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Case Study September 2016 – Pain From a Heel Spur

Heel Spur – History

On the 14th September 2016, a 47-year-old lady arrived at the clinic complaining of pain from a Heel Spur. She described a stone bruise sensation under her heel that was painful with walking. The Heel Spur triggered intense pain in the early morning or the middle of the night when she got out of bed. The pain was only in the left foot and it had been present for approximately 6 months. She had tried many different treatments to relieve the pain such as gel inserts and rolling her foot on a frozen water bottle. She arrived with X-rays of both feet and a Heel Spur could be clearly seen on the base of the left and right heels. She insisted there was no pain under the right heel, even though the spur was present.

Her GP, who had arranged the X-rays gave her an information sheet on Heel Spur treatment, which also discussed Plantar Fasciitis. This patient, who we will refer to as “Mrs X” was confused. She did not understand the difference between a Heel Spur and Plantar Fasciitis. She was assured there was nothing to worry about, and a full explanation would be given during this initial consultation.

Mrs X boasted good foot health other than this recent setback and she was in good general health too. She took no medications aside from a daily multi vitamin. She was an active lady who played golf and tennis and would walk her dog in a morning before work.

In an attempt to reduce the pain from the Heel Spur, Mrs X had decided to change her walking shoes from an Asics to a Brooks. This made no difference. She often got around in flat shoes, which were not particularly supportive. She wore Hush Puppies and Dianna Ferrari Supersoft, which were described as “comfortable” by the patient. It was explained to Mrs X that comfort was one thing, support was another! Her footwear would need to be addressed.

Physical Assessment for Heel Spur

Even though the Heel Spur was visible on X-ray, the Podiatrist carried out an assessment to determine the area of pain. When pressure was applied to the base of the heel bone, centrally, Mrs X retracted her foot and indicated she was feeling a sharp pain. The pain she was feeling as the pressure was applied was the same as the pain that she would feel when she stood on the heel. Particularly when getting out of bed.

The Podiatrist also palpated the Plantar Fascia around the heel and into the arch of the foot. Mrs X was surprised to find pain in these areas also.

Heel Spur or Plantar Fasciitis?

The Podiatrist informed MRs X that although she did in fact have a Heel Spur, the pain she was feeling was a result of a condition known as Plantar Fasciitis. This is a common condition and a common misconception. And quite understandably. A plantar Heel Spur, which is a small spike of bone under the base of the heel looks terribly sharp, like a rose thorn, so it has been the diagnosis of choice for many years. However, more recently, it is becoming widely accepted that the inflammation and irritation of the Plantar Fascia, that attaches to the base of the heel, is the cause of pain. To support this point, it is worth considering that Mrs X presented with a Heel Spur in her right foot as well as her left, and that the right foot was pain free. This explains why treatments that cushion the heel or deflect pressure away from the Heel Spur rarely resolve the pain. Treatments that are directed at the Plantar Fascia and not the spur are much more reliable.

Other Finding

Mrs X demonstrated extremely tight calf muscles. Something she was not aware of. She did not report cramps or pain in the lower leg area. This tightness in her calf muscles was a major factor in the onset of heel pain, as the muscles will create in increased pulling action on the heel. Most patients that complain of a Heel Spur, or more specifically, Plantar Fasciitis will demonstrate a reduced amount of ankle joint dorsiflexion due to tight calf muscles.

Heel Spur Treatment

As mentioned above, the treatment for this patient was to reduce the load on the Plantar Fascia as opposed to trying to cushion the heel, or deflect pressure away from the Heel Spur. To this end, it was decided to apply rigid sports tape around the affected foot, in order to reduce the spread of the bones. This would reduce the load and tension in the Plantar Fascia, which in turn reduces the pulling sensation at the heel. There is a theory that suggests that the Heel Spur develops due to this pulling action of the Plantar Fascia on the base of the heel.

Mrs X was given a short list of appropriate shoes and the outlets where these shoes could be purchased. She was treated using a Shock Wave Therapy machine which delivered 2000 reps of sound waves, at a maximum of 2 bars of pressure and a speed of 6HZ. She was asked to perform calf stretching daily and was given instructions on how to perform these supinated calf stretches and how often to do them. She was also asked to apply cold ice packs to her feet every evening before bed.

Mrs X returned to the clinic once a week for 6 weeks for repeat applications of Shock Wave Therapy. Her strapping would be changed and her calf range assessed. Each week Mrs X reported less pain from her Heel Spur (Plantar Fasciitis) and her calf range improved. The new shoes became her main shoes and she refrained from her flat and flexible footwear.

Mrs X did not need to have prescription orthotics arranged as she responded well to the support from the rigid sports tape. However, in some cases, where extra support is needed, orthotics are a reliable treatment option. (Please note that the design of the orthotic is crucial to healing, and some prescription orthotics, designed poorly can aggravate the Heel Spur (Plantar Fasciitis) and prolong the condition.

8 Week Follow Up

Mrs X reported that she was now free from pain and could walk quite happily. She was advised that her Heel Spurs would still be present but to not worry as they were not the cause of her pain. She was advised to maintain good calf range and be careful with the use of flat and flexible footwear. Naturally, Mrs X was asked to return to the clinic if her symptoms returned.

PLEASE NOTE: If you have a Heel Spur or if you suffer with Plantar Fasciitis you should seek the help of a Sports Podiatrist. The information in this case study is specific to an individual patient and should not be taken as general advice.

 

Written by Karl Lockett

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Case Study September 2016 – Achilles Tendonitis In Both Feet

Achilles Tendonitis – Case History

A recreational runner, 33 years old, presents to the clinic complaining of Achilles Tendonitis. She has been enduring pain in both feet for more than 12 months and has reluctantly ceased running. She is 176cm tall and weighs approximately 58 kilos. She runs 5 days a week covering approximately 50 kilometres in total. Before the onset of her Achilles Tendonitis she covered a kilometre in around 3 minutes 50 seconds, however, since the injury this has slowed somewhat. Mrs X has registered for a half marathon in Sydney and is keen to get well for the event. She has never had Achilles Tendonitis before and boasts good foot health.

She reports that the Achilles Tendonitis is painful when she gets out of bed in a morning but eases off slightly as she walks. Throughout the day, the pain is sporadic. Sometimes, there is a noticeable pain when she stands up from a seated position and begins to walk. The pain is worse in the right leg, and in both cases the area of concern is above the heel bone, in the part of the tendon that can be seen and pinched with finger and thumb. During the first kilometre of a run, the tendons would feel stiff and sore. Afterwards, the Achilles Tendonitis was less painful as though the legs had warmed up. This allowed Mrs X to get through most of the run, before the pain would return towards the end. However, the pain that she felt around an hour later was severe and this would cause her to limp. The next morning, following a run, the Achilles Tendonitis was even worse and the pain excruciating.

