History – Heel Pain After Walking

A mother of two children presented to the Sydney heel pain clinic with her 10-year-old boy who was complaining of heel pain after walking to school. He was experiencing heel pain in both feet and had been struggling for approximately 4 months. His mum explains to the sports podiatrist that he would complain of pain in both heels after physical activity and walking in general. His mum was extremely concerned as he also described heel pain after walking around the floorboards at home. This young boy was otherwise fit and healthy and was physically active. He plays basketball and football at school and engaged in approximately 5 sessions of sporting activity each week. The heel pain that he experienced was also quite severe after his sporting activity. His mum describes a significant growth spurt and an increase of two shoe sizes in 6 months. The 10-year-old schoolboy paid a visit to his local doctor who referred the family to the local imaging center for x-ray. The findings from the x-rays were of no particular significance and did not lead to any specific treatment plan. Please note that the most common cause of heel pain in children between 7 to 14 years of age is Severs syndrome which is a growth plate problem in the heel. X-ray imaging does not necessarily confirm the diagnosis of Severs. Moreover, the signs and symptoms such as heel pain after walking and tenderness with palpation of the posterior and plantar heel surface are more useful in determining the diagnosis. Severs is also more common in physically active children and in particular those who are growing quickly.

In frustration, the mother of this child paid a visit to her local physiotherapist who recommended stretching and strengthening exercises. After 5 weeks of physiotherapy there was no significant improvement. The mother was concerned that she was to blame and that her footwear choice had led to the problem. She was reassured that this was not the case and that the school shoes were typical school shoes worn by most children. The 10-year-old school boy explained to the sports podiatrist that he did feel some relief if he applied cold ice packs to his heels in the afternoon after walking home from school. The heel pain after walking home from school was more severe than the pain experienced in the mornings. The mother explained that the child had been forced to reduce his physical activity and was disappointed that he was unable to participate in as much sport as he would like to. In addition to heel pain after walking, it was apparent that there was significant heel pain after running and sprinting, which is typical for inflammatory heel conditions.

 

Why had the Child Developed Heal Pain After Walking, and Running?

In order to determine the cause of this patient’s heel pain after walking to school the sports podiatrist carried out a biomechanical assessment on the treadmill and a thorough physical assessment was performed. Foot measurements were taken in the standing, weight bearing position and the semi weight bearing position. Arch heights were measured and rear foot angle and calcaneal bisection were also measured. The podiatrist assessed the patient for ligament laxity and also analysed the range of motion through the foot and ankle. Firm pressure was applied to the posterior aspect of the calcaneus and the base of the heel and the patient reported significant pain, similar to the heel pain after walking to and from school. The sports podiatrist confirmed the diagnosis of Severs syndrome.

It was a parent after the physical and biomechanical assessment that this young boy demonstrated a genetic soft ligament type within the foot and ankle, and this was leading to extreme foot instability. During gait there was significant over pronation bilaterally with severe heel eversion in both feet. Both inner longitudinal foot arches were low and measured between 10 and 12 mm bilaterally. It was explained to the mother that due to the child’s age he demonstrated a weaker foot type which may strengthen post adolescence. Once again the patient was reassured that these findings were quite common and quite normal. it was also explained to the patient and the patient’s mother that Severs syndrome is a condition that children grow out of once the heel bone develops and naturally fuses. The heel pain after walking to and from school would subside with treatment. Treatment options were discussed in order to make the child more comfortable and assist in his physical movement during the developmental stages of foot growth.

Treatment Plan to Reduce the Heel Pain After Walking to and from School

In order to reduce the heel pain after walking to and from school the sports podiatrist outlined a multifactorial treatment plan.

