Case Study 28th June, 2017 – Plantar Fasciitis

History of Plantar Fasciitis

A gentleman of 42 years of age explained to the podiatrist that he was experiencing severe heel and arch pain in his right foot, and had symptoms consistent with plantar fasciitis.  This was apparent to him during the last 5 – 6 weeks and was gradually getting worse.   He describes the pain as a ‘tightness’ in the arch of his foot and a pulling sensation.  The pain is worse first thing in the morning when he first puts his feet to the floor.   This description relates to the pain caused by Plantar Fasciitis.  He has not seen his GP regarding this pain but was anxious to seek the opinion of a sports podiatrist, who had been recommended to him. He has not experienced foot problems in the past and has never suffered with plantar fasciitis.

This patient reports that he does wear thongs quite often as he is a kite-surfer and spends a lot of time on the beach.  This sport requires a lot of upper strength to control the kite whilst the lower half of the body’s strength extends to the feet where he has to balance on the surf board, placing his feet flat to the board inside footgrips.  He complains this creates unbearable strain and pain to his arch and his calf muscles.  He does not always notice the Plantar Fasciitis while surfing, but is very aware of the foot pain afterwards.

This patient had used ice packs on his foot and also elevated his leg to try to relieve his pain, and did find short term relief for a while before the aggravating pain returned.   He mentioned it was unbearable walking in his general every day footwear which he has to wear for work. He also found it impossible to walk in his bare feet on the beach.  The patient also complained he was unable to exercise in the gym as the normal movements he used to be able to carry out were creating too much pain.  The load bearing weights were making it impossible for him to train as the pressure of the weights were causing his calf muscles to tighten sending excruciating pain down his leg to his ankle and arch of his foot. This is common in patient’s with plantar fasciitis.

Physical Examination – Plantar Fasciitis

The patient reported strong pain when pressure was applied to the central aspect of the plantar heel and along the medial aspect of the calcaneus.  This is typical of plantar fasciitis. There was also a limited range of motion at the ankle joint which is due to tightness in the calf muscles.  This is also a common finding in patient’s with of Plantar Fasciitis. The Podiatrist explained to the patient that if their problem is reported at the earliest time of discomfort, which is within the first few weeks, this usually brings about quicker and more reliable results when it comes to treatment. Patients who leave their condition for more than a month or two usually take a little longer to heal and sometimes require more intervention. Plantar fasciitis treatment can range from strapping and stretching through to orthotic therapy and footwear change.  This patient was treated with sports tape, to strap and hold the affected foot and to take strain off the plantar fascia.  He felt immediate relief as he walked around the room and reported some reduction in heel pain.  His foot was still sore but felt a little easier and it would take 4-6 weeks for the plantar fasciitis to heal completely.

Footwear Changes for the Plantar Fasciitis

This patient was advised to restrict walking on the beach whilst treating his complaint, as it is crucial his foot be kept stable, and walking on the sand would definitely aggravate the plantar fasciitis. It was explained to the patient that this restriction would only apply until the affected area of the foot had recovered. He was given a specific model of sports shoe to use for the next month or so – a shoe that would help the plantar fasciitis recover, but one that could also be used afterwards as a training shoe / street shoe. This sports shoe was firm and relatively inflexible through the mid sole with some cushioning inside.

The specific shoes that were recommended to this gentleman are not available in all stores, and he was informed which stores he could purchase these shoes that had been matched to his foot type.  It was explained to him that he would be ok to wear whatever shoes he wanted once his foot had recovered and that he could lead a normal lifestyle and wear thongs from time to time in future, once the plantar fasciitis had recovered.

This patient was also shown a safe and effective set of calf stretches to be carried out both in the morning and evening.  It was also advised that he apply ice packs to the affected heel 2 to 3 times daily whilst elevating his leg.

One Week Follow Up

This patient was reviewed after one week and stated approximately 30% improvement. He was told to carry on with the ice packs and elevation of his leg together with the calf stretches twice a day. The plantar fasciitis was still present although it was becoming more bearable.

3 Week Follow Ups

The patient reported further improvement.  When the heel was examined, there was mild pain on palpation from the plantar fasciitis but it was considerably less than when first examined. Over all improvement was approximately 50%. To this end, it was decided to commence weekly sessions of shock wave therapy to accelerate the healing.

Shock Wave Therapy for Plantar Fasciitis

This patient was treated with 2000 reps of shock wave therapy at a speed of 5 HZ and 1.8 bar of pressure, which would stimulate blood flow and assist in the recovery of the plantar fasciitis. The treatment stimulates the turn over of new cell production while reducing chemical substances in the tissue that allow the transmission of pain along nerves. 3 treatments were carried out at weekly intervals, each treatment involving a slight increase in pressure, as could be tolerated.

Treatment was stopped after 3 sessions / 3 weeks of shock wave therapy. Here, at the 6 week check up there was no pain on palpation and the patient was carrying on his day to day routine without pain. The patient was informed that his plantar fasciitis had recovered but that he should always be mindful of the contributing factors.

PLEASE NOTE: The information contained in this case study relates to one individual and should not be taken as general advice. If you suffer with plantar fasciitis or any other cause of heel pain you should seek the advice and treatment of a suitable qualified medical practitioner.