Case Study 2019 Heel Pain After Running

New Patient History of Heel Pain After Running

A 39-year-old male presented to the Sydney heel pain clinic complaining of heel pain when running. This gentleman had been a keen runner for more than 10 years and was never under any podiatry care for foot problems such as plantar fasciitis. He reports to the sports podiatrist that approximately four months ago he changed his running shoe from one model to another, and not long after began to feel heal pain when running. He initially presumed he had bruised his heel and therefore decided to carry on with his exercise regime. He would ordinarily run approximately 7 km every morning before work, and would also carry out a 20 km run on the weekend. He reports to the podiatrist that after approximately 3 to 4 km the heel pain would subside slightly and he would be able to continue. However, later in the run his heel pain would return while he was running. After his exercise, the patient would remove his shoes and go through his routine of shower and stretching. Once this was completed, he felt a severe increase in the pain in the bottom of his heel. Typical of plantar fasciitis.

This person also reported significant heel pain in the morning when getting out of bed. He would need to avoid pressure on the base of his right heel and instead walk on his toes. He would favor the pressure on his left foot in order to have avoid the pain from the running injury to his right foot.

This patient reported to his chiropractor that he was experiencing heel pain when running. The chiropractor carried out some foot and ankle mobilizations and recommended some foot stretches. However, the heel pain when running continued. After approximately four sessions with the chiropractor the patient paid a visit to his regular GP. The doctor advised the patients that if he was experiencing heel pain when running, then he probably had a condition known as heel spurs or plantar fasciitis. The patient was referred for an x-ray and an ultrasound. The report from the x-ray confirmed that there was no heel spur but the report from the ultrasound suggested significant plantar fasciitis.The general practitioner that advised the patient to seek the help of a sports podiatrist.

What was the Cause of the Heel Pain When Running

The sports Podiatrist carried out a thorough physical examination to confirm the cause of the patient’s heel pain when running. The patient had all of the classic signs and symptoms of plantar fasciitis, when pressure was applied to the base of the heel and the medial aspect. A detailed biomechanical assessment was carried out on the treadmill and the patient’s biomechanics were recorded using digital software on an iPad. It was very clear that the patient demonstrated an inherent weaker foot type due to ligament laxity, leading to severe foot instability and overpronation. The patient had been using Asics gel Kayano running shoes previously which would have provided excellent support for this foot type. Upon assessment of the patient’s most recent running shoes, which were an Asics DS trainer, it became apparent that the minimal support from this latter running shoe would have been responsible for the onset of the heel pain when running.

The sudden change from one supportive shoe to another soft shoe often leads to biomechanical sporting injuries, as the foot and ankle do not have time to adapt sufficiently. It is not uncommon for podiatrists to experience this kind of problem in the clinic, when patients present with heel pain conditions such as plantar fasciitis or Achilles tendonitis.

Treatment for Heel Pain When Running

Importantly, for this patient to eradicate the heel pain when running, it was highly recommended that he revert to his Asics gel kayano. It was also decided to carry out a course of shockwave therapy treatment to stimulate healing. The patient returned to the clinic once per week for 6 weeks to receive shockwave therapy sessions. For the first 3 weeks of the shockwave therapy treatment the patient was advised to stop running. He was advised to wear his running shoes as frequently as possible, even when not exercising. The patient was given one very specific plantar fasciitis home remedy in the form of a supinated calf stretch. Many of the plantar fasciitis home remedies are problematic and the patient was advised of this. The patient was advised to avoid standing or walking in bare feet and using footwear such as thongs and slippers.

After the third session of shockwave therapy this patient reported an improvement of approximately 70%. At this stage it was decided to allow the patient to return to some short sessions of running. There was no increase in symptoms and his condition did not regress. The patient did not experience any significant heel pain when running. After the sixth and final shock wave therapy session, the patient reported very minimal pain in the mornings when rising from bed, and no pain at any other times of the day. On rare occasions he did experience some mild heel pain when running, but this was only during the first 2 kilometers of his exercise. The patient was advised to gradually build up his distance and frequency of running and to contact the clinic if his condition regressed or if there was a return of the heel pain when running. No further appointments were made for this patient and his file was closed.

 

Please note that the information contained in this case today is specific to one particular patient and should not be taken as general advice. If you are experiencing heel pain when running or if you think you have plantar fasciitis you should seek the help of a suitably qualified sports podiatrist or other healthcare practitioner. The podiatrists at Sydney heel pain clinic have a special interest in treating heel pain when running as well as all inflammatory heal pain conditions such as plantar fasciitis and Achilles tendonitis. they have vast experience and the use of shockwave therapy as a treatment modality for heel pain and other foot and ankle conditions. The clinic does not promise or guarantee specific treatment plans or outcomes unless we have carried out a detailed history and thourough physical and biomechanical examination.

This article was written by Karl Lockett, sports podiatrist and practice manager at Sydney heel pain clinic. The clinic can be contacted on the following phone number 9388-3322 or the following email address help@sydneyheelpain.com.au

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