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Case Study: Plantar Fasciitis Socks – Hit Or Miss?

Do Plantar Fasciitis Socks Exist and are they Beneficial?

A new patient visited the Sydney Heel pain clinic struggling with plantar fasciitis for at least 17 months, and presented to the podiatrist a pair of plantar fasciitis socks. She informs the podiatrist that she has been on some medical merry go round for several months and recently resulted to purchasing socks online after seeing them advertised through social media. The patient was suffering with plantar fasciitis and her left and right foot and this was causing significant heel and arch pain in both feet. This patient was approximately 20 kilos overweight and confesses to the podiatrist that she wishes to begin exercising but she is unable to do so due to the severe pain in both of her feet. She feels frustrated because she would like to lose weight and exercise but is unable to do so as both of her feet hurt. In addition to purchasing the plantar fasciitis socks this patient had paid a visit to her GP, foot specialist, physiotherapist, chiropractor, naturopath and two podiatrists. The podiatrist at the Sydney Heel Pain Clinic being the third podiatry consultation that this patient had attended in at 12 months period.

This patient had been given cortisone injections on two separate occasions into both of her feet and her platter fasciitis persisted. The physiotherapist who she paid a visit to encouraged strength training and a long list of exercises- none of which relieved her symptoms.

This patient reported a significant pain after she had been seated for long periods and would also experience a throbbing sensation if she was sitting or lying in her bed. The throbbing sensations more troublesome in her left foot compared to her right foot and she reports being left side dominant. Frustrated with the pain this patient would use one frozen bottle of water and roll her arches across it on a day today basis. She had heard about plantar fasciitis socks through social media but had avoided purchasing these in favour of more mainstream treatments.

The foot specialist that the patient had paid a visit to instructed her to persist with more conservative treatments and advised the patient that he would not perform surgery as a first line of treatment. He was unable to comment on the efficacy of the plantar fasciitis socks. This patient did spend some time with her GP and was referred for imaging. The reports that this patient received confirmed that there was no heel spur but that the plantar fascia was thinking and calcified, which is typical of plantar fasciitis.

The patient purchased plantar fasciitis socks online and began to where them immediately. She advised the sports podiatrist that she felt quite secure due to the pressure that the socks applied to the arches of her feet. It is quite likely that the benefit felt from the socks was simply you to desensitisation of the nerve endings due to the hugging effect of these socks. The patient also went to bed with the socks on but had to remove them at approximately 2:00 a.m due to them feeling too restrictive. She removed the plantar fasciitis socks and the next morning when she woke from her bed she did report a slight improvement in general foot pain. She describes to the sports podiatrist that it is difficult to say whether or not a plantar fasciitis socks actually reduced the symptoms of the condition itself, or more over they were just relieving general foot fatigue and soreness. Due to these small changes, the patient became hopeful and continued the day-to-day use of her plantar fasciitis socks. However, she decided not to use them at bedtime due to the discomfort.

The patient also reported that while she was using the plantar fasciitis socks she was also mindful that she had increased the frequency of her calf stretches. She began to become confused and was not sure which one of the two therapies was helping. To this end, she stopped stretching her calf muscles and allowed the plantar fasciitis socks to act as the main treatment.

As is usually the case with plantar fasciitis, the symptoms of this condition fluctuated greatly from day to day. Typically, patients with plantar fasciitis will have good and bad days without rhyme or reason. The increase or decrease in symptoms can sometimes be due to the number of steps taken in a day, the choice of footwear used from day to day or even things such as body temperature due to changes in the weather which can affect circulation. Patients who are attempting to resolve the condition are unable to put their finger on what is helping or what is making things worse. This patient continued to use her plantar fasciitis socks for 7 weeks before coming to the conclusion that there did not seem to be a significant improvement. This is likely due to the fact that plantar fasciitis responds to high levels of support which unloads the plantar fasciitis. It can be said that there is insufficient unloading of the plantar fascia and insufficient support from the plantar fasciitis socks, and to this end this is probably the reason why the socks were not particularly beneficial.

The sports podiatrist at the Sydney Heel Pain Clinic explained the benefits of unloading the plantar fascia to the patient and offered to treat her with either rigid sports tape to strap the feet or customised orthotics to unload the plantar fascia.

Treatments Other Than Plantar Fasciitis Socks That Have Been Tried and Tested

The podiatrist explained to the patient that the orthotics would be the most reliable and effective way to support the plantar fascia and that they would be more effective than the plantar fasciitis socks. The sports podiatrist also explained the benefits of shockwave therapy, https://sydneyheelpain.com.au/shock-wave-therapy/ , and due to the fact that this patient had to be struggling for a long period of time, she presented as an ideal candidate for shock wave therapy which would break down some of the scar tissue and therefore promote the turnover of new healthy collagen. The shock wave therapy also acts to stimulate blood flow and has been proven to increase the number of small blood vessels in the area. These more scientific treatments which have undergone more research present as more effective and more reliable treatment options than treatments found online such as plantar fasciitis socks. However, this is not to say that plantar fasciitis socks may not be useful for some people either with heel pain or other foot related conditions.

Lack of Research Into the Efficacy of Plantar Fasciitis Socks

More research is probably needed into the effect of plantar fasciitis socks before it can be conclusively claimed that they are in effective. It would be important to exclude a large number of variables when trying the socks such as footwear, number of steps taken in a day, level of activity, type of sporting activity engaged in, body weight, gender and other medical conditions that can affect the foot.

It can be concluded from this case study that there are more reliable treatment options for plantar fasciitis than the use of plantar fasciitis socks. At tthis stage, the podiatrists at the Sydney Heel Pain Clinic do not, and do not plan to stock plantar fasciitis socks due to the lack of scientific research associated with the product. However, this is not to say that an individual should not try the socks if they have foot related conditions. Perhaps the socks may be beneficial for some people with general foot fatigue or other conditions, but they may not be beneficial in the treatment of plantar fasciitis.

Please be aware that the information contained in this case today should not be taken as general medical or podiatry advice. If you have plantar fasciitis or if you wish to receive treatment for the condition you should probably consult with a suitably qualified sports podiatrist or sports medicine doctor. Please be mindful of the above information before purchasing or using plantar fasciitis socks.

This article was written by Karl Lockett of Sydney Heel Pain Clinic

This image below involves the use of the Swiss Dolorclast machine for shock wave therapy

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

Written by Karl Lockett

Shock Wave Therapy

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August 8, 2019/by karl

Case studies

Case Study – Achilles Tendon Pain

What Causes Achilles Tendon Pain

A fit and healthy male of Caucasian decent made an appointment at the Sydney heel pain clinic in order to seek treatment for his Achilles tendon pain. He had been feeling discomfort in his left Achilles tendon for more than 6 months and was not improving, regardless of his stretching programme. He advised the sports Podiatrist that he was feeling this Achilles tendon pain every single day and that it was worse on the days he played tennis. Even on rest days he would wake up and hobble. He would walk with a significant limp for the first 10 minutes of his day but would feel some slight improvement following his morning shower. He would also carry out some routine calf stretches each morning and following this he would feel slight improvement in the Achilles tendon pain. The discomfort would be greater if he was walking barefoot and to this end he would always try to wear footwear inside his house. This gentleman was a relatively active person and would play tennis three times a week. He would play for approximately 2 hours each time. During the first 20 minutes of tennis he would experience Achilles tendon pain in both ankles, but this would tend to become less painful as the game progressed. He was able to continue playing, but would always feel discomfort if he stopped and rested, and then started to play again. Approximately 1 to 2 hours after the tennis the Achilles tendon pain would return significantly while resting at home. The patient would apply cold ice packs to the Achilles tendon area in order to reduce the discomfort, but the relief was only short lived.

