A 52 year old female presents to the Sydney heel pain clinic complaining of plantar fasciitis in her left heel. She feels pain under the base of the heel on a day-to-day basis and has been struggling with these symptoms for approximately 4 months. The plantar fasciitis is causing this patient to limp and she is unable to walk normally without compensating for the foot pain. She reports to the sports podiatrist that she feels extreme pain first thing in the morning when she starts to walk. Within 10 to 15 minutes of walking around the house the pain from the plantar fasciitis drops slightly and she is able to move a bit more freely. She finds temporary relief from the heel pain if she takes anti-inflammatory medication or applies ice packs to the base of the heel before bed. This lady is a healthy individual although she is carrying approximately 10 kilos more body weight than she would like to. She takes no medication aside from Lipitor for cholesterol. This lady enjoys regular exercise and is a member of the local Tennis Club. She has not played tennis for approximately 2 months due to the plantar fasciitis. She reports to the podiatrist that she feels that the cause of her heel pain is due to wearing a relatively soft office shoe that she purchased approximately 6 months ago. Not long after buying these shoes she describes the onset of mild foot pain particularly in the heel and arch of her left foot. She has since stopped using these shoes and has reverted to her regular office shoe which is more supportive. She paid a visit to her local doctor who quite rightly diagnosed plantar fasciitis and indicated that an x-ray would not be necessary and that she should visit a sports podiatrist for treatment. This patient has never seen a podiatrist before and has never experienced plantar fasciitis or any other form of chronic foot pain. She arrives at the Sydney heel pain clinic today feeling frustrated and desperate for treatment of this debilitating condition. She is advised that there are several treatment options for plantar fasciitis and the podiatrist encourages her to remain positive.
The sports podiatrist carried out a physical assessment in order to confirm that this patient has plantar fasciitis. When pressure was applied to the base of the heel and through the arch of the foot along the line of a plantar fascia, the patient reported pain on palpation of these anatomical landmarks, consistent with plantar fasciitis. The sports podiatrist confirms and informs the patient that she does in fact have plantar fasciitis and that a biomechanical assessment will be carried out in order to determine the cause of her condition.
In order to determine the cause of this patients’ plantar fasciitis, the sports podiatrist analysed her feet as she walked on a treadmill. Anatomical markers were drawn on the back of the patient’s feet and lower leg and her gait was recorded using digital software on an iPad. The footage was replayed in slow motion and foot function was noted. The sports podiatrist was able to detect over pronation in both feet, but more so in the left. There was bulging of the ankle and subtalar joint, medially on both feet. The bisection line on the back of the left heel was extremely angulated in comparison to the right. This indicates over pronation, which is usually caused by a weakness in the foot and ankle ligaments. There was an overload of pressure through the first toe joint and insufficient resupination. The left foot was also more externally rotated than the right.
As is usually the case in patients with plantar fasciitis, this patient demonstrated tightness in the calf muscles. Both the gastrocnemius and the soleus muscles showed a limited range of motion, affecting movement through the ankle joint.
The sports podiatrist explained to this patient that in order to treat her plantar fasciitis she would need to wear some prescription orthotics inside her shoes for approximately 2 months. The orthotics would unload the plantar fascia and allow it to heal without injections or medication. The podiatrist arranged three-dimensional digital foot scans to capture the shape of the patient’s feet. The scans were emailed to the orthotic laboratory so that carbon fibre orthotics could be manufactured and fitted to her day today shoes. It was explained to the patient that people with plantar fasciitis recover more quickly when they wear their orthotics as much as possible. The patient was also educated and advised accordingly as to which type of shoes would be more appropriate for her condition. She was given the Sydney Heel Pain mobile app to install on her iPhone, which contains important information and advice. The podiatrist demonstrated a very specific stretch that the patient was advised to do on a day to day basis. As a temporary measure, the patient’s foot was strapped using rigid sports tape. Two weeks later the orthotics had arrived and the patient presented to the clinic with a variety of shoes. The orthotics were checked against the patient’s feet and then adjusted to fit her footwear. The orthotics fitted well and were well tolerated as she walked on the treadmill. The patient immediately felt a slight drop off in the pain from her plantar fasciitis. This lady was informed that she should introduce the orthotics gradually and then wear them as much as possible while continuing to stretch her calf muscles and follow the advice that was given to her, and outlined in the plantar fasciitis mobile app on her phone.
This patient was compliant with the use of the orthotics and firm shoes, and returned after 6 weeks with no pain from plantar fasciitis. She had been diligently stretching her calf muscles and reported a much greater range of motion through her ankle joint. On palpation of the affected area there was no pain around the base of the heel or the arch of the foot. She was informed that she could return to tennis and resume normal activity, but to return to the clinic if her symptoms came back.
Please note that the information contained in this case study is specific to one particular patient and should not be taken as general advice. If you suffer with foot pain or if you think you have plantar fasciitis you should seek an appointment with a suitably qualified sports podiatrist.
Written by Karl Lockett