Mrs X began to carry out on line research in an attempt to find web sites that offer advice on the treatment of Achilles Tendonitis. She came across some stretching and eccentric loading exercises, the latter of which made the pain worse. She began a course on NSAID’s in an attempt to reduce the inflammation to no avail. Her regular chiropractor informed her that he had experienced some joy in the past when treating Achilles Tendonitis. He would mobilise the foot and ankle joints and use acupuncture needles to loosen the calf. While there was some temporary pain relief from the acupuncture, the condition was not improving overall.

Achilles Tendonitis – Physical Examination

Mrs x had been suffering with Achilles Tendonitis for more than a year. There were visible signs of swelling in both tendons. There were nodules on both legs that were firm to touch. There was pain when gentle pressure was applied to the nodules with finger and thumb. There was no pain when pressure was applied to the insertion of the Achilles Tendon at the heel bone. As is typical with acute Achilles Tendonitis, this patient reported pain when she attempted a single leg calf raise.

Bio Mechanical Assessment for Achilles Tendonitis

Achilles Tendonitis can be painful when walking or running in bare feet, and can be exacerbated with an inclined running surface. Mrs X was observed on the treadmill without shoes so that her foot function could be analysed. Video was captured using digital software on an iPad. Data was captured during walking and running, on both a level surface and an inclined surface. During the walk, Mrs X did not report pain but when running, the Achilles Tendonitis was sore in both legs. The same was found on the inclined running surface.

During replay, it was evident that Mrs X had an inherent weakness in some of the joints of her feet. There was over pronation in both feet when walking, which became more severe when running. Her over pronation was taking place at the sub talar joint and this allows the Achilles Tendon to become stressed as it distorts.

Achilles Tendonitis Treatment

Mrs X was informed that her Achilles Tendonitis was chronic but also acute and to this end, there was to be a short and long term treatment approach. Primarily, due to the visible and palpable swelling, this patient was advised to apply ice packs to her tendons at least once a day for 30 minutes. A treatment plan of weekly Shock Wave Therapy sessions was put in place. The Shock Wave Therapy would stimulate blood flow and promote healing. There is also a pain relieving effect from the Shock Wave Therapy which gives patient’s an emotional break from the constant pain.

2 x 9mm heel lifts were inserted into the patient’s shoes in order to elevate the heel and unload the tendon. These were to be used for a month or 2, throughout treatment, until pain was almost gone and the Achilles Tendonitis seemed to have healed. Mrs X was advised to avoid walking bare foot and to either avoid or reduce the use of flat shoes or thongs. She was also asked to perform calf stretches with her feet supinated in order to release the tendon. She would be weaned off the heel lifts in due course.

Orthotic therapy is not always necessary in cases of Achilles Tendonitis, but with this patient there was clearly a bio mechanical issue with over pronation. This patient informed the Podiatrist that she wanted to do as much as possible to expedite the healing of her condition and ensure the Achilles Tendonitis healed completely, and so a pair of orthotics was arranged. The sports orthotics were made from lightweight Carbon Fibre and were covered with slow release poron for cushioning. These would replace the liner of her running shoes, which were deemed appropriate for her foot type.

8 Week Follow Up

Mrs X reported a marked improvement in her condition but was not yet running at her usual pace. She was running 3 days a week and wanted to return to 5 days and she was advised this will happen in due course, following a training programme. The morning pain had gone away completely, but was a little tender the morning after a run. Some stiffness was also apparent. The nodules had decreased in size and while they were not sore during walking, there was mild pain on palpation. This was to be expected and the patient was advised that further healing would take place in the coming weeks.

After 12 weeks there was further improvement and Mrs X was back to running 5 days a week. The heel lifts had been removed and calf muscle range was good. Mrs X was advised to return to the Podiatrist if her Achilles Tendonitis became sore again.

It should be noted that the information in this case study is not general advice. If you have Achilles Tendonitis you should seek the help of a Sports Podiatrist.

 

Written by Karl Lockett

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Case Study March 2017 – Plantar Fasciitis In A Patient with Auto-Immunity by Karl Lockett, Sports Podiatrist

A 55 year old lady presents to the Sydney Heel Pain Clinic complaining of Plantar Fasciitis which is causing pain in the heel and arch, of her left foot. She informs the Sports Podiatrist that the pain has been present for approximately 3 months, and seems to coincide with a flare up in her auto-immunity condition. She is under the care of a rheumatologist who has prescribed specific medication for her condition, and up until recently, her inflammatory episodes were under control. She informs the Sports Podiatrist that she has not changed her diet or level of physical activity and hence she is at a loss as to why the Plantar Fasciitis has developed. Her last blood test revealed rheumatoid factor of 45 although her specialist did not label her condition as rheumatoid arthritis.

The heel pain is more noticeable in the mornings when she gets out of bed, or in the middle of the night when she goes to the bathroom. Throughout the day, she feels like she has a pebble in her shoe, under her heel, and at times it feels like a “red hot poker” shooting into the bottom of her foot. She has never seen a Sports Podiatrist before although she feels her feet have not been great for some time. This patient informs the Sports Podiatrist that her Plantar Fasciitis and heel pain is only in the left foot, although she feels that she is dominant on the right side. She usually enjoys her morning walks with the dog but has ceased this activity due to the pain. Occasionally, she is able to push through the heel pain and after a short distance is able to walk quite comfortably. However, of late, this has not been the case and so her rheumatologist modified her medication and referred her to the Sports Podiatrist. She was informed that her symptoms do in fact resemble Plantar Fasciitis and so a physical assessment would be required.

Physical Examination for Plantar Fasciitis

The Sports Podiatrist applied firm pressure along the medial side of the heel bone and observed a jump response from the patient. She confirmed that this pain resembled the heel pain that she felt when she walked in a morning. Distal to the heel, into the arch, there was further pain along the Plantar Fascia which also caused the patient to wince. At the mid point of the arch, the Sports Podiatrist felt a small pea sized lump which was also visible to the naked eye. Interestingly, the nodule did not elicit pain on palpation but was mildly sore when very firm pressure was applied. The patient was informed that these plantar nodules were quite common in people with auto-immunity. They are often observed under Ultra sound as ganglions or fibroma’s. The patient was informed that she did in fact have Plantar Fasciitis and this was causing her heel pain and arch pain.