This patient would enjoy a 20 minute walk from the ferry to his office each morning, but this was becoming increasingly difficult. He describes to the sports podiatrist that the Achilles tendon pain would be quite severe if he was to walk up a slight hill or steps. After arriving in his office, while he was seated the Achilles tendon pain would develop into a heat and a significant awareness. If he were to stand up from his office desk and walk to the bathroom or the printer, he would experience significant Achilles tendon pain bilaterally for the first 5 or 10 steps. He was also experiencing a significant stiffness through both ankles.

Massage Therapy for Achilles Tendon Pain

In order to try to relieve the symptoms of the bilateral Achilles tendon pain, this gentleman paid several visits to a massage therapist who performed deep tissue massage on both calf muscles and Achilles tendons. The patient experienced short-term relief which lasted no more than four to six hours. Achilles tendon pain never subsided completely but did ease slightly following each massage. Due to the pain relief , he was drawn back for more appointment’s and further treatment but was becoming increasingly aware that the massage therapy was not addressing the root cause of his problem. The patient stopped attending the massage therapy rooms after 5 sessions over a 3 week period.

Dry Kneedling for Achilles Tendon Pain

A work colleague recommended that he pay a visit to a physiotherapist who could perform dry needling, which may reduce the Achilles tendon pain. Dry needling does come with an analgesic effect which way provide a false positive in some patient’s so should be engaged with caution. This patient did report an improvement in the Achilles tendon pain in one leg more than the other, but that this only lasted for approximately 4 days. After 4 sessions of dry needling the patient decided not to continue with this form of therapy. Dry needling into the calf muscles is a great wat of assisting muscle range and hence helps with movement through the ankles. This also reduces the strain on the Achilles tendon and can help with healing process, providing that all other stressors have been removed and addressed. Short term relief from the Achilles tendon pain is not a reason to continue of the condition is not actually healing.

Shock Wave Therapy for Achilles Tendon Pain

This particular patient enquired about the use of shock wave therapy for treatment of his Achilles tendon pain. The sports Podiatrist explained the benefits of this treatment, being an increase in healing due to stimulation and blood flow / collagen cells. This patient received six sessions of shockwave therapy at 1 week intervals and reported steady improvement following each session. The sports podiatrist also provided specific stretching techniques in order to assist range of motion and to reduce the Achilles tendon pain. The patient was able to continue playing tennis throughout the duration of his treatment which was well tolerated. He was instructed to refrain from physical activity if there was no improvement in his condition during the treatment.

Biomechanical Assessment and the Cause of the Achilles Tendon Pain

The podiatrist performed a biomechanical assessment with the patient walking and running on a treadmill and using digital software his gait cycle and foot function were recorded and analysed in slow motion. The podiatrist was able to determine that there were no long term biomechanical anomalies that would have contributed to the onset of the Achilles tendon pain, but he was able to observe an early heel lift due to the calf muscle tightness. The restricted range of motion through the Achilles tendon would have contributed to significant stress and therefore chronic irritation.

Diagnosis – Achilles Tendon Pain

The patient was informed that the cause of his Achilles tendon pain clearly related to a common condition known as Achilles Tendonitis. As with most patients who undergo shockwave therapy, the Achilles tendonitis was successfully treated and no further Achilles tendon pain was noted following treatment.

The information outlined in this article should not be taken as general advice and if you are suffering with Achilles Tendonitis pain or any other form of heel pain / foot pain you should consult with a sports podiatrist or sports medicine practitioner.

Case Study – Plantar Fasciitis Treatment / Heel Spur

A 34-year-old female runner came to the Sydney Heel Pain Clinic for plantar fasciitis treatment due to severe heel pain in her left foot. This otherwise healthy individual reports to the sports podiatrist that she is a keen runner who enjoys running five mornings a week, approximately 7 to 10 km each day. She has been feeling heel pain for approximately 6 months but has been avoiding plantar fasciitis treatment in favour of other home remedies.

However, her heel pain is not improving, and she is becoming increasingly frustrated. She reports to the sports podiatrist that she would like to take part in a marathon and that she would like to increase her training but is limited by the heel pain. She has never had plantar fasciitis treatment before but is now seeking medical advice. This patient reports that she has seen her regular GP who has prescribed anti-inflammatory medication and recommended foot stretching. However, she felt that this plantar fasciitis treatment was incorrect as the pain seemed to stay the same. One of her work colleagues recommended that she see a sports physiotherapist that she herself had seen for plantar fasciitis treatment in the past. Unfortunately, this did not prove to be successful and her heel pain continued. This patient carried with her regular running routine due to the fact that once she was warmed up after approximately 500 m the pain in her heel would subside sufficiently to allow her to continue training. However, shortly after her exercise the heel pain would become quite severe causing her to limp. The typical symptoms of plantar fasciitis are pain first thing in the morning when rising from bed and this patient reported exactly this. She had read online that heel spurs cause plantar heel pain which is commonly felt after periods of sitting or sleeping. She reports to the podiatrist that she is confused and does not understand if the heel pain is caused by plantar fasciitis or in fact a heel spur.

The podiatrist advised the patient that heel spurs and plantar fasciitis are commonly seen in association with each other but that’s the plantar fasciitis itself is usually responsible for the heel pain. He explains to the patient that the heel spur can be found on the base of the heel or on the back of the heel, and in fact Spurs themselves can be found throughout the entire body on bony landmarks, at the point where the soft tissue attaches to the bone. He advises the patient that she will receive plantar fasciitis treatment as this will be more beneficial than focusing on the heel spur.

Physical Examination of Heel Spur / Plantar Fasciitis

The sports podiatrist carried out a physical examination to measure the severity of the plantar fasciitis and to locate the exact position of the heel spur. The patient reported significant pain on palpation of the plantar aspect of the heel, around the heel spur, at the point where the plantar fascia attaches to the base of the heel. He advised the patient that she has the common symptoms of plantar fasciitis. The sports podiatrist also detected a limited range of ankle joint motion due to tightness in the calf mescles, and a limited range of motion through the first toe joint, due to arthritis. The podiatrist advised that she will require plantar fasciitis treatment but that it would be important to address the range of motion through the ankle joint as well. The first toe joint would also need some attention.

Bio Mechanical Assessment for Plantar Fasciitis / Heel Spur

The sports Podiatrist carried out a detailed biomechanical assessment on the treadmill and recorded the footage using digital software in order to assess the possible causes off the heel spur and in order to determine the most appropriate plantar fasciitis treatment. The footage was replayed in slow motion and biomechanical anomalies were detected and noted accordingly. With the patient standing in a weight bearing position the podiatrist carried out further measurements including arch height and heel position. plantar fasciitis treatment is usually determined by the findings of the treadmill assessment.

