Case study 9 June 2016 – Plantar Fasciitis

A 35-year- old female presents with heel pain in her right foot, which has been present over 6 months. She runs frequently but does not remember sustaining an injury. She reports of increased running activity in the last 2 months. Her job also involves her standing on her feet for extended periods of time.

She thinks the pain is due to a heel spur at the bottom of her foot as shown on an X-ray. Her heel hurts with the first few steps in the morning and subsides shortly after.

Upon visual examination there is no swelling or redness around the heel. On physical examination the medial slip of the Plantar Fascia is very sore.

She has Plantar Fasciitis – which is a very common condition causing inflammation of the Plantar Fascia, a ligamentous structure which attaches to the heel bone. It is explained to her that the heel spur is not causing her heel pain, but rather the pulling of the inflamed Plantar Fascia on to the heel bone.

A thorough biomechanical assessment is conducted and significant pronation of both feet is noted on gait analysis. The range of motion at calf muscles is also checked, and they are very tight – which exacerbates her condition.

The patient reports that she has been stretching her calf muscles and the bottom of her foot regularly. The stretches have not helped. She gets pain while doing the stretches, as the technique is incorrect, which is putting strain through the Plantar Fascia. Furthermore, her footwear is not appropriate for her foot function, which delays the recovery of her condition.

TREATMENT

A treatment plan was put into place to suit the patient’s personal circumstances. In the short term, the patient’s heel was treated with the Shockwave Therapy to increase blood flow to the area and stimulate healing. This was done at weekly intervals for 6 weeks. Patient was asked to stop all incorrect stretches, which were further irritating her condition. The correct technique to perform calf stretches was demonstrated and patient was asked to maintain good range. She was also advised to apply ice packs to the plantar heel area to reduce inflammation.

In the long term, a pair of custom-made prescription orthotics were placed in her shoes to unload the plantar fascia and allow it to recover, as well as controlling her excessive pronation. She will continue to wear the orthotics beyond the termination of her symptoms, as she is on her feet all day for work and the use of orthotics will provide support to the feet and prevent these problems from happening again. The patient was also advised to make footwear changes.

Heel pain subsided within the usual 6 week period and patient was asked to contact the clinic if pain retuned.