Case Study - Arch Pain Treated Poorly

Arch Pain Background

Mrs X – 42 years old, presents to clinic complaining of severe heel and arch pain for over 6 months now. She is very frustrated as she had recently seen her old podiatrist who made her a pair of orthotics and had sent her on her way. Unfortunately for Mrs X she is unable to wear her orthotics as she feels “ thrown off” and experiences too much pressure through her arches. The previous podiatrist insisted she keeps wearing them despite the fact that her arch pain persists. Her heel pain has gotten worse in recent months and she feels helpless as the treatments in her eyes have proven unsuccessful.

Heel Pain

Mrs X began to experience heel pain following a holiday to Europe. The trip required lots of walking and towards the end of holiday she had no choice but to skip a few of the destinations due to the severity of the pain – leaving her and her husband quite frustrated. On return to Australia her husband sent her straight to the podiatrist to have her problem fixed. The patient described to her podiatrist an aching pain felt through the heel which radiated through the arch. The arch pain felt like a severed rope and mornings felt like she was walking on egg shells. Walking barefoot was impossible and sometimes the severity of the arch pain left her hobbling around.

Her podiatrist prescribed her a pair of custom orthotics and after fitting them to her shoes sent Mrs X away to run wild with them. A week had passed and the patient could not wear her orthotics for longer than 1 hour without experiencing great discomfort and an apparent increase in arch pain. Dissatisfied with her orthotics and frustrated she decided to return to her podiatrist. The podiatrist dismissed her claims and insisted she push through the discomfort.

A month had passed with no results and the patient began to experience a slight discomfort in her knee. Disappointed but determined to fix her problem she decided to give it one last shot and attended our clinic.

Arch Pain Assessment

Following a thorough investigation and biomechanical assessment, the underlying cause of her arch pain was attributed to her biomechanical misalignments. Her resting arch heights were measured at 15mm bilaterally (flat feet). It was concluded that her poor biomechanics resulted in an increased strain in her plantar fascia thus resulting in inflammation and micro tears.

An examination of her old orthotics showed that the arch heights were at peak of 33mm on both sides! These over corrected and exaggerated arch heights in the orthotic were forcing Mrs X out of the devices, pushing aggressively against the Plantar Fascia, and causing her more arch pain than she was already in. In addition to this problem, the overly corrected arch heights caused further strain on her knees joints.

Arch Pain Treatment

Vital for the treatment of this patient was to manufacture a prescription orthotic device which appropriately matched the natural contours of her arches. The patient had nominated to have a new pair of prescription orthotics created. A digital foot scan was taken using the latest in 3D technology capture. The orthotics were designed to correct the patients foot alignment and off-load the strain going through the plantar fascia. The script for the orthotic incorporated a plantar fascia groove and intended to match the natural contours of the foot. The orthotics were made from durable slim line carbon fibre material to allow for it to fit in all her shoes. Also integrated in the devices were a soft and comfortable top cover with a slow release poron for high impact activities.

Due to the 2-week manufacturing process the patient’s foot was strapped with rigid sports tape, in order to temporarily relieve her arch pain. The technique is simple and the patient was shown how to replace the strapping so in a few days time she could reapply it herself. This would provide some relief- as it reduces the strain through the plantar fascia. The patient was also taught a simple calf stretch to complete at home to reduce strain through the posterior muscle compartment. Finally, footwear education was provided and icing recommended every night to reduce inflammation.

Fitting Appointment

The patient returned 2 weeks later for the fitting. The orthotics fitted the patient shoes very easily and the patient expressed that the plantar fascia groove was very subtle and comfortable. The orthotics maintained good arch contours and the alignment was upheld during the gait cycle. The patient reported that after 2 weeks of using the orthotics the level of arch pain had subsided significantly and that after 4 weeks, she was completely pain free. A follow up session to re-assess her progress was recommended in 12 months time.

Conclusion – Arch Pain Problems

Orthotics are very commonly prescribed for a wide range of lower limb conditions, including arch pain. A corrective device is one that is prescription made and is designed specifically to the patient’s foot type. As we know, no two feet are the same thus no two orthotics should be the same. Thickness, length, corrections, padding and flexibility of device range from patient to patient depending on their condition. One thing that we see time and time again are orthotic devices that have an exaggerated arch height which in turn places more pressure in the arch and further aggravates the condition! A good orthotic is one that matches the natural contours of the foot and corrects the patient’s alignment without causing more issues.

The circumstances outlined in this article relate to one person only and should not be taken as general advice. If you are suffering with arch pain or any other form of Plantar Fasciitis then you should seek the help of a suitable qualified Sports Podiatrist.

Written by Karl Lockett