Plantar Fasciitis Treatment

The patient was advised that we would worry less about the heel spur but instead focus on the treatment for plantar fasciitis. It was explained to the patient that in order for the plants of fashion to recover it would be essential to unload the fascia using a prescription orthotic that would touch and hold the sole of the foot and therefore reduce the strain on the plantar fascia. This is the best method of plantar fasciitis treatment. Orthotics with high arches apply too much pressure to the base of the heel and to the mid-portion of the plantar fascia and this can increase the symptoms and prolong the heel pain condition. He advised the patient that regular use of the orthotics on a daily basis for approximately 6 to 8 weeks would reduce the heel pain in the short term but would help the plantar fascia to heal in the long term. He reminded the patient that the heel spur would remain but would not be the source of pain. In addition to the use of the orthotics the sports podiatrist insisted that the patient carry out rigorous calf stretching three times per day on both legs. He also advised the patient that the orthotics would incorporate a specific forefoot modification which would help to unload and treat the first toe arthritis. The design of the orthotic with the forefoot modification would form a crucial part of the plantar fasciitis treatment. The orthotic would not help the heel spur to resolve and often the heel spur can remain in place for a lifetime, without discomfort. This patient did not have a heel spur around the back of the heel bone nor did she seem to present with plantar fasciitis in the good foot. The patient was recommended to change her running shoes from a Nike free to a Brooks adrenaline.

Plantar Fasciitis Treatment – Follow Up – 8 Weeks On

Plantar fasciitis treatment should always involve regular reviews to monitor the progress of the heel pain and also to measure the severity of the condition. After 8 weeks this patient reported a significant improvement in her condition and explained to the sports podiatrist that she had minimal heal pain on a daily basis. She described approximately 80% improvement at this 8 week mark. She understood that her heel spur may remain but this did not confront the patient as she understood the discomfort she felt was driven by the plantar fasciitis. This patient was diligent with her plantar fasciitis treatment plan and explained to the podiatrist that she had been stretching her calf three times a day every day since the first appointment. The orthotics she was using were comfortable and she felt the right level of support in the right areas of the foot. She was able to run with her orthotics and explained that she had much less foot and lower leg fatigue and was completing her running route in a shorter time. She had been able to increase her cadence and increase her personal best.

No further appointments were needed for this patient as she had been diligent with her plantar fasciitis treatment, understood that the heel spur was not the cause of pain and had resolved her heel pain.

Written by Karl Lockett

Podiatrist

Sydney Heel Pain Clinic

July 25, 2019/by karl

Case studies

Case Study 2019 Heel Pain After Running

New Patient History of Heel Pain After Running

A 39-year-old male presented to the Sydney heel pain clinic complaining of heel pain when running. This gentleman had been a keen runner for more than 10 years and was never under any podiatry care for foot problems such as plantar fasciitis. He reports to the sports podiatrist that approximately four months ago he changed his running shoe from one model to another, and not long after began to feel heal pain when running. He initially presumed he had bruised his heel and therefore decided to carry on with his exercise regime. He would ordinarily run approximately 7 km every morning before work, and would also carry out a 20 km run on the weekend. He reports to the podiatrist that after approximately 3 to 4 km the heel pain would subside slightly and he would be able to continue. However, later in the run his heel pain would return while he was running. After his exercise, the patient would remove his shoes and go through his routine of shower and stretching. Once this was completed, he felt a severe increase in the pain in the bottom of his heel. Typical of plantar fasciitis.

This person also reported significant heel pain in the morning when getting out of bed. He would need to avoid pressure on the base of his right heel and instead walk on his toes. He would favor the pressure on his left foot in order to have avoid the pain from the running injury to his right foot.

This patient reported to his chiropractor that he was experiencing heel pain when running. The chiropractor carried out some foot and ankle mobilizations and recommended some foot stretches. However, the heel pain when running continued. After approximately four sessions with the chiropractor the patient paid a visit to his regular GP. The doctor advised the patients that if he was experiencing heel pain when running, then he probably had a condition known as heel spurs or plantar fasciitis. The patient was referred for an x-ray and an ultrasound. The report from the x-ray confirmed that there was no heel spur but the report from the ultrasound suggested significant plantar fasciitis.The general practitioner that advised the patient to seek the help of a sports podiatrist.

What was the Cause of the Heel Pain When Running

The sports Podiatrist carried out a thorough physical examination to confirm the cause of the patient’s heel pain when running. The patient had all of the classic signs and symptoms of plantar fasciitis, when pressure was applied to the base of the heel and the medial aspect. A detailed biomechanical assessment was carried out on the treadmill and the patient’s biomechanics were recorded using digital software on an iPad. It was very clear that the patient demonstrated an inherent weaker foot type due to ligament laxity, leading to severe foot instability and overpronation. The patient had been using Asics gel Kayano running shoes previously which would have provided excellent support for this foot type. Upon assessment of the patient’s most recent running shoes, which were an Asics DS trainer, it became apparent that the minimal support from this latter running shoe would have been responsible for the onset of the heel pain when running.

The sudden change from one supportive shoe to another soft shoe often leads to biomechanical sporting injuries, as the foot and ankle do not have time to adapt sufficiently. It is not uncommon for podiatrists to experience this kind of problem in the clinic, when patients present with heel pain conditions such as plantar fasciitis or Achilles tendonitis.

Treatment for Heel Pain When Running

Importantly, for this patient to eradicate the heel pain when running, it was highly recommended that he revert to his Asics gel kayano. It was also decided to carry out a course of shockwave therapy treatment to stimulate healing. The patient returned to the clinic once per week for 6 weeks to receive shockwave therapy sessions. For the first 3 weeks of the shockwave therapy treatment the patient was advised to stop running. He was advised to wear his running shoes as frequently as possible, even when not exercising. The patient was given one very specific plantar fasciitis home remedy in the form of a supinated calf stretch. Many of the plantar fasciitis home remedies are problematic and the patient was advised of this. The patient was advised to avoid standing or walking in bare feet and using footwear such as thongs and slippers.

After the third session of shockwave therapy this patient reported an improvement of approximately 70%. At this stage it was decided to allow the patient to return to some short sessions of running. There was no increase in symptoms and his condition did not regress. The patient did not experience any significant heel pain when running. After the sixth and final shock wave therapy session, the patient reported very minimal pain in the mornings when rising from bed, and no pain at any other times of the day. On rare occasions he did experience some mild heel pain when running, but this was only during the first 2 kilometers of his exercise. The patient was advised to gradually build up his distance and frequency of running and to contact the clinic if his condition regressed or if there was a return of the heel pain when running. No further appointments were made for this patient and his file was closed.