Bio-Mechanical Assessment by Sports Podiatrist

The Sports Podiatrist requested the patient walk bare foot on a treadmill so that her foot function could be assessed. This was done with bisection lines drawn on the back of the heel bone and tibia. The patient’s walking style was recorded using digital software and was replayed in slow motion. One of the causes of Plantar Fasciitis and other conditions that cause heel pain or arch pain is over-pronation through the sub-talar joints and mid-foot. It was clear from the replay that this patient suffered from severe over-pronation which allowed her feet to collapse under body weight. The Podiatrist explained that this over-pronation puts a great deal of stress on the foot, the Plantar Fascia in particular. Other muscles in the foot and lower leg also work over time, in order to compensate for the weakness in the foot ligaments, and this causes tightness. It was likely that this over-pronation was responsible for the strain on the Plantar Fascia which led to the Plantar Fasciitis and heel pain.

Further assessment revealed extreme tightness in the calf muscles. The posterior shin muscles were also very tight and tender. The Sports Podiatrist carried out some standing foot measurements and found bi-lateral flat feet. The left medial arch measuring a mere 12mm in height, and the right only 14mm. Foot posture index revealed an 18 degree eversion at the left heel and 14 degrees at the right.

Plantar Fasciitis Treatment by Sports Podiatrist

Firstly, due to the flare up in this patient’s auto-immune condition, she was advised that she must re-visit and maintain communication with her specialist. It was likely that she would need to adjust and monitor her medications for some time in order to bring the inflammation under control. Plantar Fasciitis is common in patient’s with these medical conditions and it is important to address the internal workings of the body, in addition to the physical load on the feet. The Sports Podiatrist also explained that it was important to address the bio-mechanical weakness in the patient’s feet. Her flat foot condition and over-pronation would prevent or delay healing and would probably cause other foot and leg issues later in life.

Orthotics for Plantar Fasciitis

Using a 3D camera and digital software, scans were taken of this patient’s feet while her sub-talar joints were held in a neutral position. This would allow for the manufacture of prescription orthotics. The orthotics for this patient’s feet would be designed with a 15mm aperture in the mid arch, to take pressure off the plantar nodule. The orthotics would be made from a semi-rigid Carbon Fibre material which is lightweight and low bulk in the shoes. The dorsal surface of the device would be padded with slow release poron. These would be worn every day for 2 to 3 months, or until the Plantar Fasciitis had settled. Once the heel pain had subsided and the arch pain had reduced significantly, the patient would be able to walk without the orthotics occasionally. However, she was advised by the Sports Podiatrist that she would always need the orthotics due to her ligament weakness.

Plantar Fasciitis Footwear

The Sports Podiatrist also advised this patient to purchase some firm neutral shoes to suit her body weight and foot type. A brooks Dyad was the recommendation and the liner would be removed to allow for the orthotics. The firm mid-sole in this shoe would provide great support, and in conjunction with the orthotics, would allow the Plantar Fasciitis to settle without the need for injections.

The patient was also advised to perform regular calf stretches on a daily basis, as these would release the heel and take pressure off the foot. Most patient’s with Plantar Fasciitis or other conditions that cause heel pain will have tight calf muscles and regular stretching is always found to be beneficial.

6 Week Follow Up

The patient reported to the Sports Podiatrist that she got used to her orthotics quickly and was happily using them every day. She was compliant with calf stretching and was applying ice packs to the heel and arch every night before bed. She was very happy with the footwear recommendation and felt very secure in the Brooks Dyad shoes.

The Plantar Fasciitis symptoms had subsided although had not gone completely. She reported approximately 70% improvement, which was to be expected in a patient with auto-immunity. The specialist had also modified her medications and this seemed to be helping with inflammation in general, especially hands and wrists.

The patient was advised to continue with treatment and return for a 12 week check up in a further 6 weeks.

NOTE: If you have heel pain, arch pain or Plantar Fasciitis symptoms you should consult with a Sports Podiatrist. This case study is specific to one particular patient and is not general advice.

 

Written by Karl Lockett

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Case Study April 2017 – Arch Pain Treated Poorly

Arch Pain Background

Mrs X – 42 years old, presents to clinic complaining of severe heel and arch pain for over 6 months now. She is very frustrated as she had recently seen her old podiatrist who made her a pair of orthotics and had sent her on her way. Unfortunately for Mrs X she is unable to wear her orthotics as she feels “ thrown off” and experiences too much pressure through her arches. The previous podiatrist insisted she keeps wearing them despite the fact that her arch pain persists. Her heel pain has gotten worse in recent months and she feels helpless as the treatments in her eyes have proven unsuccessful.

Heel Pain

Mrs X began to experience heel pain following a holiday to Europe. The trip required lots of walking and towards the end of holiday she had no choice but to skip a few of the destinations due to the severity of the pain – leaving her and her husband quite frustrated. On return to Australia her husband sent her straight to the podiatrist to have her problem fixed. The patient described to her podiatrist an aching pain felt through the heel which radiated through the arch. The arch pain felt like a severed rope and mornings felt like she was walking on egg shells. Walking barefoot was impossible and sometimes the severity of the arch pain left her hobbling around.

Her podiatrist prescribed her a pair of custom orthotics and after fitting them to her shoes sent Mrs X away to run wild with them. A week had passed and the patient could not wear her orthotics for longer than 1 hour without experiencing great discomfort and an apparent increase in arch pain. Dissatisfied with her orthotics and frustrated she decided to return to her podiatrist. The podiatrist dismissed her claims and insisted she push through the discomfort.

A month had passed with no results and the patient began to experience a slight discomfort in her knee. Disappointed but determined to fix her problem she decided to give it one last shot and attended our clinic.

Arch Pain Assessment

Following a thorough investigation and biomechanical assessment, the underlying cause of her arch pain was attributed to her biomechanical misalignments. Her resting arch heights were measured at 15mm bilaterally (flat feet). It was concluded that her poor biomechanics resulted in an increased strain in her plantar fascia thus resulting in inflammation and micro tears.

An examination of her old orthotics showed that the arch heights were at peak of 33mm on both sides! These over corrected and exaggerated arch heights in the orthotic were forcing Mrs X out of the devices, pushing aggressively against the Plantar Fascia, and causing her more arch pain than she was already in. In addition to this problem, the overly corrected arch heights caused further strain on her knees joints.

Arch Pain Treatment

Vital for the treatment of this patient was to manufacture a prescription orthotic device which appropriately matched the natural contours of her arches. The patient had nominated to have a new pair of prescription orthotics created. A digital foot scan was taken using the latest in 3D technology capture. The orthotics were designed to correct the patients foot alignment and off-load the strain going through the plantar fascia. The script for the orthotic incorporated a plantar fascia groove and intended to match the natural contours of the foot. The orthotics were made from durable slim line carbon fibre material to allow for it to fit in all her shoes. Also integrated in the devices were a soft and comfortable top cover with a slow release poron for high impact activities.

