A 52 year old female presents to the Sydney heel pain clinic in Miranda, complaining of heel pain which she thinks is due to plantar fasciitis. She has been suffering with this condition for nearly 2 years and has been unable to find a solution. The plantar fasciitis is causing pain every single day and is very noticeable first thing in the morning when the patient commences her day. She gets out of bed each morning and is hobbling around the bedroom and cannot walk to the bathroom without limping. She also reports to the podiatrist that the pain from the plantar fasciitis is present each time she stands from a seated position. For example, when she drives to the local gardening centre and gets out of the car she hobbles for the first minute or so. Furthermore, after she has been seated watching television or having dinner, when she stands up to walk the pain from the plantar fasciitis causes her to limp. This patient is a member of a local community group and two of the members suggested that she was suffering with plantar fasciitis. Each of these members, had experienced the same symptoms of heel pain in the past. To this end, the patient decided to see her local GP to seek advice. The GP advised the patient that plantar fasciitis is a condition that is difficult to treat and will commonly take approximately 18 months to subside. The GP did not offer any treatments or solutions but did suggest that the patient take anti-inflammatory medication if the pain becomes unbearable. The patient refused to take medication and decided to continue her search for treatment of her painful condition. This patient has a long history of ankle sprains but has never had plantar fasciitis before. She is approximately 10 kilos overweight but is generally in good health. She takes no medication.
The sports podiatrist takes a detailed history from the patient in order to determine the cause of her plantar fasciitis. The patient reports that she is a keen gardener and spends approximately 10 to 12 hours per week working around her grounds. She tends to her lawns and spends a lot of time kneeling down, tending to the plants and flowers and soil beds. She also walks approximately 3 times a week with her husband as a form of exercise. She is unsure as to the cause of the plantar fasciitis. She cannot recall anything different in her lifestyle that could have contributed to this heel pain. The podiatrist probes a little deeper with his questions as he is suspicious about the positions that her foot adopts while gardening. It becomes apparent that this patient spends time kneeling, with her foot flexed – the pressure on her forefoot pushing her toes backwards.
The podiatrist is able to determine that this foot position puts stress on the plantar fascia and is possibly the cause of her plantar fasciitis. He advises the patient accordingly. The patient questions this suggestion, as she has always positioned herself this way when gardening. The podiatrist explains that this could be a cumulative problem and in particular could relate to the shoes becoming fatigued and more flexible, therefore less supportive. The podiatrist advises that the patient extend her ankle completely when kneeling, so that the top of her foot is in contact with the floor and so that there is no pressure on the sole of the foot at all. This would remove any stress or tension running through the plantar fascia, and would help with the healing of her plantar fasciitis. Long term, this would also ensure that her plantar fasciitis would be less likely to reoccur.
The sports podiatrist carries out a footwear assessment in order to determine whether or not her footwear has been a contributing factor in the onset of her plantar fasciitis. It becomes very quickly apparent that both her walking shoes and gardening shoes are well worn and are therefore fatigued. Her footwear has lost the ability to support her feet. The podiatrist advises that patient that this is likely a contributing factor in the development of her plantar fasciitis as the foot would become more and more fatigued over time, and that the intrinsic foot muscles would soon lose the ability to support the foot efficiently. To this end, the plantar fascia would be working overtime. It would only be a matter of time before the plantar fascia becomes stressed and inflamed.
The sports podiatrist puts a treatment plan in place for this patients plantar fasciitis. Primarily the patient is advised to purchase two new pairs of shoes. The podiatrist advises that she must purchase firm and non flexible cross trainers for walking, and a newer pair of gardening shoes offering more support. The sole of the shoes to be stiffer and less flexible. The patient is also advised to avoid walking in flat and flexible shoes, and to reduce the amount of time that she spends walking barefoot. At home, she is instructed to apply ice packs to the affected heel everyday at least once. The ice pack should be applied for at least 30 minutes in order to reduce swelling. By reducing the swelling, the plantar fasciitis would be more likely to heal over a shorter time frame. She is also advised to cease any home treatments that she is engaged in. In particular the application of heat to the affected area is detrimental and is therefore ill-advised.
The podiatrist determines that the patient would benefit from dry needling in order to increase the recovery rate of her plantar fasciitis. Acupuncture needles were used for deep tissue dry needling and were inserted into the patients posterior lower leg and quadratus plantae muscles. The treatment was well tolerated and signs of vaso dilation were observed.
The sports podiatrist downloaded and installed the Sydney heel pain mobile app for plantar fasciitis. The application contains information surrounding treatment. This includes but is not limited to footwear advice and stretching techniques.
The podiatrist assessed the patient’s new footwear and carried out one further session of dry needling using acupuncture needles. Evaluation was good and footwear was determined to be appropriate. Dry needling was well tolerated and further vaso dilation was observed.
4 weeks later the patient returned to see the sports podiatrist for a follow-up of her plantar fasciitis. She reported a significant improvement in pain. Her new firm footwear was comfortable and was feeling beneficial. She reported a feeling that the dry needling was improving the range of motion at her ankle joint and was therefore helping to reduce the pain from her plantar fasciitis. The “start up” pain from a seated position and from her bed had improved significantly.
The pain from the plantar fasciitis had subsided completely and the patient was able to walk on the treadmill barefoot, without pain. On palpation, there was no pain beneath the heel or along the band of plantar fascia. This patient was advised that her plantar fasciitis had now subsided and she could continue normal physical activity. Naturally, she was advised to reach out to the clinic if her plantar fasciitis returned or if she felt any other form of foot pain.
Please note that the information contained in this case study is specific to one particular patient, and if you experience heel pain or plantar fasciitis you should consult with a sports podiatrist or suitably qualified healthcare practitioner.
Written by Karl Lockett