Please note that the information contained in this case today is specific to one particular patient and should not be taken as general advice. If you are experiencing heel pain when running or if you think you have plantar fasciitis you should seek the help of a suitably qualified sports podiatrist or other healthcare practitioner. The podiatrists at Sydney heel pain clinic have a special interest in treating heel pain when running as well as all inflammatory heal pain conditions such as plantar fasciitis and Achilles tendonitis. they have vast experience and the use of shockwave therapy as a treatment modality for heel pain and other foot and ankle conditions. The clinic does not promise or guarantee specific treatment plans or outcomes unless we have carried out a detailed history and thourough physical and biomechanical examination.

This article was written by Karl Lockett, sports podiatrist and practice manager at Sydney heel pain clinic. The clinic can be contacted on the following phone number 9388-3322 or the following email address help@sydneyheelpain.com.au

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Written by Karl Lockett

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July 25, 2019/by karl

Case studies

PLANTAR FASCIITIS ALONGSIDE ACHILLES TENDONITIS

Detailed History of Plantar Fasciitis/Achilles Tendonitis

A 36 year old male attended the Sydney heel pain clinic complaining of Plantar fasciitis in his right foot and Achilles tendonitis in his left. This healthy individual had been experiencing bilateral heel pain for over 18 months and was struggling to find any resolve. He describes pain in the base of his right heel and around the back of his left ankle. The heel pain from the Plantar fasciitis seemed to be troubling this gentleman more than the Achilles tendon problem on the left side. He describes the Plantar fasciitis as being excruciating and at times he is forced to hobble. Each morning when he rises from his bed he is forced to bear most of his weight on his left side in order to avoid a sharp stabbing pain under the base of his right heel. He reports to the sports podiatrist that on some days he needs to hold on to his bedside cabinet or lean against the wall while he’s walking. This individual patient describes common symptoms of Plantar fasciitis in that following his morning shower the Plantar heel pain begins to ease. After he has walked around his bedroom while preparing to leave the house, he reports a further improvement in symptoms.

This patient reports a further increase in symptoms if he has been seated for more than 5 or 10 minutes. At other times of the day there are extended pain free periods. When the pain increases he describes a stone bruise sensation or a sharp stabbing feeling like a hot knife. He has never suffered with heel pain before and has never been diagnosed with Plantar fasciitis.

With respect to the Achilles tendonitis the patient describes stiffness and pain but no stabbing sensations. His symptoms are less aggressive in the left ankle than the right foot. Mornings are also symptomatic and as with the Plantar fasciitis, the patients symptoms improve the more he warms up and begins to move.

In terms of physical activity this patient reports to the sports podiatrist that he has always been fit and active. He is not overweight and does not report any chronic illness or ill health. Typically this patient would attend gym classes and enjoyed treadmill and cross training machines. He also enjoys social touch football and occasional games of tennis. Prior to the onset of this patients Plantar fasciitis and Achilles tendonitis, he agreed to join some friends at a local basketball tournament. He recalls that following the third game of basketball he began to feel an increase in calf muscle tightness and overall foot pain in general. He described a burning in the soul of his feet and a dull ache through both ankles. Quite soon after this, he recalls a very sudden onset of pain under the base of his left heel which he later discovered was due to Plantar fasciitis. The calf muscle tightness was coupled with cramping and quite soon this led to the increase in symptoms through the left ankle, which developed into Achilles tendonitis.

This patient did not restrict his physical activity during this time but instead continued with the basketball tournament until it’s close.

This patient decided to refrain from all physical activity following the onset of these injuries and spent the next four weeks resting as much as possible. He found only a slight improvement in symptoms and therefore made an appointment with his local doctor. He was referred for x-rays and was referred to a reputable Sydney based sports medicine doctor. The sports medicine doctor did confirm the presence of Plantar fasciitis and Achilles tendonitis and to this end referred to patient for ultrasound imaging. The ultrasound imaging reports further confirmed the diagnosis but also confirmed the presence of a deep surface tear in the right Plantar fascia.

The sports medicine doctor prescribed a course of medication to reduce pain and inflammation and advise the patient to perform stretching and strengthening exercises on a daily basis. The same exercises were to be performed on both feet in order to treat both conditions.

The patient was diligent and performed the stretches and exercises religiously but found no relief. He reports to the sports podiatrist that the pain from his Plantar fasciitis increased dramatically following repetitive exercises on the right foot.

The patient did not return to the sports medicine doctor but instead began to carry out online research. He purchased a night splint in an attempt to treat the Plantar fasciitis in the right foot. He also began rolling his foot on a frozen bottle of water on a daily basis. He decided not to stretch or strengthen the foot as this would only make things worse. Furthermore, this patient purchased a pair of stability running shoes from athlete’s foot and wore these every day. He decided not to walk using thongs or slippers or in his bare feet. He would use his trainers to and from the office and change into his business shoes when at work. In doing so he found there was some slight improvement with the Achilles tendonitis but minimal improvement with respect to the Plantar fasciitis. The night splint was disregarded due to discomfort, which is common.

This patient was unable to continue with the medication due to side effects causing reflux and stomach pain.

Physical Examination of Plantar Fasciitis

With the patient seated and non weight bearing the sports podiatrist applied mild pressure to the base of the heel around the attachment of the Plantar fascia, in order to determine the severity of the Plantar fasciitis. With mild pressure centrally and medially, the patient demonstrated a significant jump response and retracted his foot immediately. Firm pressure was applied through the arch of the foot and it was noted by the podiatrist that the distal arch was tender but the proximal arch also very sore. This painful area correlated with the location of the deep surface tear.

With the patient lying prone the podiatrist was able to examine the Achilles tendon. Typical of patients with Achilles tendonitis, the patient reported significant pain when lateral pressure was applied with finger and thumb. Around the painful area there was redness and some mild heat. The tendon felt slightly thicker and less pliable. This is commonly the case in patients with chronic Achilles tendonitis.

The sports podiatrist decided not to carry out a biomechanical assessment due to the severity of the patients Plantar fasciitis. The patient was advised that biomechanical assessment would be carried out at some point in the near future after significant improvement in symptoms. At the time of consultation the patient would not be able to walk or run naturally on the treadmill without limping. This would distort the findings and render the assessment useless.

Treatment of Plantar Fasciitis

It was explained to the patient that the treatment of his Plantar fasciitis would involve the use of a full height rebound walking boot. Due to the severity of his condition and the tear within the facia this would be the quickest and the most reliable way to relieve the pain and treat the facia. The Plantar fascia would heal quickly and naturally with the use of the walking boot. The patient did enquire about the use of orthotics but the podiatrist discouraged this treatment option due to the severity of his condition. He was advised to use the boots as much as possible throughout the day for at least three to four weeks. The immobilisation boot could be removed for sleeping, showering and driving.

The patient tested the boot in the clinic and immediately reported a significant improvement in pain levels from the Plantar fasciitis. His foot was stable inside the boot and did not move, and the pain level was close to 1/2 out of 10 on the vas score.

It was explained to the patient that after approximately 3 to 4 weeks there would be a change in the treatment plan and this may involve strapping, stretching, shockwave therapy or orthotic therapy.