Due to the 2-week manufacturing process the patient’s foot was strapped with rigid sports tape, in order to temporarily relieve her arch pain. The technique is simple and the patient was shown how to replace the strapping so in a few days time she could reapply it herself. This would provide some relief- as it reduces the strain through the plantar fascia. The patient was also taught a simple calf stretch to complete at home to reduce strain through the posterior muscle compartment. Finally, footwear education was provided and icing recommended every night to reduce inflammation.

Fitting Appointment

The patient returned 2 weeks later for the fitting. The orthotics fitted the patient shoes very easily and the patient expressed that the plantar fascia groove was very subtle and comfortable. The orthotics maintained good arch contours and the alignment was upheld during the gait cycle.  The patient reported that after 2 weeks of using the orthotics the level of arch pain had subsided significantly and that after 4 weeks, she was completely pain free.  A follow up session to re-assess her progress was recommended in 12 months time.

Conclusion – Arch Pain Problems

Orthotics are very commonly prescribed for a wide range of lower limb conditions, including arch pain. A corrective device is one that is prescription made and is designed specifically to the patient’s foot type. As we know, no two feet are the same thus no two orthotics should be the same. Thickness, length, corrections, padding and flexibility of device range from patient to patient depending on their condition. One thing that we see time and time again are orthotic devices that have an exaggerated arch height which in turn places more pressure in the arch and further aggravates the condition! A good orthotic is one that matches the natural contours of the foot and corrects the patient’s alignment without causing more issues.

The circumstances outlined in this article relate to one person only and should not be taken as general advice. If you are suffering with arch pain or any other form of Plantar Fasciitis then you should seek the help of a suitable qualified Sports Podiatrist.

 

Written by Karl Lockett

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Case Study April 2017 – Arch Pain by Rami Ghorra, Sports Podiatrist

Arch Pain History

Patient X whom is 28 years old presented to our clinic complaining to our sports Podiatrist of severe arch pain. He explains the pain has been on and off for over 6 months now, however only since starting soccer four weeks ago did the pain become unbearable. Within 30 minutes of field play he would be required to be benched due to the severity of pain. He attended his local GP clinic a week earlier at which point his doctor had sent him for an X-ray of both feet. The X-rays revealed heel spurs on the heel bone of both feet. The patient who was quite concerned of being diagnosed with “heel spurs”, decided to seek professional advice from one of our sports Podiatrists.

Patient X informs our sports Podiatrist that the arch pain has been ongoing for a while, approximately 6 months. However, it wasn’t until he started soccer with his friends that the pain levels surged. He also engages in other physically demanding activities; gym 3 times a week, F45 high intensity classes 4 days a week and works as a full time construction worker. Patient X describes his arch pain as a burning sensation and in the mornings feels like an uncomfortable aching pain. The tiles at home haven’t helped the arch pain either and he spends 10-15mins warming his feet up just to make it out of the bed. Gym has always played a large part of the patients’ daily routine and he was heavily into his cardio routine. He felt great once he started f45 and thought adding soccer to the list of activities would only help. Unfortunately, soccer was the tipping point and has forced his activities to a halt, and hence drove him to seek help from a Sports Podiatrist.

Physical Examination of Arch Pain

Despite the diagnosis of heel spurs by Patient X’s doctor a thorough physical examination is always warranted for an appropriate diagnosis. Our sports Podiatrist performed a squeeze test on the heels which on light pressure elicited a high level of pain. Our sports Podiatrist then palpated the entire plantar fascia from the heel through the arches which replicated the arch pain experienced during the soccer games. Pt X was informed that he had a condition known as Plantar Fasciitis and this can cause heel and / or arch pain.

Biomechanical Assesment by Sports Podiatrist

The Sports Podiatrist carried out a walking and running assessment using a treadmill and footage was taken of the patients gait. During gait the patient’s feet were collapsing through the arches – a movement known as pronation, or in this case, over pronation. This poor-alignment of his feet meant that excessive strain was placed on his plantar fascia, and this was the likely cause of his arch pain. The video was played back in slow-motion so the patient could see the significant amounts of pronation his feet were experiencing and the underlying cause of his problem. The patient informed the Sports Podiatrist that he had been feeling his feet collapse at times, particularly when walking in thongs or barefeet.

Heel Spur Misconception in Plantar Fasciitis

The diagnosis of “heel spurs” is a common misconception. The actual cause of the pain is due to the high levels of stress placed on the plantar fascia. This can affect the heel and arch area as the Plantar Fascia spans the sole of the foot. This excessive strain eventually develops into micro tears in the plantar fascia which is known as plantar fasciitis. As a result of this high strain and stress on the plantar fascia the body lays down bone in attempt to make the attachment site of the fascia stronger. The plantar heel spur is rarely the cause of heel pain, but rather the inflamed fascia. Hence we do not use the term heel spur syndrome, but instead Plantar Fasciitis.

Treatment for Arch Pain

Due to the severity and physically demanding lifestyle of the patient, a vigorous treatment plan was to be implemented promptly. The key to resolving arch pain is to unload the plantar fascia. A pair of custom made orthotics were designed by our sports podiatrist for the patient to use on a day to day basis. The orthotics were to be made from carbon fibre to allow for a slim line fit in his soccer boots without adding too much bulk to the shoes. A slow release poron material was added into the top cover to assist in high impact activities. The orthotics were made to the natural contours of the patient’s foot and were to hold his foot in a neutral alignment, thus avoiding excessive pronation. This reduction in pronation meant that less strain was placed on the plantar fascia and the arch pain would subside over time. Strapping was applied to both feet as a temporary measure while the orthotics were being made.

Additionally, a simple stretching program was designed specifically for the patient to complete daily. Our sports podiatrists had prescribed a wall stretch with a few modifications designed to lengthen the posterior muscle compartment but also reduce any risk of further straining the plantar fascia.

Shockwave therapy was also to be conducted on a weekly basis. The shockwave therapy works by promoting micro-circulation to the area allowing for an acceleration in recovery time whilst providing temporary relief. Each week the intensity of shockwave therapy was increased fast-tracking the overall recovery. The arch pain would reduce gradually over the course of the 3 weeks.

Arch Pain Follow Up with Sports Podiatrist

At the 6 week follow up the patient reported to the sports podiatrist that his arch pain had completely subsided. The patient returned to playing soccer and was able to complete a full game without any arch pain or other foot issues. His physically demanding lifestyle is back on track with gym classes, training camp and full working activities. His Plantar Fasciitis has subsided and he was asked to return to the clinic if his symptoms retuned.

