Presentation- Plantar Fasciitis?
A 35 year old male presented at the Sydney Heel Pain Clinic requesting plantar fasciitis treatment for his heel pain in both feet, which was more severe in the left foot. He reported that he had been experiencing the pain for at least 4 or 5 months. He was otherwise very fit and healthy. The patient explained to the sports podiatrist that he had recently increased his running distance and training days in preparation for his gym’s annual fun run fundraiser. He reported that he was running 5-7km four days per week before the plantar fasciitis symptoms started.
Pain Symptoms Consistent with plantar Fasciitis
The patient’s explanation of his pain, as reported to the sports podiatrist was consistent with that of plantar fasciitis: very sharp, almost like there were nails stuck in his heels. He said that his heel pain was at it’s worst first thing in the morning, and that he often hobbled for his first few steps as he got out of bed- also a hallmark of plantar fasciitis. After a few minutes of walking around, the pain would subside and feel more like a dull aching. When asked about how his heels felt when running, the patient told the sports podiatrist that he had been performing five minutes of stretching before his runs, and he felt that after the first 5-10 minutes of running, his feet felt warmed up and the plantar fasciitis pain was bearable. However, he was most concerned about the fact that once he’d finished his run, the heel pain would become so severe that he would end up limping back to his car.
Plantar Fasciitis Home Remedies Tried by the Patient
The patient told the sports podiatrist that he had been doing some reading about plantar fasciitis online, in some runner’s forums, and based on the information he’d read, he had been trying some home remedies to relieve his heel pain. He had been icing his feet in a tub of ice and water in the evening. He had visited his local pharmacy where he told the assistant that he suspected he may have plantar fasciitis, and he was given some generic over-the-counter orthotics to try, which he placed inside his work shoes (casual shoes) on a daily basis. He said the orthotics made walking uncomfortable hence he spent a long time at his desk. The patient was taking ibuprofen on average, 2-3 times per week on occasions when his heel pain was so bad after his morning run that it bothered him throughout his working day.
A friend from the gym recommended to the patient that he visit a sports podiatrist for a correct diagnosis and treatment, as she had suffered with plantar fasciitis in the past as well.
Examination to Assess Patient’s Plantar Fasciitis
The sports podiatrist carried out a thorough physical examination in order to assess the severity of the plantar fasciitis. On palpation, the patient reported a lot of pain around the plantar aspect of the heel, in the area where the plantar fascia ligament attaches to the heel bone. The sports podiatrist’s examination also revealed tight calf muscles in both legs, which was limiting the range of motion in the ankles of the patient. The patient was advised that his clinical signs and symptoms were consistent with plantar fasciitis.
Biomechanical Assessment for Plantar Fasciitis
As part of the examination for plantar fasciitis, the sports podiatrist carried out a biomechanical assessment and gait analysis on the in-house treadmill. Treatment for plantar fasciitis is often based around the findings of the treadmill assessment. To perform the assessment, markers were applied on the patient’s lower leg and foot and the camera was used to record footage of the patient running on the treadmill. Foot strike was then analyzed in slow motion and abnormalities were noted. Arch height and heel position were measured.
Commencement of Treatment for Plantar Fasciitis
The aim of the treatment plan for the patient’s plantar fasciitis was to reduce inflammation and relieve his heel pain, whilst allowing the plantar fascia to heal. The treatment plan prescribed by the sports podiatrist comprised three main components:
- Stretches for the calf muscles
- Prescription (custom-made) orthotics
- Shockwave therapy
The patient was prescribed a series of stretching exercises by his sports podiatrist. The exercises were particularly selected to assist with increasing flexibility in the calf muscles therefore allowing the plantar fascia to heal. The sports podiatrist explained the importance of following the exercise regime closely so that the patient would not worsen his plantar fasciitis.
In order for the plantar fasciitis to recover, the patient was advised that he would have to wear some custom-made orthotics in order to appropriately support the arch of the foot without placing undue pressure on it. The sports podiatrist advised the patient to wear the orthotics every day for 6-8 weeks, which would relieve his heel pain in the shorter term and allow the ligament to heal in the long term.
The patient was scheduled to receive a shockwave therapy treatment once a week for four sessions. Shockwave therapy is a clinically proven treatment for plantar fasciitis. It can provide almost immediate relief from heel pain, whilst facilitating tissue regeneration and stimulating blood flow to the area.
The sports podiatrist advised the patient that whilst he was undergoing treatment for the next 8-12 weeks, he should not run the distances that he had been covering previously. In the meantime, he was suggested to walk and jog for short intervals only, making sure to warm up correctly as instructed prior to exercising. Cooling down with appropriate exercises was just as important, followed by applying ice packs to the feet following exercise. The patient was compliant and happy to do so, as he still had plenty of time to train for his fun run!
The patient was advised, and opted to switch his minimalist-style runners for a pair of appropriate Asics Gel Fortitude running shoes, as recommended by his sports podiatrist. (These were a match for his foot type / shape / boy weight)
Plantar Fasciitis Treatment Outcomes
A week after the initial consultation, the patient returned to the clinic to have his custom orthotics fitted and to receive his second shockwave therapy treatment. Immediately following the treatment, the patient reported that he experienced relief from the heel pain.
The following treatment for his plantar fasciitis was scheduled for one week later. This next treatment also provided instantaneous pain relief. The patient reported that he was becoming used to wearing his orthotics and he felt that he was tolerating them well. He had so far been compliant with the exercise regime that the sports podiatrist had prescribed, and the heel pain from his plantar fasciitis was reducing.
The patient received two more shockwave therapy treatments for his plantar fasciitis in the following two weeks.
A follow-up consultation and assessment was performed by the sports podiatrist when the patient visited the clinic again 8 weeks later. The patient was very pleased to report that his heel pain had completely resolved. His plantar fasciitis had been treated successfully. He was advised that he could begin to run again, starting with short distance intervals of running incorporated with the current walking/jogging. He was instructed to gradually build his distance up by no more than around 2-3% per week, and to contact the sports podiatrist in the event of any returning heel pain.
Please note that this case study is unique to the individual patient as described. Any mention of treatment should not be taken as general medical advice. If you have heel pain or suspect you may have plantar fasciitis, you should consult with a qualified sports podiatrist for a full assessment and diagnosis.
Podiatrist: Rami Ghorra
Sydney Heel Pain Clinic
Written by Karl Lockett