Treatment for the Achilles Tendonitis

The sports podiatrist advised the patient that his Achilles tendonitis would improve quickly if treated with shockwave therapy. One session per week for approximately 6 weeks. The shockwave therapy would stimulate blood flow and promote healing of the tissue. The patient was also provided with a 9 mm heel wedge and this was placed underneath the liner of his functional running shoe, left foot only. Elevating the heel reduces the strain on the Achilles tendon and allows it to recover.

Calf stretching was demonstrated and the patient was advised to perform these on both legs every evening before bed. (following the removal of the boot at night)

After 4 weeks the patient was able to take short walks without the boot as the symptoms from the Plantar fasciitis had improved significantly. The sports podiatrist applied firm pressure to the base of the heel and through the arch of the foot and while the pain was still noted, the patient reported that the pain was much less. At this 4 week point the patient also reported an improvement of approximately 50% in the pain from his Achilles tendonitis on the left foot. He had been diligent with calf stretching and was using his running shoes with the heel lift inside.

During this appointment at the four week review the sports podiatrist carried out a detailed biomechanical assessment with the patient walking on the treadmill. He was also asked to run as naturally as possible on the treadmill while his gait cycle was captured using digital software. The sports podiatrist replayed the digital software footage and notes were taken. All biomechanical anomalies were noted and it was decided to arrange prescription orthotics. The patient was asked to remain in the moon boot until the orthotics arrived 10 days later, from the lab. He was compliant with this request. 10 days later he returned to collect his prescription orthotics and as planned the walking boot was removed. The prescription orthotics were fitted into the patients shoes and it was explained to the him that these supports would now provide all of the necessary control to reduce the strain on the Plantar fascia and allow the Plantar fasciitis to recover completely.

The patient reported further improvement in the Achilles tendonitis at this stage and the treatment was ceased after the 6th session. The heel lift was removed from the patients left running shoe in order that he maintain equal heel height and equal hip position.

Further Review

The patient was booked in for a follow up two weeks on from the orthotic fitting so that the sports podiatrist could monitor the improvement in the Achilles tendonitis and the Plantar fasciitis. The patient did not report any side effects or problems from the orthotics. He advised the sports podiatrist that they were being used on a day-to-day basis and were comfortable. While walking with the orthotics the patient did not feel pain from the Plantar fasciitis or the Achilles tendonitis. He did report some mild morning stiffness and mild pain in the Achilles tendonitis and Plantar fascia respectively, each morning when rising from bed. The symptoms would settle quickly and were not severe.

The podiatrist gave clear instructions on a reintroduction to physical activity in order to prevent a return flare up of the Plantar fasciitis or Achilles tendonitis. He was asked to re-introduce physical activity slowly with sufficient rest days in between each session to begin with. He was advised to increase the workload gradually.

As with all Sydney heel pain clinic patients this individual was instructed to return to the clinic if his Plantar fasciitis deteriorated or if the symptoms of his Achilles tendonitis increased. No further appointments were noted.

Please note that the information contained in this case study is specific to one particular person. It should not be taken as general advice. If you have been diagnosed with Plantar fasciitis or Achilles tendonitis then you should seek the help of a suitably qualified medical practitioner or sports podiatrist.

Written by Karl Lockett

February 6, 2019/by karl

Case studies

Case Study – Plantar Fasciitis in a Runner Causing Heel Pain

Plantar Fasciitis History

A 38 year old runner presented to the Sydney heel pain clinic complaining of plantar fasciitis in both feet. This gentleman explains to the sports podiatrist that his condition has been ongoing for approximately 4 months. He describes a stone bruise sensation in the base of his heel which troubles him on a day-to-day basis. The pain in his left heel is worse than the pain in his right heel. He also explains to the podiatrist that the heel pain is dreadful every morning as he takes his first few steps of the day. He has never suffered with plantar fasciitis before but does report to the podiatrist that he has experienced Achilles tendonitis approximately 12 months ago. The Achilles tendonitis lasted approximately 2 months and was successfully treated using shockwave therapy and calf stretching techniques. The patient covers approximately 60 km per week and enjoys running approximately 3 to 4 times per week. He is a type 1 diabetic but his blood sugar is under control. He’s not overweight and does not report any other medical conditions.

Previous Plantar Fasciitis Treatments

This patient became frustrated with his heel pain and attempted 2 find treatment for his plantar fasciitis. He naturally paid a visit to the podiatrist that was able to help him with his previous Achilles tendon problem. The podiatrist recommended footwear changes and provided calf stretching techniques and also commenced a 4 week course of shock Wave therapy.

After approximately 6 weeks his heel pain persisted and his plantar fasciitis was not improving.

Physical Assessment for Plantar Fasciitis

The sports podiatrist carried out a physical assessment in order to diagnose the plantar fasciitis and to exclude other causes of heel pain. The patient reported significant pain when pressure was applied to the base of the heel and the medial aspect. The podiatrist advised the patients that these were the typical pain locations in patients with plantar fasciitis.

The patient was able to perform single leg heel raises on each foot without pain.

The podiatrist was confident to exclude other causes of heel pain such as Achilles tendonitis, bursitis, nerve entrapment and plantar fascial tearing.

Biomechanical Treadmill Assessment

Using digital software, the sports podiatrist recorded the patient as he walked and ran on the treadmill. Anatomical landmarks were highlighted using black texter and the podiatrist was able to replay the video in slow motion and assess the patients biomechanics. The sports podiatrist was able to determine hyper mobile foot and ankle joints leading to severe over pronation. The pronation was greater in the left foot. The increase in pronation bilaterally quite possibly preventing the plantar fasciitis from healing.

Whilst running on the treadmill with functional running shoes, there was a slight improvement in bio mechanics. The patient was running in an ASICS gel kayano and there was only slight compression of the medial aspect of the heel counter during running. Both feet pronated heavily inside the running shoes.

Why didn’t the Shock Wave Therapy Resolve the Plantar Fasciitis and the Heel Pain?

The podiatrist explained to the patient that his heel pain had not improved due to poor biomechanics. Shockwave therapy is a reliable treatment option for plantar fasciitis providing there is sufficient support for the feet. Insufficient support allows over pronation which produces repetitive stress through the arch of the foot and through the plantar fascia, at it’s insertion onto the base of the heel. The podiatrist explained to the patient that every step that he took delivered stress through the plantar fascia, preventing it from healing.

Plantar Fasciitis Treatment

It was explained to the patient that in order to treat his plantar fasciitis he would be issued with prescription orthotics which would replace the soft liner of his running shoes. The orthotics would correct poor biomechanics and provide all the support necessary in order to reduce the stress running through the sole of the foot and into the base of the heel.

Using a 3D scanner and digital software, the podiatrist captured 3D foot scans. two weeks later the patient was fitted with carbon fibre sports orthotics which were placed into his ASICS running shoes. The podiatrist observed the patient running on the treadmill with his new orthotics. No abnormalities were detected and the patient reported no pain or discomfort. He described his orthotics to be comfortable. The sports podiatrist advised the patient that he should try to wear his orthotics every day for approximately 6 or 8 weeks. It would also be beneficial if he were able to wear them to and from work and when walking on a day-to-day basis.

It was decided not to proceed with further shock Wave therapy at this stage but rather allow the orthotics to encourage healing. The patient was advised to apply ice packs to the base of the heels every evening for approximately 30 minutes.

