, but also mental illnesses like depression due to weight gain. Those who had previously emphasised intensive physical activity as a means of preventing overweight, anxiety or depression, worried about their future in terms of how stress and fear would develop. Leder describes being in control and out of control as a paradox of pain ([27], p.36–38). Participants in our study juggled feelings of being in control and of losing control; they often felt overwhelmed, passive and out of control when handling their pain, but, at other times, some felt in control when finding alternative ways to stay active and avoid weight gain. These experiences are reflected in contemporary Western society’s emphasis on physical activity as essential to staying healthy and as an active treatment for different diseases. Health authorities repeatedly emphasise evidence-based advice on the type and frequency of physical activity we should include in our daily routines in order to stay healthy [37]. Participants in our study explained how they used to follow these recommendations by walking, running and engaging in other weight-bearing activities. Being aware of the importance of physical activity, but being hindered by foot pain, seemed to make the individuals in our study feel out of control, which, in turn, gave rise to health-related fear.

Previous research has identified difficulties with weight loss when individuals are unable to be as physically active as usual due to heel pain [17]. However, the findings in our study on participants’ fears of being overweight and developing lifestyle diseases, have, to our knowledge, not been described previously in the foot literature.

Our results highlight the importance of being engaged in meaningful work when living with long-term heel pain. The participants explained how they strove to avoid sick leave. They described the value of working on a daily basis and interacting socially with collegues, both of which helped them to focus on something other than pain. They worried about how they would cope on sick-leave, and feared experiencing isolation, depression and an increased focus on their pain. Some of the participants struggled for a long time at work, trying to ignore their foot pain and not involve their employer or colleagues. When the pain began affecting their sleep, it became impossible to perform their duties at work and they had to go on sick leave. Being on sick leave seemed to entail less heel pain for those with standing or walking jobs, however, participants found it hard to come to terms with both in regards to their own self-respect as well as the fear of losing the respect of others.

Along with the desire to remain in work, participants explained how avoiding involving family, friends, colleagues and employers was the best way to handle the pain. They did not wish to be seen as whiners, and many were uncomfortable asking others for help. Zeiler suggests that lack of social support when in pain contributes to a deepened feeling of social dys-appearance [29]. She argues that the intersubjective dimensions of help are a means of softening the social dys-appearance while being rejected can aggravate the dys-appearance.

According to Leder, social dys-appearance develops when the “gaze of others” is experienced as distanced and objectifying. He also emphasizes the importance of intersubjectivity. “My awareness of my body is a profoundly social thing, arising out of experiences of the corporeality of other people and their gaze directly back upon me” ([26], p.92). Leder’s theories of social dys-appearance are in line with our participants’ experiences of not wanting to involve others in their pain and feelings of isolation. Individuals in pain sometimes isolate themselves from others in order to conceal their pain or avoid being reminded of what they have lost [27].

Some of the participants in our study experienced fear of being disbelieved by others, in particular by their colleagues and employers. Not being met with empathy made the participants hesitant to involve others in handling their pain. According to the philosopher Havi Carel, empathy is the human emotion in greatest shortage. She shares her experience when suffering from a severe disease, saying that the lack of empathy, was what hurt the most [30]. By not involving others, our participants avoided focusing on their painful heel, and the fear of being objectified or not being met with empathy. On the other hand, by not reaching out for support, our participants missed out on empathy, compassion and support from others.

Few participants in our study were on 100% sick leave. Work status is, as far as we can see, not a common factor in descriptive information in quantitative or qualitative studies concerning foot and ankle disorders. Studies demonstrating the negative or positive consequences of sick leave have previously been called for [38]. In a study from 2021, Adams et al. found that employees attending work and suffering from chronic pain experience higher levels of psychosocial stress than those without pain [39]. Although the majority of the participants in our study managed to stay in work and believed it helped them to for cope, they might also experience increased pain and higher level of psychosocial distress which could influence their recovery from heel pain.

As documented in previous studies, patients with PF and other foot conditions report that the pain affects their participation in social life, leading to a feeling of isolation [10, 17]. The importance of being met with empathy and a feeling of being taken seriously by healthcare providers is emphasised by Mallows et al. who performed a qualitative study with patients with Achilles tendinopathy and their perspective on participating in rehabilitation. The participants identified individualised approaches and addressing fears as among the elements that mattered to them [40].

Some issues highlighted in our study have not been addressed by previous research and therefore expand the knowledge in this field. Furthermore, this new knowledge would not be fully captured by using PROMs. We argue that the new themes addressed in our study also are relevant to other foot populations. The participants in this study were exclusively included from a specialist setting and 73% were women, which could limit the diversity of the population and thereby its transferability. We selected our sample purposely in order to create variation and richness of the data. In our study, the first author collected all the interviews, but the analysis was conducted through dialogue with the co-authors. The interpretation of the qualitative data is influenced by the background and views of the authors, and we have provided a information on the authors and their involvement with the aim of presenting a transparent process.