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.