Primarily it was important to reduce the load through the Achilles tendon due to the excess pulling on the posterior aspect of the heel bone. The pulling of the calf muscle through the Achilles tendon onto the heel would certainly be a contributing factor in the heel pain after walking, jogging and running. Therefore, the patient was advised to use 12 mm heel lifts inside his footwear at all times. Calf stretching was demonstrated and instructed. The patient’s mother installed the Sydney heel pain mobile phone application which contained the information outlining the detailed treatment plan. The stretching technique with diagrams was included in the application. A list of useful treatments and importantly a list of things to avoid were also included in the mobile phone application. The 12 mm heel lifts would certainly reduce the heel pain after walking but it was also important that the patient begin to perform regular calf stretching. Due to the foot instability and excessive for pronation, rigid sports type was applied to both feet in order to provide extra support. This would reduce the strain on the foot and ankle and therefore unload the stress on the heel. With the rigid sports tape in place the patient began to walk around the corridors and the treatment rooms and provided feedback. Immediately, there was a rapid reduction in heel pain after walking around the clinic. This implied that the inherent foot weakness was a contributing factor and that stabilising both feet and ankles would assist in reducing the heel pain from the Severs syndrome. The footwear that the patient was using had become significantly worn and had compressed quickly. Arrangements were made for the school boy to wear non standard shoes in the form of orthopedic style footwear offering extra support. These shoes were readily available in athletes foot. These shoes would assist and relieve the heel pain after walking but would not be appropriate for use during sporting activity. Therefore, the sports podiatrist requested that’s the patient return within the next week so that his sporting footwear could also be assessed. At this appointment they would have the opportunity to discuss progress and also reapply the rigid sports tape. At the 1 week follow up appointment the patients mother was satisfied and reported that her son had much less heel pain after walking to and from school. The school boy reported to the sports podiatrist that he felt stable and supported with the rigid sports tape in place. Sporting footwear assessment was made and further recommendations were provided. The patient was advised that he could return to physical activity providing that he was comfortable and able to do so. His pain levels would be the key factor in restricting the level and amount of physical activity. Patients mother reported that the child had been diligent and was performing calf stretches on a day-to-day basis.

The Sports podiatrist informed the patient and his mother that there would be no changes to the treatment plan due to the significant improvement and the lack of heal pain after walking. A follow-up appointment was made for 6 weeks and the patient was instructed to return to the clinic if there was a problem.

Please be advised that information contained in this case study is specific to one particular patient with heel pain after walking and should not be taken as medical advice. If you are suffering with foot or heel pain you should inquire with a medical practitioner.

This article was written by Rami Ghorra of Sydney Heel Pain Clinic.

 
Written by Karl Lockett

Plantar Fasciitis Home Remedy – Do they Work?

At Sydney heel pain clinic we are often asked the question is there a plantar fasciitis home remedy and does it actually work. Truthfully, there are many home remedies available online if we search long and hard enough. Many of these home remedies have been around for more than 10 years and can be considered to be old science.

Plantar Fasciitis Symptoms – Is this You?

Patients with plantar fasciitis usually report pain first thing in the morning when they rise from bed. They normally hobble around for the first 10 minutes of their day until the heel warms up and the pain subsides slightly. They also report pain after periods of being seated such as driving or watching television. Other people report pain after they have been seated at their office desk while at work. The pain from plantar fasciitis is usually under the base of the heel and can be central for more often towards the medial side.

Plantar Fasciitis Home Remedy

Sometimes, one plantar fasciitis home remedy will work for one person but not for another. Sometimes a plantar fasciitis home remedy is beneficial simply because the patient has a very mild case of heel pain and has begun to treat it quickly, before it becomes chronic. To this end, a home remedy can be useful, but will not always work for everybody.

A Note

“After treating thousands of patients at the Sydney heel pain clinic it has become apparent that the single most important factor in resolving plantar fasciitis is the physical support and unloading of the plantar fascia itself. The sports podiatrist is able to achieve this in one of several ways but is also able to demonstrate a very reliable and simple strapping technique that can be applied as a plantar fasciitis home remedy, by the patient themselves.”

A Popular Plantar Fasciitis Home Remedy

One of the most popular plantar fasciitis home remedies exercises is to roll your foot on a frozen bottle of water or any other hard cylindrical object. The theory here is to massage the soul of the foot and to release the plantar facia. At the same time the iced water allegedly reduces inflammation and reduces pain. However, it is not uncommon for the patient to report an increase in symptoms following this particular exercise. In theory, this may be due to an overload of physical pressure against the base of the heel from the hard object, which simply further irritates the plantar fascia. While some of these plantar fasciitis home remedies provide short-term relief, sometimes for a few minutes only, they often create long-term irritation and can prolong the heel pain condition. Therefore, at Sydney Heel Pain Clinic we do not recommend this treatment.

Foot Streches as a Plantar Fasciitis Home Remedy

Another popular plantar fasciitis home remedy is to stretch the sole of the foot. One way of doing this is to stand on the edge of the steps and allow your heel to drop. Some people perform this exercise as a way of stretching the calf muscles and also as a way to stretch the plantar fascia through the bottom of the foot. In theory, this would also stretch the flexor tendons and the muscles bottom of the foot too. For some people these step stretches can be beneficial but for some people they cause tearing or extreme irritation in the plantar fascia. This is due to a massive increase in load through the soul of the foot at the point where the plantar fascia attaches to heel. The plantar fascia can also be affected through the mid-arch area during these old-fashioned stretches. Again, not advised at Sydney Heel Pain Clinic.