PLEASE BE AWARE: The conditions laid out in this case study are specific to one individual and should never be taken as general advice. If you are suffering with arch pain or any type of foot injury you should seek the help of a qualified Sports Podiatrist.

 

Written by Karl Lockett

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Case Study 5th May – PLANTAR FASCIITIS, by Fatemeh Abdi – Podiatrist

A 36-year-old female presented to the clinic complaining of Plantar Fasciitis and heel pain in her right foot. She reported that the pain came on gradually over a period of 4 months. She was initially advised to take Panadol and roll her foot on a frozen bottle and a spikey ball. She found this to be temporarily helpful, however the heel pain consistently got worse over time. Furthermore, she had been sent for X-rays which confirmed a bony spur at the bottom of her right heel. It was explained that the spur, and not Plantar Fasciitis, was the cause of her heel pain, and not much could be done about this. She decided to seek the advice of a Podiatrist.

She is a physically active person who plays soccer 3 times a week, and runs regularly. She is a nurse by profession and her role mainly involves her standing on her feet for prolonged periods of time.

She also mentioned to the Podiatrist that her heel pain has gotten worse since there was an increase in her shift hours.

A thorough footwear assessment was conducted whereby the support and stability of the shoes she mainly wears for her sporting activities and for work were assessed. The sneakers she wore for sporting activities were supportive and suitable for her foot type. However, the shoes she wore for work were not supportive, and this may be one of the causes, and an aggravating factor for the onset of her heel pain and Plantar Fasciitis.

It was explained to the patient by the Podiatrist why her shoes were not appropriate and what features to look out for when she is looking to purchase new shoes in the future. Some recommendations were also given. She also reported that she wore non-supportive slippers around the house, which included mainly tiled floors. Hence she was also advised of the type of shoes she needs to wear around the house.

Plantar Fasciitis Examination by Podiatrist

The Podiatrist carried out a physical examination, and upon palpation of her right heel this elicited pain. This was further narrowed down to the specific anatomical positioning of the plantar fascia, which is a band of fibrous tissue located under the foot. The area closest to the inside and centre of the heel elicited the most pain on examination. Other structures were also examined; however, no pain was reported. There was also no swelling, redness or warmth present.

These findings were compared to her left heel. The plantar fascia and other structures seemed unremarkable.

It was explained to the patient by the Podiatrist that the cause of her heel pain is plantar fasciitis – which is inflammation of the plantar fascia. The misconception that her bony spur was causing her heel pain was also cleared. There are a number of reasons why the plantar fascia can get inflamed, and each was carefully examined, and explained to the patient. It wa also explained to the patient that the goal of therapy is to treat the cause of the heel pain, and not only the symptoms, so the chances of flare-ups in the future are reduced.

 BIOMECHANICAL ASSESSMENT FOR PLANTAR FASCIITIS

In order to understand the causes and/or contributing factors of her Plantar Fasciitis, a thorough biomechanical assessment was conducted by the Podiatrist. This involved a gait analysis, whereby the patient was observed walking and running on a treadmill. This was video recorded and played back to the patient, in order to provide feedback on her overall biomechanics, as well as running style, and to relate this back to her Plantar Fasciitis.

It was noted by the Podiatrist that she moderately pronated through her subtalar joints while walking, more so on the right than left. An early heel lift was also noted when she walked, meaning her heels lifted off the ground sooner than they should have in the gait cycle.This indicates tightness in the calf muscles, which was confirmed when their range of motion was assessed. Tight calf muscles increase the pull through the plantar fascia, hence contribute to further inflammation and heel pain.

It was explained that in addition to reducing inflammation of the plantar fascia, it is essential to stretch the calf muscles to reduce strain on the plantar fascia, which reduces heel pain and rids the foot from Plantar Fasciitis.

The correct way to stretch her calf muscles without increasing her heel pain was demonstrated to the patient by the Podiatrist.

Her arches were also measured, and they were very flat, and lower than average. It was explained how her low arches were also contributing to her condition.

Plantar Fasciitis Treatment

 Given the duration, severity and personal lifestyle factors of the patient, the different treatment options that were available to her were explained. In the short term, shockwave therapy was conducted at weekly intervals for 5 sessions. This is to promote blood flow and healing, which speeds up recovery time, as well as providing heel pain relief. Cases of Plantar Fasciitis will usually heal quicker if the Podiatrist applies Shock Wave Therapy.

In the long-term, a pair of prescription orthotics were prescribed. This was beneficial in controlling her pronation, flat arches, as well as unloading the plantar fascia and reducing the strain going through it, which in turn reduces her heel pain.

The patient commenced the use of her orthotics 2 weeks after the initial consultation – by which point, 2 sessions of shockwave therapy had already been conducted. This was continued until no more heel pain was reported on the 5th visit. The patient was educated on ways to reduce the likelihood of flare-ups in the future, and was reminded of the different things that can cause Plantar Fasciitis. This included keeping up with the stretches and all other advice initially given at the start of treatment.

Patient was advised to contact the clinic if her heel pain returned.

Please note: The information in this case study is specific to one particular patient and should not be taken as general advice. There are several causes of Plantar Fasciitis and if you are having foot problems, heel pain, or symptoms consistent with Plantar Fasciitis you should consult with a Podiatrist or suitably qualified healthcare practitioner.

 

Written by Karl Lockett

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Case Study 5th May – ARCH PAIN by Fatemeh Abdi – Podiatrist

A 44-year old male presented to the clinic complaining of arch pain in both feet, but more noticeable in the left. He reported to the Podiatrist that the arch pain came on gradually over a period of 2 months. He mentioned he had plantar fasciitis of the base of the heel about 4 months ago, and this was treated with orthotics and stretches. The arch pain came on after his heel pain was eradicated.

He is not a very physically active person, but walks 3 times a week, and he informs the Podiatrist that he enjoys gardening frequently. His job involves him being mainly seated, and not standing on his feet for prolonged periods.

He has noticed that his arch pain reduces when he is not wearing his shoes and orthotics, and when he massages his arches. He has been to his GP, who has advised him he still suffers from plantar fasciitis, and to keep using his orthotics and performing the stretches initially advised.

A thorough footwear assessment was conducted by the Podiatrist to ensure enough stability and support is being provided by his footwear. It was noted that the sneakers he wears for walking are not supportive enough or appropriate for his foot type. His work shoes were also not providing the best amount of support. It was explained to the patient why his shoes were not supportive, and the features to look for when purchasing new shoes in the future. Some recommendations were given.

He also mentioned to the Podiatrist that he wears sandals around the house, which have minimal arch support. He has noticed that his arch pain significantly reduces when wearing these sandals, however he attributes this to being not very physically active around the house.

