Case Study – November 2016 Plantar Fasciitis Causing Arch Pain

History

A 56-year-old retiree has been suffering with Arch Pain due to Plantar Fasciitis for approximately 6 months. She is going through menopause and reports several of the typical symptoms such as facial flushing. While the exact etiology is unknown, it is not uncommon to find patient’s who are going through this change who develop acute Arch Pain.

This lady describes burning and a tearing pain through the arches of both feet and she is forced to hobble when weight bearing. She confirms that the Arch Pain is unbearable in the mornings when she walks from her bed, and is also very sore after periods of being seated. She has never had Plantar Fasciitis before and has always had good foot function, without any significant foot problems.

In order to make life a little easier, and to reduce the Arch Pain, she has been given prescription anti-inflammatories, which she takes in conjunction with her hormone replacement therapy medication. Her regular GP did not mention the correlation between Plantar Fasciitis and menopause but her endocrinologist was open to the possibility that they were connected.

This patient usually enjoys a morning walk of approximately 3 km’s and the occasional game of tennis, but she has had to refrain from all types of physical activity because of this Plantar Fasciitis. She applies ice packs to each foot every night before bed and also at lunch time when at home. The ice packs reduce the pain but only temporarily. Her GP also asked her to role her feet on a tennis ball but she finds that this irritates the fascia and increases the pain.

Arch Pain and Footwear

This lady has been wearing her tennis shoes as much as possible as she finds they give her more support and she feels a little less pain. When she wears ballet flats or soft summer sandals her Arch Pain increases. Walking bare foot is also a problem and she reports that this seems to exacerbate her Plantar Fasciitis.

Arch Pain – Physical Examination

As pressure was applied to the mid arch of the patient’s foot, distal to the heel, she reported extreme pain and retracted her foot away from the Podiatrist. An area of approximately 5cm x 3cm was symptomatic throughout both arches. The area of pain correlates with Plantar Fasciitis and there was also some pain more proximally at the attachment of the Plantar Fascia, at both heels. Typically with Plantar Fasciitis the pain is in one foot and is usually more prominent at the heel. In cases like this where the patient has menopause or some other underlying chronic illness the pain is often in both feet and can be more prominent in the arch as opposed to the heel. Heel pain can still be present but the main symptom is usually Arch Pain.

Plantar Fasciitis Treatment

This patient had not been receiving treatment for her Plantar Fasciitis from her GP or any other allied health practitioner. It was explained to her that her condition had likely come about due to the hormonal changes within her body and that this was a rare cause of Plantar Fasciitis. She was advised that she should consult with her endocrinologist with a view to changing or modifying her medications. It was also explained to this patient that in usual circumstances we often use orthotics to unload the Plantar Fascia but in her case the orthotics would probably cause pain. The pressure and support from the orthotics against the sole of the foot would be too much for her to tolerate, as her Plantar Fasciitis was acute. Other treatment’s such as immobilisation boots were not an option as they are designed to treat one foot only and not both simultaneously. Shock wave therapy was deemed inappropriate as both feet seemed hot and red and hence circulation was not an issue. To this end it was decided to offer some pain relief via the use of acupuncture needles, and some support with rigid sports tape.

Dry needling is a western version of traditional Chinese acupuncture whereby needles are inserted into trigger points along a muscle. This refers chemical and circulatory changes along the referral pattern line, to other parts of the body. In this case, the needles were inserted in to the calf muscles and the sole of the foot, and this provided relief from the Arch Pain. Dry needling is very good for pain relief from Plantar Fasciitis and it also softens and loosens the calf muscles which helps with bio mechanics. In turn, this helps to unload the Plantar Fascia.

Rigid sports tape was applied to both feet using a technique that would reduce the spread of the bones in the feet and hence help to unload the plantar fascia, but without applying pressure to the fascia itself – which would induce Arch Pain. The patient was advised that the strapping should remain in place for as long as possible, usually 5 days, and that it should be reapplied at home once it comes off. Strapping the feet continually for at least 3 weeks would become part of an ongoing treatment plan. In addition to the strapping, the patient was instructed to apply ice packs as frequently as possible while elevating her feet, at least twice a day for 30 minutes. She was asked to continue using her tennis shoes and to avoid soft, flat shoes and walking bare foot. She was advised not to role her feet on a tennis ball as this could irritate the Plantar Fascia and increase the Arch Pain.

Once again, it was important for this patient to revisit her endocrinologist as the cause of her Plantar Fasciitis did not seem to be physical but more so hormonal. While the treatment’s suggested here were important to help with the Arch Pain, they would not remove the cause of the condition. Changes to HRT usually take some time to take affect and so it was expected that any improvement would be 2 to 3 months away. As yet, there has been no follow up appointment with this patient so we have not been able to monitor her Arch Pain or Plantar Fasciitis.

Please note that this is a case study of one individual and the information here should not be taken as general advice.