The most beneficial plantar fasciitis home remedy, when it comes to stretching, is a supinated calf stretch while standing and leaning against a wall. One foot back, one foot forward and both feet pointing straight ahead. However, the foot must be supinated and it is important that it does not pronate during the stretch. It should be noted that plantar fasciitis treatment is multifactorial and there is no one magic bullet. Even if this stretch is performed perfectly, or if another home remedy is executed correctly, this does not mean that the condition will resolve. There are often at least one of two other contributing factors that need to be addressed. During a biomechanical assessment and physical examination at the Sydney heel pain clinic, the sports podiatrist is able to correctly diagnose and highlight one or more of the contributing factors. Following these examinations, the podiatrist is able to execute a treatment plan which may or may not involve a plantar fasciitis home remedy. The sports podiatrist is able to demonstrate the supinated calf stretch during consultation.

Sydney Heel Pain Mobile Phone App

In order to provide the correct plantar fasciitis home remedy, Sydney heel pain clinic will provide every patient with the Sydney heel pain mobile phone application. Listed in the app are the home remedies that should be avoided but importantly the home remedies with a higher success rates are included. Each patient is provided with a password in order to open and access the contents of the application. The application is available in the Apple store and the Google play store, and is completely free of charge for patients attending the clinic.

Stretching with a Beach Towel or Bath Towel

Another common plantar fasciitis home remedy is stretching the bottom of the foot by using a long beach towel or bath towel. Again, this is risky. It can be beneficial for mild cases of plantar fasciitis and can be beneficial if the condition is caught early enough. There are benefits to this particular stretch as it is a good way to lengthen the calf muscles. It should be noted here that the plantar fascia is not an elastic structure that can be stretched or lengthened. Hence, there is the risk of overloading the facia and increasing the pulling sensation on the base of the heel. Some patients will report short-term relief when carrying out this plantar fasciitis home remedy however the condition persists.

The Application of Heat Packs as a Plantar Fasciitis Home Remedy

If a patient’s heel pain condition has been persisting for long enough they will continue to search as many plantar fasciitis home remedies as possible. The application of a warm wheat bag or any other form of heat pack against the base of the heel will provide short-term relief. Due to this short-term pain relief the patient will continually and repeatedly reapply the heat pack against the heel every day until they realise that the condition is not resolving. It has been suggested that the increase in blood flow from the heat pack creates vasodilation and allows an increase in inflammatory cells around the heel. This increase in inflammation only prolongs the condition and causes an increase in heel pain.

Throbbing or Stabbing / Shooting Pains

If a patient experiences throbbing or shooting pains this would indicate an acute case of plantar fasciitis for which there is no real plantar fasciitis home remedy. At this stage it is important to seek the opinion of a medical practitioner such as a sports podiatrist.

In summary, there are at least four or five plantar fasciitis home remedies and on occasions one of them may work for an individual if the condition is mild and has only been present for a very short time. It should be understood that plantar fasciitis is a complex condition and that there are many contributing factors, some of them only recognisable by a healthcare practitioner. If a patient has tried one or two home remedies but is still suffering with heel pain from plantar fasciitis then it is advisable to seek the help of a suitably qualified medical practitioner. Please note that the home remedies listed in this article should not be taken as medical advice and therefore should not be used as a treatment plan or as a guide for a plantar fasciitis home remedy.

Please read “shock wave therapy as a new and wonderful treatment option for plantar fasciitis”.

 
Written by Karl Lockett

https://sydneyheelpain.com.au/shock-wave-therapy/

What are the Signs of Achilles Tendinitis

A patient arrived at the Sydney heel pain clinic describing the signs of Achilles tendinitis in his left ankle. He was 34 years old and was an extremely healthy individual who regularly ran. He had a history of completing Ironman events as well as several marathons and half marathons. He explained to the sports podiatrist that he had never experienced the signs of Achilles tendinitis before and therefore was uncertain about the condition in his feet. The symptoms of Achilles tendinitis developed approximately four months ago and there did not seem to be any apparent reason for the onset of his symptoms. The patient reported to the sports podiatrist that he initially began to feel tightness in his calf muscles and would experience a stiffness through the Achilles tendon first thing in the morning when rising from bed. He would also experience this stiffness and lack of range of motion when walking after being seated for a prolonged period, for example after driving his car. After being seated in the office, the patient would stand up from his chair and would also begin to feel stiffness in his Achilles tendon while walking. These are probably the early signs of Achilles tendinitis, and should be treated immediately. The patient did not stop running but instead continued with his regular exercise program. The majority of the patients runs were on flat surfaces but occasionally involved inclination. Once a week he would include steps and stairs into his running program and this seemed to increase the symptoms of the Achilles tendinitis. Once the patient had began running and his ankle was warmed up, he was able to continue running without too much discomfort and without really feeling the signs of Achilles tendinitis. Therefore, he continued with his training program and did not seek medical advice. After approximately three weeks of discomfort, the patient began to perform on line research. Dr Google provided home remedies in the form of stretching and strengthening exercises as well as foam rolling. The symptoms did not subside and as time progressed signs of Achilles tendinitis increased.

