Case Study 5th May – PLANTAR FASCIITIS, by Fatemeh Abdi – Podiatrist
A 36-year-old female presented to the clinic complaining of Plantar Fasciitis and heel pain in her right foot. She reported that the pain came on gradually over a period of 4 months. She was initially advised to take Panadol and roll her foot on a frozen bottle and a spikey ball. She found this to be temporarily helpful, however the heel pain consistently got worse over time. Furthermore, she had been sent for X-rays which confirmed a bony spur at the bottom of her right heel. It was explained that the spur, and not Plantar Fasciitis, was the cause of her heel pain, and not much could be done about this. She decided to seek the advice of a Podiatrist.
She is a physically active person who plays soccer 3 times a week, and runs regularly. She is a nurse by profession and her role mainly involves her standing on her feet for prolonged periods of time.
She also mentioned to the Podiatrist that her heel pain has gotten worse since there was an increase in her shift hours.
A thorough footwear assessment was conducted whereby the support and stability of the shoes she mainly wears for her sporting activities and for work were assessed. The sneakers she wore for sporting activities were supportive and suitable for her foot type. However, the shoes she wore for work were not supportive, and this may be one of the causes, and an aggravating factor for the onset of her heel pain and Plantar Fasciitis.
It was explained to the patient by the Podiatrist why her shoes were not appropriate and what features to look out for when she is looking to purchase new shoes in the future. Some recommendations were also given. She also reported that she wore non-supportive slippers around the house, which included mainly tiled floors. Hence she was also advised of the type of shoes she needs to wear around the house.
Plantar Fasciitis Examination by Podiatrist
The Podiatrist carried out a physical examination, and upon palpation of her right heel this elicited pain. This was further narrowed down to the specific anatomical positioning of the plantar fascia, which is a band of fibrous tissue located under the foot. The area closest to the inside and centre of the heel elicited the most pain on examination. Other structures were also examined; however, no pain was reported. There was also no swelling, redness or warmth present.
These findings were compared to her left heel. The plantar fascia and other structures seemed unremarkable.
It was explained to the patient by the Podiatrist that the cause of her heel pain is plantar fasciitis – which is inflammation of the plantar fascia. The misconception that her bony spur was causing her heel pain was also cleared. There are a number of reasons why the plantar fascia can get inflamed, and each was carefully examined, and explained to the patient. It wa also explained to the patient that the goal of therapy is to treat the cause of the heel pain, and not only the symptoms, so the chances of flare-ups in the future are reduced.
BIOMECHANICAL ASSESSMENT FOR PLANTAR FASCIITIS
In order to understand the causes and/or contributing factors of her Plantar Fasciitis, a thorough biomechanical assessment was conducted by the Podiatrist. This involved a gait analysis, whereby the patient was observed walking and running on a treadmill. This was video recorded and played back to the patient, in order to provide feedback on her overall biomechanics, as well as running style, and to relate this back to her Plantar Fasciitis.
It was noted by the Podiatrist that she moderately pronated through her subtalar joints while walking, more so on the right than left. An early heel lift was also noted when she walked, meaning her heels lifted off the ground sooner than they should have in the gait cycle.This indicates tightness in the calf muscles, which was confirmed when their range of motion was assessed. Tight calf muscles increase the pull through the plantar fascia, hence contribute to further inflammation and heel pain.
It was explained that in addition to reducing inflammation of the plantar fascia, it is essential to stretch the calf muscles to reduce strain on the plantar fascia, which reduces heel pain and rids the foot from Plantar Fasciitis.
The correct way to stretch her calf muscles without increasing her heel pain was demonstrated to the patient by the Podiatrist.
Her arches were also measured, and they were very flat, and lower than average. It was explained how her low arches were also contributing to her condition.
Plantar Fasciitis Treatment
Given the duration, severity and personal lifestyle factors of the patient, the different treatment options that were available to her were explained. In the short term, shockwave therapy was conducted at weekly intervals for 5 sessions. This is to promote blood flow and healing, which speeds up recovery time, as well as providing heel pain relief. Cases of Plantar Fasciitis will usually heal quicker if the Podiatrist applies Shock Wave Therapy.
In the long-term, a pair of prescription orthotics were prescribed. This was beneficial in controlling her pronation, flat arches, as well as unloading the plantar fascia and reducing the strain going through it, which in turn reduces her heel pain.
The patient commenced the use of her orthotics 2 weeks after the initial consultation – by which point, 2 sessions of shockwave therapy had already been conducted. This was continued until no more heel pain was reported on the 5th visit. The patient was educated on ways to reduce the likelihood of flare-ups in the future, and was reminded of the different things that can cause Plantar Fasciitis. This included keeping up with the stretches and all other advice initially given at the start of treatment.
Patient was advised to contact the clinic if her heel pain returned.
Please note: The information in this case study is specific to one particular patient and should not be taken as general advice. There are several causes of Plantar Fasciitis and if you are having foot problems, heel pain, or symptoms consistent with Plantar Fasciitis you should consult with a Podiatrist or suitably qualified healthcare practitioner.
Written by Karl Lockett