He was advised to continue wearing these sandals inside the house.

Arch Pain Examination by Podiatrist

A thorough physical assessment of the heels was conducted by the Podiatrist, whereby the most common structures to become inflamed were examined, namely the plantar fascia. Palpation of the origin of the plantar fascia did not elicit pain, however palpation through his arches elicited a lot of pain, more so in the left than right.

Other structures were also examined, but no pain reported. There was also some mild redness noted surrounding the arch areas.

The Podiatrist explained to the patient that the most common area to become painful as a result of plantar fasciitis is the base of the heel, where he was originally experiencing the pain. However, his pain had since moved to the arches, and there are typically a few reasons why he now has pain in the arch of his foot.

One of the most common reasons for this is if the prescribed orthotics are not matching with the height of the patient’s arches. If the device is too high and pushing into the arches, this can further aggravate the plantar fascia and cause arch pain over time.

The patient was asked by the Podiatrist to stand bare feet and his arches were measured to be at 22mm on the left, and 20mm on the right foot. His orthotics measured 30mm for both feet. He was then asked to stand on the orthotics bare feet, and it became immediately apparent that they were aggressively pushing up against his arches.

Therefore, the most obvious cause of his arch pain were the orthotics, however his biomechanics were also assessed to find out whether there were any further contributing factors.

Biomechanical Assessment for Plantar Fasciitis

The patient was asked to walk on a treadmill and his gait was carefully examined by the Podiatrist. It was noted that he significantly pronates through his subtalar joints, more so on the left than the right.

This, in combination with his extremely low arches, was also contributing to his arch pain. The range of motion at his calf muscles were also assessed, and mild tightness was noted. The correct technique of stretching his calf muscles, without giving him further arch pain was demonstrated by the Podiatrist.

It was explained that in addition to removing the aggravating factor (his orthotics) in order to reduce his arch pain, it is important to address the other factors which may also be contributing to strain on the Plantar Fascia, in order to ensure full recovery and to reduce the likelihood of flare-ups in the future.

Arch Pain Treatment

A treatment plan was put in place to treat his arch pain. This was determined by with the severity and duration of his condition, as well as the patient’s personal lifestyle factors.

Given that he pronated significantly, and had arches below average height, the use of orthotics for controlling these biomechanical abnormalities was advised. However, his current orthotics were not appropriate as they were too high in the arches, and thus further aggravated his arch pain.

A new pair of custom made orthotics were designed by the Podiatrist for this patient, ensuring the arch of the device matched closely with the patient’s foot arches. They also controlled his pronation and unloaded the plantar fascia.

His arches were also treated with 3 sessions of shockwave therapy to promote blood flow and accelerate recovery time.

At 5 week review, he advised the Podiatrist that his arch pain had completely subsided and that he had no other symptoms. He was asked to contact the clinic if his symptoms returned.

Please note: The information in this case study is specific to one particular patient and should not be taken as general advice. There are several cause of arch pain and if you are having foot problems you should consult with a Podiatrist or suitable healthcare practitioner.

 

Written by Karl Lockett

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Case Study April 2017 – PLantar Fasciitis Following Metatarsal Injury

A fit and healthy 42 year old lady presents with heel pain and arch pain of approximately 4 months. She describes symptoms consistent with Plantar Fasciitis which came on shortly after a metatarsal foot injury. This patient is a very keen martial arts practitioner and enjoys kick boxing and karate. She has no other medical ailments and has never had Plantar Fasciitis before, boasting good foot health. She takes no medications, although Voltaren has helped recently with the symptoms of Plantar Fasciitis.

This lady reports injuring her right foot during training back in December 2017. She kicked a punch bag with the top of her foot which resulted in an acute metatarsal injury. X ray was performed within a week of the incident and came back clear with no break or fracture. The foot swelled and was bruised and was sore for several weeks. During this time she was forced to walk on the outside edge of her right foot as she was unable to fully weight bear on this leg.

After approximately 4 weeks she started to feel heel pain, then arch pain along the Plantar Fascia but was unaware of the condition known as Plantar Fasciitis. She assumed the pain was referred pain from her original metatarsal injury. After 2 months, the metatarsal injury settled and the bruising and swelling subsided, but the Plantar Fasciitis persisted. The patient then realised that this heel pain was not related to the original metatarsal injury and so she sought help. The heel pain was extreme first thing in a morning and the arch pain was present all day.

NOTE: It is commonly found that patient’s with a variety of foot injuries, unrelated to Plantar Fasciitis, can develop the condition due to limping. The altered gait increases the load on the Plantar Fascia due to poor bio-mechanics, and also causes tightness in the calf muscles. This limited range of motion in the ankle / calf muscles is one of the main causes of Plantar Fasciitis.

Plantar Fasciitis Examination

Mild pressure was applied to the medial band of the Plantar Fascia at the calcaneal attachment, which elicited a significant jump response from heel pain. Pressure was also applied to the central portion, again at the calcaneal attachment and the patient once again reported heel pain. Finger pressure along the mid fibres, running into the arch caused the patient to retract her foot as she confirmed extreme arch pain – all of this confirming an acute case of Plantar Fasciitis. There was no visible swelling and no bruising, and the patient informed the Podiatrist that she did not feel any throbbing whilst lying down or seated. Again, this would suggest that she had not torn her Plantar Fascia but that she was indeed suffering from an acute case of Plantar Fasciitis.

Plantar Fasciitis Ultra Sound Vs Ray

This lady was referred for an Ultra sound scan which is an excellent form of medical imaging for soft tissue injuries such as Plantar Fasciitis. The technique allows the Radiologist to assess the level of trauma and the amount of inflammation within the soft tissue. Unlike an x ray, which provides images of the ligament and bone – which can then allow one to observe anomalies such as heel spurs, the Ultra sound focuses on the soft tissue and can allow us to detect micro tears, laminar tears or deep surface tears within structures such as the Plantar Fascia. In cases of Plantar Fasciitis an Ultra sound should be the imaging of choice, as opposed to an X ray. It was confirmed that this patient did in fact have an acute case of Plantar Fasciitis in her right foot, but no tears were seen.

Plantar Fasciitis Treatment

This patient was informed that her Plantar Fasciitis had been going on for too long and was unlikely to settle without professional intervention. She was advised that prescription orthotics made from carbon fibre, with sufficient padding, would control her foot function and reduce strain on the Plantar Fascia. She would need to use the orthotics in her shoes every day for approximately 2 months. With this additional support in her shoes, the Plantar Fascia would heal by itself without injections and without tablets or surgery.

