Case Study March 2017 – Plantar Fasciitis and Tight Calf Muscles

Plantar Fasciitis History

A new patient with heel pain arrives at the clinic and complains of Plantar Fasciitis in both feet. She is 45 years of age and reports recently gaining weight. The pain in the heel has been present for 6 months and is very noticeable in the early mornings, when the patient rises from bed. In the middle of the night, if she has to attend to her children, she finds it very difficult to walk without hobbling. The pain from the Plantar Fasciitis tends to ease after a few minutes of walking but is present every day. Throughout the day, if the patient has been seated and then stands up to walk, she must move with a limp for a short while until the heel pain subsides slightly. The Plantar Fasciitis started in her left foot first, and after 2 months it developed in the right foot.

This patient recalls purchasing a new pair of shoes which she wore most of the time, prior to the development of her condition. She reports that the shoes were very soft and comfortable but within 3 weeks of purchasing them, the Plantar Fasciitis started to develop. This lady is 19 kilos overweight and has been mindful of her body mass for approximately 12 months, while struggling to shed the pounds. She is borderline diabetic but does not take medication. Her GP is monitoring her blood sugar levels and a dietitian is helping with food consumption.

Prior to the onset of this Plantar Fasciitis, and the associated acute pain that this lady endures, she enjoyed Zumba and long walks. Since the heel pain has taken hold, she has stopped Zumba and has reduced the frequency and distance of walks. Once warmed up, and with the help of a solid walking shoe, she can enjoy a walk of approximately 45 minutes. She informs the podiatrist that her calf muscles have been aching most days, and that she waked in the night with calf cramps from time to time. When seated, she is aware of twitching in the calf muscles too.

In an attempt to reduce the pain she has been rolling her foot on a frozen water bottle but she has found short lived, minimal relief from this remedy. She read on line that people with Plantar Fasciitis should hang their heels off a step in an attempt to stretch the sole of the foot. After a week of trying this she reports no improvement and sometimes an increase in the over-all amount of pain.

Possible Causes of this Patient’s Plantar Fasciitis

In this case there appears to be a combination of related factors that could have caused this ladies Plantar Fasciitis. Primarily, and increase in body weight puts more stress on the feet. Combined with the use of a soft shoe which provides cushioning, but not support, her feet would have been “working harder” and the Plantar Fascia would have been stressed and strained, causing it to repeatedly pull on the base of the heel. Furthermore, both of the above can lead to tightness in the calf muscles, as they again “work harder” to carry the additional body weight and compensate for the lack of support in the soft shoes.

Assessing the Plantar Fasciitis

Firm pressure along the medial slip of the Plantar Fascia caused the patient to retract her foot due to pain, confirming that she did in fact have all the classic signs and symptoms of Plantar Fasciitis. Pain was also present at the base of the heel, centrally. There was also mild discomfort more distally, into the arch of the foot and the patient reported a feeling of “tightness”.  Calf muscle range was limited and the muscles group was tight.

Plantar Fasciitis Treatment

This patient was advised to stop using the soft and cushioning shoes and was given 3 brands to choose from that would suit her foot type and assist in the recovery of her Plantar Fasciitis. These shoes would be more supportive. She was shown how to perform supinated calf stretched that would release the heel, without straining the Plantar Fascia. She would need to stretch 3 times a day for the next month. This patient was advised to continue working with her dietitian so that she could take some body weight off her feet, and to swim instead of walk, as exercise. Patient’s with Plantar Fasciitis will always benefit from non-weight bearing activities like swimming as there is no stress on the foot. Rigid sports tape was applied to both feet, and this was to remain in place until her next appointment in a week. This lady was asked to install the Sydney Heel Pain mobile phone app which outlines treatment and provides information relating to things that should be avoided.  She was then treated with Shock Wave Therapy – 2000 reps at 1.4 Bar and 5 HZ.  She was asked to stop rolling her foot on a frozen bottle, and to use a soft ice pack instead. She was also asked to stop hanging her heel off the back of a step.

If after 3 weeks, and 3 sessions with the Shock Wave Therapy machine, her Plantar Fasciitis was not improving sufficiently, then the treatment plan would be modified.

After 3 weeks, this lady reported an improvement of approximately 30%. Each week she was feeling less pain. The healing of her Plantar Fasciitis was typical, and to be expected. Healing is slow due to a reduced blood flow to the Plantar Fascia, but the Shock Wave Therapy promotes circulation.

After 6 weeks and 6 sessions of Shock Wave Therapy this lady was approximately 80% better. She reported that while her Plantar Fasciitis had not subsided completely it was not causing much pain at all. In the mornings, there was mild discomfort but this was reducing with time. Throughout the day she was pain free and she no longer hobbled after being seated. Her calf range was better, but still needed continued attention. To this end, she was referred to a physiotherapist who is very capable with dry needling and calf massage / soft tissue release.

A further 4 weeks on and the patient retuned for follow up. She was free from heel pain and her Plantar Fasciitis had fully recovered. She was asked to return to the clinic if her condition deteriorated.

A NOTE:

Please do not take this case study as general medical advice. If you have Plantar Fasciitis you should consult with a Sports podiatrist.