A 38 year old runner presented to the Sydney heel pain clinic complaining of plantar fasciitis in both feet. This gentleman explains to the sports podiatrist that his condition has been ongoing for approximately 4 months. He describes a stone bruise sensation in the base of his heel which troubles him on a day-to-day basis. The pain in his left heel is worse than the pain in his right heel. He also explains to the podiatrist that the heel pain is dreadful every morning as he takes his first few steps of the day. He has never suffered with plantar fasciitis before but does report to the podiatrist that he has experienced Achilles tendonitis approximately 12 months ago. The Achilles tendonitis lasted approximately 2 months and was successfully treated using shockwave therapy and calf stretching techniques. The patient covers approximately 60 km per week and enjoys running approximately 3 to 4 times per week. He is a type 1 diabetic but his blood sugar is under control. He’s not overweight and does not report any other medical conditions.
This patient became frustrated with his heel pain and attempted 2 find treatment for his plantar fasciitis. He naturally paid a visit to the podiatrist that was able to help him with his previous Achilles tendon problem. The podiatrist recommended footwear changes and provided calf stretching techniques and also commenced a 4 week course of shock Wave therapy.
After approximately 6 weeks his heel pain persisted and his plantar fasciitis was not improving.
The sports podiatrist carried out a physical assessment in order to diagnose the plantar fasciitis and to exclude other causes of heel pain. The patient reported significant pain when pressure was applied to the base of the heel and the medial aspect. The podiatrist advised the patients that these were the typical pain locations in patients with plantar fasciitis.
The patient was able to perform single leg heel raises on each foot without pain.
Using digital software, the sports podiatrist recorded the patient as he walked and ran on the treadmill. Anatomical landmarks were highlighted using black texter and the podiatrist was able to replay the video in slow motion and assess the patients biomechanics. The sports podiatrist was able to determine hyper mobile foot and ankle joints leading to severe over pronation. The pronation was greater in the left foot. The increase in pronation bilaterally quite possibly preventing the plantar fasciitis from healing.
Whilst running on the treadmill with functional running shoes, there was a slight improvement in bio mechanics. The patient was running in an ASICS gel kayano and there was only slight compression of the medial aspect of the heel counter during running. Both feet pronated heavily inside the running shoes.
The podiatrist explained to the patient that his heel pain had not improved due to poor biomechanics. Shockwave therapy is a reliable treatment option for plantar fasciitis providing there is sufficient support for the feet. Insufficient support allows over pronation which produces repetitive stress through the arch of the foot and through the plantar fascia, at it’s insertion onto the base of the heel. The podiatrist explained to the patient that every step that he took delivered stress through the plantar fascia, preventing it from healing.
It was explained to the patient that in order to treat his plantar fasciitis he would be issued with prescription orthotics which would replace the soft liner of his running shoes. The orthotics would correct poor biomechanics and provide all the support necessary in order to reduce the stress running through the sole of the foot and into the base of the heel.
Using a 3D scanner and digital software, the podiatrist captured 3D foot scans. two weeks later the patient was fitted with carbon fibre sports orthotics which were placed into his ASICS running shoes. The podiatrist observed the patient running on the treadmill with his new orthotics. No abnormalities were detected and the patient reported no pain or discomfort. He described his orthotics to be comfortable. The sports podiatrist advised the patient that he should try to wear his orthotics every day for approximately 6 or 8 weeks. It would also be beneficial if he were able to wear them to and from work and when walking on a day-to-day basis.
It was decided not to proceed with further shock Wave therapy at this stage but rather allow the orthotics to encourage healing. The patient was advised to apply ice packs to the base of the heels every evening for approximately 30 minutes.
This gentleman returned to the Sydney heel pain clinic 8 weeks later for a review of his heel pain and to assess the improvement in his plantar fasciitis. He informed the podiatrist that he no longer experienced pain throughout the day when walking. Road running did not cause him any discomfort. He described a mild pain each morning when rising from bed and rated this approximately 2 out of 10 on the vas scale. He informed the podiatrist that he was happy with progress and wanted to continue with orthotic therapy. He felt confident that the minimal pain that persisted would dissipate completely very soon.
The sports podiatrist advised the patient to return to the clinic if his heel pain persisted or if he felt his plantar fasciitis recovery plateaued.
Please be mindful that the information contained in this case study is very specific to one particular patient. If you feel that you have plantar fasciitis or any other cause of heel pain you should seek the opinion of a suitably qualified medical practitioner.
Sports Podiatrist with special interest in heel pain / plantar fasciitis – Karl Lockett
Written by Karl Lockett