Case Study November - Plantar Fasciitis in a Builder

History

A 42-year-old man, a builder, has been suffering with Plantar Fasciitis for approximately 4 months. He reports pain under the ball of his heel and has a hard time walking when he gets out of bed in a morning. His Heel Pain is only in one foot and he has never had Plantar Fasciitis before. He enjoys good health and is taking no medications. He is carrying approximately 5kg’s more than he would like to but is unable to exercise properly due to the Plantar Fasciitis.

This gentleman’s Heel Pain came out of the blue and came on very suddenly. He woke up one morning and the Plantar Fasciitis was so bad that he could not walk properly. There was a throbbing sensation and a stabbing pain under the ball of his heel and he had to take the day off work. He lay down and rested his foot all day and applied an ice pack. The following day he went to his GP who mentioned a heel spur and Plantar Fasciitis. The doctor arranged an X ray and gave him a prescription for some anti inflammatorie’s. The Heel Pain did settle down slightly but he reports a pain level of 7 out of 10 every day. His Plantar Fasciitis persists and is constant.

Out of frustration, he purchased some gel cushions for his shoes but after using these for 3 weeks they did not change the Heel Pain. If anything, they made his feet wobble a bit more inside the shoe and so his Plantar Fasciitis felt worse on some days.

This gentleman usually enjoys a game of squash, once or twice a week, but he has given up on this for now as the Heel Pain and Arch Pain are too much to cope with the following day. He would return from squash and within an hour or so he would feel throbbing and shooting pains which would render him idle. He would again lie down and elevate his foot, applying an ice pack.

Plantar Fasciitis / Heel Pain / Arch Pain and Footwear

This patient’s squash shoes are typical of this sport in that they are without a heel drop, and so are flat and flexible which means they do not offer much support. His work boots although appear to have a thick and robust sole, are actually constructed from a low density rubber and hence are also flexible, offering minimal support. They are also over 12 months old and have become very soft underneath. This extreme wear on such a work boot in a patient who has such a physical job is a problem. Not only is he on his feet for long periods, but he is carrying heavy loads and is up and down ladders throughout the day, which adds a lot of strain to his Plantar Fascia and feet in general. Heel Pain and Arch Pain are common symptoms in this situation and Plantar Fasciitis is also common.

Physical Examination – Plantar Fasciitis

Direct finger pressure was applied to the central aspect of the plantar heel and the patient reported pain, immediately. Along the medial aspect of the calcaneus was also tender, and this is typical of Plantar Fasciitis. Ankle joint range of motion was limited due to tightness in the calf muscles. In particular Gastrocnemius but also soleus muscles. Again, this is extremely common in patient’s with Plantar Fasciitis. It is rare that we see a patient with Plantar Fasciitis or Achilles Tendonitis who does not have tight calf muscles. The muscles pull hard on the back of the heel bone and this in turn puts strain on the Plantar Fascia which is attached to the base of the heel. This patient also had some soreness along the tibialis posterior muscle and its tendon, and as sports podiatrist’s we see this commonly. The tibialis posterior muscle becomes over active as it fires too soon in the gait cycle due to that early heel lift.

Treatment for Plantar Fasciitis – Sports Podiatrist Recommendation

This gentleman had not seen a sports podiatrist before and so it was explained to him that he had a very common condition known as Plantar Fasciitis and this was causing his Heel Pain and Arch Pain. It was explained to him that his footwear was a big part of his problem and had probably caused his condition. His work boots needed to be changed as did his squash shoes.

Specific shoes were recommended to this gentleman and he was informed which stores he could purchase these shoes that had been matched to his foot type. New squash shoes, new work boots and a pair of every day walking shoes that he should get around in while his foot made a full recovery. He was informed that it would be ok for him to wear whatever shoes he wanted to once his foot had recovered and that he could lead a normal Australian lifestyle, so to speak, and wear bare feet and thongs from time to time. However, he should always keep a close eye on the state of his work boots as he spends most of his time in these shoes and it is here that he needs lots of support.

A very specific set of calf stretching techniques was demonstrated to this patient. He was given an instruction sheet which guided him through the techniques and reminded him how often they should be done. In cases of Plantar Fasciitis, if the technique is not adhered to then it can actually strain the Plantar Fascia and prolong the condition, increasing the symptoms and preventing healing.

The patient was advised that he would make a full recovery and that Plantar Fasciitis is not a life long condition such as arthritis. His Arch Pain and heel pain would subside completely as long as he is compliant with the advice of the sports Podiatrist. To help him along his road to recovery, rigid sports tape was applied to the affected foot and the patient was shown how to reapply the tape once it was due. He could continue to apply the strapping for several weeks until the Plantar Fasciitis had healed. He was also informed that he should continue applying ice packs every night before bed, until the heel pain had gone.

In cases of Plantar Fasciitis the morning pain is the metaphorical measuring stick. Once the morning pain has gone, the condition has likely healed.

The above information should not be taken as general advice as it is specific to one patient who had been diagnosed with Plantar Fasciitis.

Written by Karl Lockett