Plantar Fasciitis Progress

This gentleman returned to the Sydney heel pain clinic 8 weeks later for a review of his heel pain and to assess the improvement in his plantar fasciitis. He informed the podiatrist that he no longer experienced pain throughout the day when walking. Road running did not cause him any discomfort. He described a mild pain each morning when rising from bed and rated this approximately 2 out of 10 on the vas scale. He informed the podiatrist that he was happy with progress and wanted to continue with orthotic therapy. He felt confident that the minimal pain that persisted would dissipate completely very soon.

The sports podiatrist advised the patient to return to the clinic if his heel pain persisted or if he felt his plantar fasciitis recovery plateaued.

Please be mindful that the information contained in this case study is very specific to one particular patient. If you feel that you have plantar fasciitis or any other cause of heel pain you should seek the opinion of a suitably qualified medical practitioner.

Sports Podiatrist with special interest in heel pain / plantar fasciitis – Karl Lockett

Written by Karl Lockett

December 13, 2018/by karl

Case studies

Case Study – Heel Pain from Plantar Fasciitis and Bursitis

Plantar Fasciitis Symptoms – Causing Heel Pain

A 44 year old female presented to the Sydney heel pain clinic complaining of pain in the base of her heel consistent with plantar fasciitis. She described a frustrating heel pain that felt like a pebble in the shoe, and that had been troubling her for approximately 7 months. She was unable to inform the sports podiatrist of any particular reason as to why this heel pain gradually came on. She explains her activity to be dog walking on a daily basis and that she has performed this activity for several years. She explains that the heel pain is extremely prominent during the beginning of her walks but then begins to settle. She informs the podiatrist that she would always wear cross trainers or trekking shoes while walking the dogs. This patient has never experienced plantar fasciitis before and explains to the podiatrist that she boasts good foot and general health. She did explained to the practitioner that her heel pain was noticeable first thing in the morning after sleeping. The pain from the plantar fasciitis was also evident after long periods of sitting down. She had been rolling her foot on a Frozen can of Coke on a daily basis in order to relieve the pain.

Physical Assessment of Plantar Fasciitis

The sports podiatrist carried out through physical assessment in order to assess the severity of the heel pain and to diagnose / confirm the diagnosis of plantar fasciitis. When pressure was applied to the insertion of the plantar fascia onto the heel bone the patient reported significant pain consistent with her day to day heel pain. The pain was more medial and central on the heel bone and less on the lateral side of the heel or the outer heel. The patient also described some tenderness through the more distal fibres of the plantar fascia as it passes into the arch area. These are all the typical pain locations found in people with chronic plantar fasciitis.

The patient was able to perform a single leg heel raise without significant pain. When standing and balancing on one leg the patient reported pain under the base of the heel on the affected foot. The podiatrist carried out further physical tests around the foot and ankle joint and through the muscles and tendons affecting the area. No other abnormalities were detected. The patient did report calf cramping in the evenings, after she had been busy on her feet all day, but demonstrated good range of motion through the ankle.

The podiatrist carried out a biomechanical assessment on the treadmill and recorded the footage using digital software. Foot posture index including arch height and heel angle were measured and noted.

The podiatrist carried out of footwear assessment following the treadmill assessment and was able to determine that this person was not receiving sufficient support from her fatigued cross trainers. While this particular sports model was a reputable shoe maker the patient had been using this particular pair for more than 12 months and the midsole had consequently fatigued. The net effect was that the patient was walking on a daily basis in minimally supportive shoes. This would have been one if not the only likely cause of the patient’s plantar fasciitis.

The patient was referred for ultrasound imaging in order to exclude any other complex heel pain conditions aside from plantar fasciitis. There are other causes of heel pain that can appear on ultrasound images.

The patient returned to the Sydney heel pain clinic and the report was discussed. The imaging showed definite plantar fasciitis with a thickness of approximately 7 mm. Of interest, the patient had also developed a small adventitial bursa overlying the plantar fascia.

Plantar Fasciitis Treatment

The podiatrist installed the Sydney heel pain mobile phone application for the patient. This would allow the patient to be well informed and to avoid conflicting and contradictory treatment advice.

The treatment for this patient would include the following:

Supportive strapping using rigid sports tape
Footwear recommendations and the purchasing of new shoes.
The application of shockwave therapy on a weekly basis for 3 to 6 weeks.

Treatment Results – Heel Pain

After 4 sessions of shockwave therapy and after 4 weeks of using new supportive walking shoes the patient reported an improvement of approximately 50%. However, there was one small area of tenderness which did not seem to be improving as much as the other areas of heel pain. To this end the podiatrist referred the patient back to the imaging centre for a small injection of cortisone into the adventitial bursa. The needle was guided into the affected bursal tissue using ultrasound. Treatment was well tolerated and there were no complications.

One week later the patient returned to the Sydney heel pain clinic and reported that her heel pain at all but disappeared. There was some mild pain from the plantar fasciitis but this was improving on a day to day basis. She had been compliant with the use of the new shoes and had been consistent with the application of rigid sports tape. The patient requested one more session of shockwave therapy and the treatment was received and well tolerated. Immediate relief from the shock wave therapy followed the session. Further treatments were ceased to allow natural healing. The patient was advised that 1 more shock wave therapy session would be considered if the plantar fasciitis did not completely resolve or if there was residual heel pain.

The patient was asked to return to the Sydney heel pain clinic in two weeks time to discuss her progress. This person called the clinic to cancel the appointment 2 days prior to the review, explaining to the receptionist that she was completely pain free and did not need further treatment.

Please note that the information contained in this particular case study is specific to one person and should not be taken as general advice. If you have heel pain or if you think you have plantar fasciitis please consult with a suitably qualified sports podiatrist.

Written by Karl Lockett

December 6, 2018/by karl

Case studies

Case Study – Plantar Fasciitis in a Recreational Tennis Player

Case history of Plantar Fasciitis Causing Heel Pain

A fit and healthy 52 year old male presented to the Sydney heel pain clinic complaining of heel pain from plantar fasciitis in his right foot. This gentleman is a keen tennis player who plays competitively at the local tennis club. He trains two to three times per week and competes on a weekend. He has been complaining of heel pain from plantar fasciitis for approximately 6 or 7 months. He informs the podiatrist that the condition came on slowly but that approximately 3 weeks ago became extremely sore. The heel pain prevents the patient from walking without a limp. Each morning the pain from the plantar fasciitis causes a patient to hobble around his bedroom for the first 5 or 10 minutes until the blood flows and the acute pain reduces slightly. The heel pain then becomes more bearable and the patient is able to complete his morning routine with mild discomfort.

At this time of consulting with the patient, he had not reduced his training regime and was continuing to play his regular sessions of tennis. He describes to the podiatrist a situation that allows him to play tennis and get through the session once the foot has warmed up. However, approximately an hour or two after the session, and particularly when the patient has been seated, the heel pain returns with a vengeance as he becomes mobile again.