Advanced Signs of Achilles Tendinitis

For this particular patient the early signs of Achilles tendinitis did not subside and his symptoms began to increase. The stiffness turned into sharp stabbing pains and there was significant discomfort when finger and thumb pressure was applied to the sides of the tendon. Each morning upon rising from bed the mild discomfort had turned into significant pain which would cause the patient to hobble to the bathroom. The morning pain lasted longer and did not disappear following his first few steps. Once out on the train on his way to work he would also experience warmth, heat and an awareness through the Achilles tendon. He also experienced another typical sign of Achilles tendinitis which is a visible thickening of the tissue and observable inflammation. At this stage, the patient decided to reduce his running by half, and he inserted more rest days in between his runs. He also excluded the steps and stairs training from his program. However, his symptoms did not subside, and the advanced signs of Achilles tendinitis seemed to be firmly established.

This patient paid a visit to a reputable sports medicine doctor in North Sydney for treatment of his persistent Achilles tendinitis. In addition to some general advice, which is often given to patients with the signs of Achilles tendinitis, the sports medicine Dr offered an injection of cortisone into the Achilles tendon. The patient was rather unhappy about the suggestion and did not want injection therapy. The sports doctor also referred the patient for ultrasound imaging which confirmed thickening of the Achilles tendon, proximal to the heel bone, and inflammatory change consistent with Achilles tendinitis. Fortunately, no tears detected and bursitis was also ruled out.

Other Signs of Achilles Tendinitis

Other signs of more severe and acute Achilles tendinitis involve throbbing sensations and shooting pains when sitting or lying down. This patient did describe to the sports podiatrist on occasions when he was laid down in his bed, the feeling of extreme heat and throbbing sensations through the tendon.

This patient reported to the sports podiatrist that he was disappointed in himself for not acting quickly when he first began to experience the signs of Achilles tendinitis. His condition could have been treated and the advanced symptoms of the condition could have been halted. He explained to the practitioner that he was committed to whatever treatment was on offer as he was desperate to recover quickly and return to his normal training program.

Physical Testing for the Signs of Achilles Tendinitis

The sports podiatrist carried out some physical tests within the clinic to confirm the diagnosis which would tie in with the signs of Achilles tendinitis that the patient presented with. The patient was asked to stand on one leg bearing all of the weight on his troublesome ankle. He was that asked to perform a heel raises with his knee fully extended. The patient was able to perform seven repetitions on his troublesome leg, compared to more than 20 on his stronger leg. This physical test which loads the Achilles tendon is a common test performed when patients present with the signs of Achilles tendinitis, and forms part of the diagnostic process. The practitioner applied lateral pressure using finger and thumb to the Achilles tendon which invoked a significant reaction from the patient. The majority of the pain was along the shaft of the Achilles tendon approximately 3 cm above the heel bone. The patient was also asked to walk on the treadmill in his bare feet while the podiatrist inclined the surface. With the patient walking briskly on the inclined treadmill he reported significant discomfort after approximately two minutes. He was unable to run or sprint on the treadmill due to the pain in the tendon.

As you can see from the descriptions above, there are a variety of signs and symptoms of Achilles tendinitis all of which should be addressed promptly before the condition deteriorates. In summary, the signs of Achilles tendinitis are those such as stiffness, sharp pain, stabbing sensation, throbbing and heat, through the shaft of the tendon, above the heel bone. Some of the symptoms will be present without physical load or pressure on the foot and can cause pain when non-weightbearing. The most obvious sign of Achilles tendinitis is pain with lateral pressure from finger and thumb.

A clear diagnosis was made for this patient and he was booked into the Sydney Heel Pain Clinic for treatment. Please note that the information contained in this article outlines common signs of Achilles tendinitis which should not be taken as medical advice. If you think you have Achilles tendinitis or if you feel like you are developing some of the signs of Achilles tendinitis and you should seek the help of a podiatrist.

Shock Wave Therapy

A new and reliable treatment for Achilles Tendonitis : https://sydneyheelpain.com.au/shock-wave-therapy/

 
Written by Karl Lockett