Using a 3D digital foot scanner, the patient’s feet were captured and saved into Orthotech software. The orthotics would take 2 weeks to make and would incorporate a Plantar Fascial groove, to further reduce strain and assist the Plantar Fasciitis.

Strapping for Plantar Fasciitis

As a temporary form of support it was decided to apply rigid sports tape to the patient’s foot. This would reduce strain on the Plantar Fascia until the orthotics were in place.

NOTE: In mild cases of Plantar Fasciitis, or very new cases with recent onset, applying strapping to the patient’s foot can provide sufficient support to allow complete healing. Orthotics are not always needed.

The strapping that was applied to this patient’s foot stayed in place for one week, and was then replaced by the Podiatrist. The patient reported some relief with the strapping in place, although her heel pain was still present overall.

The Application of Cold Packs for Plantar Fasciitis

Due to the inflammatory change within the Plantar Fascia it was decided that this patient must apply ice packs to her foot, to reduce the Plantar Fasciitis. The cold packs were to be applied every day at least once, especially in the evening for approximately 20-30 minutes. The ice packs help to reduce the inflammation and hence increase the rate of healing. They also reduce the heel pain that is present in the mornings as the foot is placed onto the ground.

2 Weeks Later

This lady came to the clinic and her orthotics were fitted into her day to day shoes. She had a seated job whereby her feet were not loaded, and hence there was no need to fit the orthotics into her office shoes. The orthotics were also fitted into her Asics sports shoes, the existing liner removed, and then checked on the treadmill. The orthotics fitted well into the desired shoes and were well tolerated. She was advised to ease into the orthotics and to remove them if she felt like she needed a break from them during the first week.

This patient was given very specific advice regarding shoes. Her foot type had been assessed and she was now equipped with the knowledge as to which shoes she should and shouldn’t wear, and which shoes would help her Plantar Fasciitis.

4 Weeks Later

This patient returned for a follow up and reported a 60% improvement in her condition. She had been compliant with the use of orthotics and her Plantar Fasciitis was improving. She was applying ice packs daily and was performing very specific calf stretches which the Podiatrist had instructed her on.

Final Check Up for Plantar Fasciitis

A further  4 weeks on and the patient reported that her Plantar Fasciitis had gone. She felt mild “stiffness” in the mornings but no pain at all, and no pain at any other time. On palpation of the medial calcaneus, central calcaneus and mid fibres there was mild pain. Her Plantar Fasciitis had not completely subsided but had improved to the point where the patient was symptom free while weight bearing.

She was advised to continue with all treatments and was permitted by the Podiatrist to return to martial arts. Due to the martial arts being bare foot, she was advised to apply strapping during her training sessions and to pull back on training if her Plantar Fasciitis symptoms returned.

PLEASE NOTE: This case study is specific to one individual and should not be taken as general advice. If you have foot pain, heel pain, arch pain or Plantar Fasciitis you should consult with a suitably qualified Sports Podiatrist.

 

Written by Karl Lockett

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Case Study – Arch Pain – Is it Plantar Fasciitis ?

ARCH PAIN – Is it Plantar Fasciitis ?

A 49 year old man visits the Sydney Heel Pain clinic and informs the Sports Podiatrist that he has been struggling with arch pain for 6 months. He thinks he has Plantar Fasciitis and has been trying to treat this himself at home, with ice packs and a Strasbourg sock. He is a healthy man and takes no medications and has enjoyed social tennis for 20 years or more. The pain in the arch of his foot is only present in the right foot, and although he has had Plantar Fasciitis in the left foot in the past, his left foot is not troubling him. His previous Plantar Fasciitis actually caused heel pain, and his arch was un affected.

This gentleman has been sleeping with the Strasbourg sock for 6 weeks and he finds it very uncomfortable to use. It wakes him in the night and due to an increase in pain he finds himself removing it. Furthermore, the sock was only partially beneficial, and the patient found only a small improvement in his arch pain, when his foot hit the ground in the morning. Throughout the day, and the longer the day went on, his arch pain would get gradually worse. He describes a burning through the sole of the foot and a tight pulling sensation. Typically, he feels pain during toe-off, as his heel lifts away from the floor. He describes an intense pain in the arch of his foot if he stands on his tip-toes or hangs his heel off the step.

This patient has had to stop playing tennis as this was causing pain during the game, and an increase in pain the following day. A course of anti-inflammatory medication did not help and after completion, his arch pain persists. His GP referred him for an x ray and this came back all clear.

ARCH PAIN – Physical examination

Firm pressure was applied to the sole of the foot, from the heel to the ball of the forefoot. As pressure was applied to the Plantar Fascia the patient reported pain, and this was similar to the arch pain that he would feel during walking or playing tennis.

There was also arch pain when the patient was asked to perform a single leg heel raise and these symptoms were consistent with Plantar Fasciitis. (As the long peroneal tendon also runs through the arch of the foot and when inflamed can give the same symptoms, it was important to exclude Peroneal tendonitis)

Ankle and sub talar joint range of motion were assessed and were found to be within normal rage. Leg length was measured and appeared to be of equal length. The joints of the foot moved well although there was some minor arthritic change the big toe joint on the right foot. Calf muscle range was fine and there was no real tightness.

BIO MECHANICAL ASSESSMENT – to find the cause of arch pain

Bisection lines were drawn on the heel and tibia and the patient was asked to walk and run on the treadmill while his foot function was recorded, with digital iPad software. Upon playback, in slow motion, it was quite clear that this patient pronated severely. His left and right foot showed signs of extreme ligament laxity and allowed and excessive amount of pronation. There was severe eversion at both heels. This was allowing excessive internal lower limb rotation and tracking issues at the knee joint. It was fairly likely that this patient’s arch pain was caused by this bio mechanical issue. The excessive pronation leading to stress and strain on the Plantar Fascia. The joints of the foot do not “lock” or function as efficiently in this over pronated position, and the muscles and tendons all work a little harder to compensate. They can only do so much in terms of giving extra support, before they fatigue and injury ensues. The Plantar Fascia is inelastic and will not lengthen with the flattening foot, so becomes strained. Most cases of Plantar Fasciitis cause heel pain, and arch pain is less common.

ARCH PAIN TREATMENT

It was decided to take digital foot scans of this patient’s feet, so that prescription orthotics could be designed and manufactured. It was important to design these in such a way that they did not aggravate the Plantar Fascia by pressing too firmly against it. Heel correction on the orthotics was paramount.

This patient was advised that he must use his new orthotics all day, every day until his arch pain had subsided. Once his condition had settled he was advised to continue to use his orthotics in order to maintain good foot function and prevent further injuries such as Plantar Fasciitis and heel pain. He was told that his arch pain would probably take 6 to 8 weeks to settle.