Previous Treatments for Plantar Fasciitis

This patient was informed by his family doctor that his heel pain would take approximately 18 months to settle, and that there were no reliable treatment options for plantar fasciitis. He was referred for an x-ray which returned negative. No heel spurs work present. The patient requested some prescription medication to reduce inflammation and heel pain.

The patient experienced mild pain relief from the medication but decided to stop using the tablets after 2 weeks. He explains to the podiatrist that the medication felt like a band-aid solution and that he wanted a deeper understanding and more thorough treatment plan. After performing some online research he typically found conflicting information on a variety of web pages for plantar fasciitis treatment. Following this he decided to make an appointment at the Sydney heel pain clinic to avoid prolonging his condition any further.

Physical Assessment for Plantar Fasciitis

The sports podiatrist carried out a thorough physical foot and lower leg assessment in order to confirm that the plantar fasciitis was the cause of the patients heal pain. The patient reported pain on palpation of all of the typical parts of the foot the correspond to plantar fascial irritation. Namely the medial aspect of the base of the heel bone. This is known as the plantar fascial attachment.

Typical of a tennis player the podiatrist informs the patient that he demonstrated a restricted range of motion through the ankle joint due to tight calf muscles. He was informed that calf stretching with the foot supinated would form part of his treatment plan for the plantar fasciitis. This particular patient demonstrated and extreme jump response when mild pressure was applied to the base of the heel, indicating an extremely acute case of plantar fasciitis. To this end the podiatrist decided not to carry out a biomechanical assessment on the treadmill but instead progressed to the treatment plan.

Plantar Fasciitis Treatment

The podiatrist explained to the patient but there was a chance he had developed micro tears in the plantar fascia and that the quickest and most reliable way to treat him would be by the use of an immobilisation boot. The onset of the patient’s condition corresponds well with the incidence of a plantar fascial tear, namely that the condition was mild for approximately 6 months before becoming extremely acute approximately 3 weeks ago. It is likely that the patient developed a plantar fascial tear during a game of tennis at this time. An ultrasound referral would give a clearer understanding as to the level of pathology within the plantar fascia. The report would not affect the plantar fasciitis treatment plan.

The sports podiatrist applied rigid sports tape to the affected foot and fitted the gentleman with a full height immobilisation walking boot. He was given a referral to Medscan imaging and the report would come back to the clinic within the next 5 business days.

The Sydney heel pain mobile phone application was installed on the patient’s smart phone and he was instructed to read the literature pertaining to the treatment of his plantar fasciitis. He was asked to stop all other forms of treatment in view of the fact that some home treatments can cause problems.

The patient was advised to apply soft ice packs to the base of his heel on a daily basis and to elevate the foot during the process. Unfortunately in this particular case the patient was advised to stop all forms of physical activity on his feet.

Ultrasound Report and Heel Pain Follow Up

The patient returned to the Sydney heel pain clinic 5 days later for a follow-up assessment and a discussion of the ultrasound report for his plantar fasciitis. The reports confirmed a deep surface tear measuring 17 mm by 3 mm. The patient was advised that he should remain in the immobilisation boot for at least another 3 to 4 weeks and possibly 6 to 7 weeks. Due to minimal blood flow to the plantar fascia the healing is slow even though the foot is immobilised and thoroughly supported.

The podiatrist booked the patient in for shockwave therapy a week later. The shock Wave therapy would increase blood flow and stimulate healing and the patient would undergo at least three to four sessions with weekly intervals. The shock Wave therapy does reduce the heel pain but this is simply a positive side effect.

After 4 weeks the patient was able to walk on the treadmill in the clinic without limping and therefore a biomechanical assessment was carried out in order to determine the cause of the patient’s plantar fasciitis and heel pain. This patient demonstrated an extremely rigid foot type with a very high arch and minimal shock absorption or pronation. To this end the patient was advised to use arch supports inside his tennis shoes which would unload the sole of the foot and reduce strain on the plantar fascia long term. He would need to use the arch supports diligently for the next month or two to ensure complete healing of the plantar fasciitis. A supinated calf stretch was demonstrated and the patient was advised to follow these instructions in the Sydney heel pain mobile app.

6 weeks later the patient returned to the clinic and was completely free of any symptoms. There was no longer any heel pain first thing in the morning and the patient was able to walk throughout the day with his trainers and arch supports without feeling any pain. The podiatrist designed a physical activity program for the patient in order that he could slowly become more active without exerting too much stress on his foot over a short period of time. This allowed the patient to return to tennis within a month.

The patient was advised to return to the clinic if his heel pain persisted or if he felt like his plantar fasciitis was returning.

Please be aware that the information contained in this case study is specific to one person. If you think you have heel pain or plantar fasciitis please consult with a suitably qualified sports podiatrist.

Written by Karl Lockett

November 28, 2018/by karl

Case studies

PLANTAR FASCIITIS – THE CAUSE OF HEEL PAIN

Case History of Plantar Fasciitis

A 32 year old female runner presented to the Sydney heel pain clinic complaining of heel pain from plantar fasciitis, that had been troubling her or approximately 18 months. The patient explains to the podiatrist that she is a recreational runner and simply enjoys a 3 or 4 km run, approximately 2 to 3 times a week. She describes a slight increase in weight gain approximately 2 years ago due to some medication she was using for a thyroid gland issue. After gaining approximately 8 kilos in body weight she remembers feeling heel pain in both of her feet. Online research pointed to plantar fasciitis and the patient has been suspicious of this condition ever since. The patient was advised to perform calf stretches and foot exercises in order to rebuild strength in the lower leg area. The patient was diligent in performing these routines but reported an increase in heel pain. She ceased this rehabilitation and began to search for other alternatives to treat her plantar fasciitis. After approximately 6 months of heel pain and without any joy in relieving the symptoms, she consulted with a Sports Medicine Doctor in Sydney. Imaging was arranged and reports confirmed bilateral plantar fasciitis. The left plantar fascia measuring 7 mm, right plantar fascia measuring 8 mm in thickness. The Sports Medicine Doctor offered similar advice to that of the online articles that the patient had already come across. She advised the Dr that she did not want to perform further rehabilitation because it increased her heel pain and prolonged the plantar fasciitis. To this end, the Dr offered cortisone injections.

The patient received ultrasound guided injections of cortisone into both of her heels. She described an immediate relief in pain that lasted for approximately 5 days. Her heel pain returned and she was back where she started.

Physical Assessment – Plantar Fasciitis

The sports podiatrist at Sydney heel pain clinic applied pressure to the plantar medial aspect of both heels are noted a significant jump response from the patient, typical of acute plantar fasciitis. The patient described the pain level on a VAS to be 8 out of 10. She also described to the podiatrist that the pain level is elevated in this way on a day to day basis and that when she lies down both of her heels are throbbing.

During this physical assessment the patient reports to the podiatrist that she has significant pain each morning upon rising and that she has been hobbling around her bedroom to reach her bathroom.

Repeat Ultrasound Referral for Plantar Fasciitis

Due to the extreme pain levels from the plantar fasciitis the podiatrist decided to arrange a repeat ultrasound. It was explained to the patient that her condition may have deteriorated since the injections and that there was a chance she may have developed tears in the fascia. It is not unusual to encounter soft tissue tearing following the administration of cortisone. The report was conclusive, and the patient had developed micro tears in both plantar fascia.

