Case Study – Plantar Fasciitis – Also a Tourist Problem

Plantar Fasciitis History

A 32 year old female who came to Sydney on holiday from Poland, presents to the Sydney heel pain clinic complaining of plantar fasciitis. She reports to the podiatrist that she has been walking around the city every day for approximately 10 days. Prior to this she was sightseeing and travelling around Queensland and spent some time on her feet in the city of Brisbane. She reports that the plantar fasciitis became painful while in Queensland, but has become much more painful while here in Sydney. She has been walking around in flat and flexible shoes, namely Converse All Star high top boots. She informs the podiatrist that prior to the symptoms of plantar fasciitis, her feet became fatigued and hot. She felt strain and a pulling sensation through the sole of her foot that ran from the arch and into the base of the heel. She also reports that her calf muscles felt tight and she was driven to attend massage therapy sessions. She has plans to travel the rest of Australia over the next 6 weeks and therefore is keen to fix her foot problem and resolve the plantar fasciitis as soon as possible. This patient reports pain under the ball of her heel which is very apparent first thing in the morning when she puts her foot to the floor. She also describes severe heel pain after she has been seated for long periods, such as traveling on the train or the bus. The patient reports good general health and has never experienced plantar fasciitis before nor any other significant foot conditions. The condition is affecting the left foot only and her right foot is asymptomatic. She presented with no x-rays or ultrasounds and has not engaged in any treatments aside from the remedial massage to the calf muscles. In addition to the Converse all-star, this patient has been walking with Havaiana thongs. The patient informs the podiatrist that the pain has been so bad that she has resorted to anti-inflammatory over the counter medication. The medication provided little relief. The patient informs the podiatrist that she is in Sydney for a further 4 weeks only before she travels to Melbourne. Therefore, the podiatrists designs a treatment plan for the plantar fasciitis inside of these time constraints.

Physical Examination for Plantar Fasciitis

The podiatrist carries out a detailed physical examination in order to make a full diagnosis and to assess the severity of the plantar fasciitis. Pressure was applied to the base of the heel around the attachment of the plantar fascia, which elicited significant pain. Pressure was also applied to the medial aspect of the heel and more distally into the proximal arch area. This also triggered a reaction from the patient, which confirmed the diagnosis of plantar fasciitis. Calf range was assessed and it was determined that there was average range of motion through the ankle. However, both calf muscles were tender on palpation particularly through the medial head of the gastrocnemius. The Achilles tendon was asymptomatic. The patient was informed that she did in fact have all the symptoms consistent with plantar fasciitis and that she would need immediate treatment.

Biomechanical Assessment for Plantar Fasciitis

In order to determine the cause of this patient’s plantar fasciitis, the podiatrist carried out a detailed biomechanical assessment. Anatomical landmarks were drawn on the back of the patients calf muscle and heel, and she was asked to walk on the treadmill in her bare feet. Her walking style was captured using digital software on the iPad and replayed in slow motion. Some static measurements were also taken with the patient standing in a relaxed calcaneal stance position and a subtalar joint neutral position. Medial arch heights were measured and noted. On some occasions, patients with plantar fasciitis will present with no abnormalities. This 32 year old lady demonstrated acceptable foot biomechanics but did have a slightly lower arch contour on her left foot by approximately 5 mm. This may not be relevant in the onset of a plantar fasciitis.

Footwear Changes for Plantar Fasciitis

The patient was advised that in order to rectify her plantar fasciitis she would need to change her footwear to something more substantial. She was advised to avoid flat and flexible shoes as these are less supportive and allow the foot to work harder, which adds strain to the plantar fascia. She was given a specific recommendation of a more functional walking shoe that would suit her foot type and dress style.

Shockwave Therapy for Plantar Fasciitis

The patient was advised that her plantar fasciitis would recover quicker if shock wave therapy was applied. Shockwave therapy stimulates blood flow and accelerates healing by increasing the turnover of new tissue cells. The patient consented to treatment and agreed to receive her first session.

Sydney Heel Pain Mobile App

The Sydney heel Pain mobile app was installed on the patient’s smartphone so that she had all the information she needed relating to the treatment of her plantar fasciitis. Within the app, she was directed to the pages containing footwear information and calf stretch advice. The main plantar fasciitis page, containing advice on things to avoid and things that would be beneficial. This included but was not limited to the application of ice packs on a daily basis.

The sports podiatrist also applied rigid sports tape to the affected foot in order to reduce strain on the plantar fascia, and allow healing of the plantar fasciitis. The patient reported the feeling of extra support and more comfort with the strapping in place. She was advised to return to the clinic in a further 5 days to receive another session of Shockwave therapy and to have the strapping replaced.

Treatment Plan for Plantar Fasciitis

This patient returned to the clinic on a weekly basis to receive shockwave therapy treatment and to have rigid sports tape applied to the affected foot. She was compliant and purchased the footwear that the podiatrist had recommended, and brought these to the  second appointment for the sports podiatrist to assess. She received the 4 sessions of shockwave therapy for the four weeks that she had remaining in Sydney. At each appointment, the patient reported that the pain from her plantar fasciitis was reducing. At the second appointment she reported an improvement of approximately 30 to 40%. As is usually the case with plantar fasciitis and shock wave therapy, the improvement between appointments after this, was slower but nonetheless still evident.  After the 4 sessions of shockwave therapy she reported an overall Improvement of approximately 70%. She was given the contact details of the Melbourne heel pain clinic who are associated with Sydney heel pain clinic.

Please note that the information contained in this case study is particular to one person and should not be taken as general advice. If you think you have plantar fasciitis you should seek the help of a suitably qualified podiatrist.

 

Written by Karl Lockett