SHOCK WAVE THERAPY FOR ARCH PAIN

In order to stimulate blood follow and accelerate healing this gentleman was treated with 2000 reps of Shock Wave Therapy, at 5HZ and 1 Bar of pressure. The treatment was well tolerated and gave immediate pain relief. The patient was advised that after approximately 5 days his arch pain would be apparent again, and at this point he would be ready for more treatment.

Shock Wave Therapy was applied at weekly intervals for 5 weeks, and the pressure was increased to 1.3 Bar. After each session, the patient reported that his arch pain felt better, and overall, week by week, his pain was less.

STRAPPING FOR ARCH PAIN

Rigid sports tape was applied to both feet to reduce pronation and to support the joints of the foot. This was used for 2 weeks to temporarily assist foot function, until the orthotics arrived at the clinic. The patient reported that this definitely helped and that he had less arch pain with the strapping in place.

ORTHOTICS FOR ARCH PAIN

The patient was fitted with his orthotics 2 weeks after his initial appointment. He reported no problems getting used to the orthotics and was compliant with their use. After using the orthotics for 6 weeks the patient was assessed and there was no arch pain on palpation of the Plantar Fascia. He reported some minor stiffness first thing in a morning but this was mild and was improving. The patient was instructed to return to the clinic for a check up if his arch pain returned.

Please note: If you are suffering with arch pain, heel pain or Plantar Fasciitis you should not take this case study as general advice, and seek professional advice from a Sports Podiatrist.

 

Written by Karl Lockett

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Case Study February 2017 – Plantar Fasciitis and Failed Injection Therapy

Plantar Fasciitis

A 44 year old male of slight build presents to the heel pain clinic and gives a detailed history of his Plantar Fasciitis. He is a healthy man, 179cm tall and only 82 kg’s and is a keen runner. There are no known medical conditions and he takes no medications, just supplements such as Endura sports drink. He describes a good foot health history and has never injured his feet or ankles before. He has never had Plantar Fasciitis or Arch Pain before and is now feeling frustrated as the condition has been going on for some time. Despite his efforts to resolve this acute case of Plantar Fasciitis he has been feeling arch pain and heel pain for approximately 12 weeks. The pain is present every day and is very noticeable each morning when he walks. Getting out of bed is unpleasant and he has to hobble to the bathroom for at least 5 or 10 minutes before the pain eases. Throughout the day he also feels the pain if he has been sitting down, and then begins to walk. Once again, the pain eases within minutes.

Plantar Fasciitis History

He describes the heel pain as a stone bruise under the central part of his heel, which is very typical of Plantar Fasciitis. On occasions, it also feels like a stabbing pain under the heel. He also describes a tightness in the arch of his foot and when he runs there is a sudden onset of arch pain. He reports that the first few km’s of his run are uncomfortable but when he is warmed up the arch pain eases and he can continue quite happily. The heel pain also reduces within minutes and so he is able to complete his 15k’s.

After the run, when the patient has rested for approximately an hour, the pain returns. This is very typical of Plantar Fasciitis and the pain often comes back quite acutely. This patient would apply an ice pack to his foot and this would temporarily relieve his heel pain. However, the arch pain would persist.

Plantar Fasciitis Injection

In desperation, he went to visit his GP who quite rightly diagnosed Plantar Fasciitis and therefore suggested that an X ray would be of no use. The GP suggested some home remedies such as rolling the foot on an iced water bottle and stretching. The stretching seemed to increase the arch pain and the heel pain also persisted. The patient was performing heel drops off the back of a step and was pulling his toes back with a towel. It is highly likely that these stretches increased the load on the Plantar Fascia and hence were prolonging his condition. He returned to his GP who then referred him for an injection of cortisone.

The injection was performed blind and the patient reported no complications following the procedure. This patient reported that for 3 weeks there was reduced heel pain but there was no change in the arch pain. He continued to run 3 times a week seeing as the running was bearable. Within 3 weeks the heel pain returned and was feeling as painful as it was prior to the injection. The arch pain also continued and although this patient was applying ice packs daily he was still unable to walk without a limp.

This patient decided, against all his will, to refrain from running and this seemed to help a little. After 2 weeks of not running the pain was no longer acute as long as he walked with his sports shoes on and providing he took over the counter anti-inflammatories. However, each morning and after being seated he would still hobble.

Treatment for Plantar Fasciitis

It was decided by the Podiatrist at Sydney Heel Pain Clinic to refer this patient for an Ultra sound scan. He seemed to have some symptoms that indicated he had a tear in his Plantar Fascia. A treatment plan woul

mortons neuroma

d be put together once we had the report back from the imaging centre.

The report did in fact confirm Plantar Fasciitis with an intra substance tear measuring 4mm x 3mm, approximately 28mm from the attachment at the heel. Most cases of Plantar Fasciitis that we see do not involve tears but stubborn cases that are acute often do.

This patient was immediately fitted with an immobilisation boot to unload his Plantar Fascia. He walked back and forth in the treatment room for several minutes, with no heel pain and reported no arch pain at all.

He was advised that he would need to be in the Immobilisation boot for at least 3 weeks and that he should wear it at all times when standing and walking. He was advised to remove the boot when sleeping, showering and driving. The patient was instructed to apply ice packs to his heel each evening before bed and to refrain from all the home remedies that he was doing prior to coming to see us. He was assessed for a specific foot type and given a list of 3 specific shoes that suited his foot function. These would become his running shoes, but he would also be using these in the short term when he was ready to come out of the boot.

He was given a list of things that help the Plantar Fascia to heel, and a list of things that we believe aggravate it and prolong the arch pain. There is a lot of confusion for patient’s when trying to decide which treatment’s to engage in and which remedies are beneficial for Plantar Fasciitis, and so he was given clear instructions in a 4 page document.

Follow up and Review of Heel and Arch Pain

After 3 weeks the immobilisation boot was removed and the patient was reassessed. On palpation of the medial heel and plantar arch the patient reported mild pain. He also mentioned that his morning pain was considerably reduced.

It was decided to use some rigid sports tape to strap and support the foot and also allow further healing. Calf muscle range was assessed and a specific stretching technique was demonstrated. Regular calf stretches were to be avoided as these can prolong Plantar Fasciitis.

Ice packs were to be continued. One week later there was further improvement and no more sessions were required. The patient was advised how to return to running and was asked to come back to the clinic if his heel or arch pain returned.

Please note: This case study is not general advice and if you have Plantar Fasciitis or any type of heel pain you should see a suitably qualified practitioner.

 

Written by Karl Lockett

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