Heel Pain Treatment

The patient was advised that the treatment of her plantar fasciitis would be multi-factorial. It was explained to the patient that supporting and unloading the plantar fascial was essential. To this end the patient was fitted with a full height immobilisation boot on her right foot. The boot would be moved to the left foot in due course.

In addition to this, rigid sports tape was applied to both feet in order to prevent displacement of the joints. This would further reduce the load on the plantar fascia. Please note unloading the facia here is the opposite of exercising or attempting to strengthen the foot. – crucial for patients with heel pain.

The patient was advised to apply soft ice packs to the base of her heels every night before bed for approximately 20 minutes. She was advised to avoid using heat. This usually assists with the heel pain that patients encounter first thing in a morning.

The patient was also advised and informed of the importance of calf stretching, not strengthening. Stretching the calf releases the heel and therefore further unloads the plantar fascia – also crucial in cases of plantar fasciitis and heel pain.

The Sydney heel Pain mobile phone application was installed allowing the patient access to the full range of rehabilitation advice including diagrams and an outline of the calf stretching technique.

4 Week Review of Plantar Fasciitis

The patient returned to the Sydney heel pain clinic for a review of heel pain and to assess the progress in healing of her plantar fasciitis. The patient reported approximately 60% improvement in the pain in her right heel. She reported that her left foot was manageable and tolerable so long as she was compliant with advice that included the regular application of rigid sports tape and the use of correct footwear. Ice packs and stretching techniques had also helped. The patient was now advised that the moon boot would be shifted to the left foot and that Shockwave therapy would commence on the right foot.

The patient returned for weekly sessions of Shock Wave therapy to her right foot and repeat applications of rigid sports tape. After 2 weeks the moon boot was removed from the left foot due to a significant reduction in pain. Shockwave therapy was then commenced and the patient returned to the clinic for weekly sessions on the left foot. In total the patient had 6 sessions on her right foot and 6 sessions on her left foot. The patient reported less heel pain after each session. Her plantar fasciitis was improving steadily, as to be expected.

Treatment was then reduced to strapping, stretching , ice packs and firm shoes.

Rehabilitation time with this particular patient was approximately 6 to 8 weeks in total. This was to be expected due to the complexity of the condition, affecting both feet.

The patient returned 4 weeks on from the shock wave therapy sessions to discuss reintroduction to physical activity and running. She was given long term advice on running style and was reminded of the factors that can trigger heel pain and plantar fasciitis.

Please note the information contained in this case study is specific to one particular patient. If you have heel pain or plantar fasciitis and please consult with a suitably qualified sports podiatrist.

Written by Karl Lockett

November 22, 2018/by karl

Case studies

CASE STUDY – 34-YR. OLD MALE WITH CHRONIC HEEL PAIN FROM PLANTAR FASCIITIS

Patient Case History – Plantar Fasciitis

Patient came to Sydney Heel Pain clinic complaining of heel pain from plantar fasciitis. The patient has worked in construction for about 4 years and his heel pain began around 12-18 months prior to coming to Sydney Heel Pain. Within the past 6 months, the pain and occurrence of the pain have increased. The patient notices the pain is most intense first thing in the morning when getting out of bed, but then subsides a bit in the morning hours. The pain becomes intense again in the afternoons after several hours of work.

Patient’s heel pain has become debilitating and he fears the plantar fasciitis will interrupt his career. Patient has been taking over-the-counter pain medication daily, with some relief, but needs a more effective and long-term solution for his heel pain. Over the past year, he has also tried a variety of at-home treatments. The patient has changed his work boots to something more supportive. The new work boots did not seem to help. Patient then tried using cushion inserts for the heel. These added a bit of comfort, but did not last and only offered minimal relief. Patient has been icing and massaging his heel for almost 2 months and is not seeing significant effects. His plantar fasciitis persists.

The patient most recently visited his primary care doctor who suggested he see a podiatrist for the most appropriate assessment and treatment of his foot pain before prescribing any long-term pain medications. A family member referred him to Sydney Heel Pain, suggesting custom foot orthotics.

Podiatrist Assessment of Condition – Chronic Heel Pain

A biomechanical assessment was needed to assess whether the patient had physical foot or ankle factors that could be contributing to the patient’s heel pain. The podiatrist at Sydney Heel Pain Clinic recorded the patient’s foot movements while walking using a treadmill and digital software. An ultrasound scan and thorough physical exam of the foot, ankle, and calf were also done.

As is typical with plantar fasciitis , the patient had a significant jump response, when pressure was applied to medial slip of the fascia, at the insertion on to the heel.

The podiatrist concluded that the patient had low arches in both feet. His left foot arch was slightly higher than his right. These low arches, likely accompanied by the patient carrying heavy loads in his workplace, has caused plantar fasciitis, an inflammation of the fascia that runs from the base of the heel through the arch of the foot.

Treatment Plan & Progress of the Plantar Fasciitis

Treatment

The podiatrist suggested a two-part approach to address the patient’s heel pain from plantar fasciitis.

First, the patient will be fitted with custom-made sports orthotics for his work boots. This is a common approach to plantar fasciitis. This will provide the most effective support for his arches while standing, walking, and carrying loads during his long working hours. This will provide a long-term solution to end the inflammation and to prevent further inflammation. Patient was also encouraged to avoid going barefoot while not working in favour of keeping his arches supported.

Next, the podiatrist prescribed a series of shockwave therapy treatments. This would provide immediate relief from the heel pain and would stimulate collagen production & promote new blood vessel formation. The patient was informed he would likely need a series of shockwave therapy treatments over the course of 3-6 weeks for the most effective and thorough relief of the plantar fasciitis

The patient could continue with his normal work schedule and daily routine during the treatment. No interruption of daily life would occur. The patient would be fitted for his custom sports orthotics and would begin the first shockwave therapy treatment within the next week.

Progress – the Heel Pain Reduces as the Plantar Fasciitis Heals

The first shockwave therapy treatment was for approximately 4 minutes and the patient tolerated the treatment well. He reported a mild discomfort during the treatment and reported a decrease in pain immediately following treatment. The custom orthotics were fitted to his work boots and trainers.

One week later, the patient came back for the second shockwave therapy treatment and reported a lessening of pain from an 8 to a 4 on a 10-point scale over the past week. Immediately following the second treatment, the patient again reported an immediate relief in pain.

The patient continued shockwave therapy for a total of 4 treatments over 4 weeks. At this time, the patient reported his pain was almost completely gone—rating the pain a 1 on a 10-point scale. Since the effects of the treatment continue in the days to weeks after the therapy ends, the therapy was discontinued.

The patient was scheduled for a follow-up assessment for 6-8 weeks later. At the follow-up, the patient reported no pain in his heel and continued to use the custom orthotics. His plantar fasciitis and heel pain were successfully treated.

This details of this case study are specific to this patient. If you suffer from heel pain, or plantar fasciitis consult a podiatrist for a full assessment and treatment plan specific to your needs.

Written by Karl Lockett

November 20, 2018/by karl