A 34-year-old female runner came to the Sydney Heel Pain Clinic for plantar fasciitis treatment due to severe heel pain in her left foot. This otherwise healthy individual reports to the sports podiatrist that she is a keen runner who enjoys running five mornings a week, approximately 7 to 10 km each day. She has been feeling heel pain for approximately 6 months but has been avoiding plantar fasciitis treatment in favour of other home remedies.
However, her heel pain is not improving, and she is becoming increasingly frustrated. She reports to the sports podiatrist that she would like to take part in a marathon and that she would like to increase her training but is limited by the heel pain. She has never had plantar fasciitis treatment before but is now seeking medical advice. This patient reports that she has seen her regular GP who has prescribed anti-inflammatory medication and recommended foot stretching. However, she felt that this plantar fasciitis treatment was incorrect as the pain seemed to stay the same. One of her work colleagues recommended that she see a sports physiotherapist that she herself had seen for plantar fasciitis treatment in the past. Unfortunately, this did not prove to be successful and her heel pain continued. This patient carried with her regular running routine due to the fact that once she was warmed up after approximately 500 m the pain in her heel would subside sufficiently to allow her to continue training. However, shortly after her exercise the heel pain would become quite severe causing her to limp. The typical symptoms of plantar fasciitis are pain first thing in the morning when rising from bed and this patient reported exactly this. She had read online that heel spurs cause plantar heel pain which is commonly felt after periods of sitting or sleeping. She reports to the podiatrist that she is confused and does not understand if the heel pain is caused by plantar fasciitis or in fact a heel spur.
The podiatrist advised the patient that heel spurs and plantar fasciitis are commonly seen in association with each other but that’s the plantar fasciitis itself is usually responsible for the heel pain. He explains to the patient that the heel spur can be found on the base of the heel or on the back of the heel, and in fact Spurs themselves can be found throughout the entire body on bony landmarks, at the point where the soft tissue attaches to the bone. He advises the patient that she will receive plantar fasciitis treatment as this will be more beneficial than focusing on the heel spur.
Physical Examination of Heel Spur / Plantar Fasciitis
The sports podiatrist carried out a physical examination to measure the severity of the plantar fasciitis and to locate the exact position of the heel spur. The patient reported significant pain on palpation of the plantar aspect of the heel, around the heel spur, at the point where the plantar fascia attaches to the base of the heel. He advised the patient that she has the common symptoms of plantar fasciitis. The sports podiatrist also detected a limited range of ankle joint motion due to tightness in the calf mescles, and a limited range of motion through the first toe joint, due to arthritis. The podiatrist advised that she will require plantar fasciitis treatment but that it would be important to address the range of motion through the ankle joint as well. The first toe joint would also need some attention.
Bio Mechanical Assessment for Plantar Fasciitis / Heel Spur
The sports Podiatrist carried out a detailed biomechanical assessment on the treadmill and recorded the footage using digital software in order to assess the possible causes off the heel spur and in order to determine the most appropriate plantar fasciitis treatment. The footage was replayed in slow motion and biomechanical anomalies were detected and noted accordingly. With the patient standing in a weight bearing position the podiatrist carried out further measurements including arch height and heel position. plantar fasciitis treatment is usually determined by the findings of the treadmill assessment.
Plantar Fasciitis Treatment
The patient was advised that we would worry less about the heel spur but instead focus on the treatment for plantar fasciitis. It was explained to the patient that in order for the plants of fashion to recover it would be essential to unload the fascia using a prescription orthotic that would touch and hold the sole of the foot and therefore reduce the strain on the plantar fascia. This is the best method of plantar fasciitis treatment. Orthotics with high arches apply too much pressure to the base of the heel and to the mid-portion of the plantar fascia and this can increase the symptoms and prolong the heel pain condition. He advised the patient that regular use of the orthotics on a daily basis for approximately 6 to 8 weeks would reduce the heel pain in the short term but would help the plantar fascia to heal in the long term. He reminded the patient that the heel spur would remain but would not be the source of pain. In addition to the use of the orthotics the sports podiatrist insisted that the patient carry out rigorous calf stretching three times per day on both legs. He also advised the patient that the orthotics would incorporate a specific forefoot modification which would help to unload and treat the first toe arthritis. The design of the orthotic with the forefoot modification would form a crucial part of the plantar fasciitis treatment. The orthotic would not help the heel spur to resolve and often the heel spur can remain in place for a lifetime, without discomfort. This patient did not have a heel spur around the back of the heel bone nor did she seem to present with plantar fasciitis in the good foot. The patient was recommended to change her running shoes from a Nike free to a Brooks adrenaline.
Plantar Fasciitis Treatment – Follow Up – 8 Weeks On
Plantar fasciitis treatment should always involve regular reviews to monitor the progress of the heel pain and also to measure the severity of the condition. After 8 weeks this patient reported a significant improvement in her condition and explained to the sports podiatrist that she had minimal heal pain on a daily basis. She described approximately 80% improvement at this 8 week mark. She understood that her heel spur may remain but this did not confront the patient as she understood the discomfort she felt was driven by the plantar fasciitis. This patient was diligent with her plantar fasciitis treatment plan and explained to the podiatrist that she had been stretching her calf three times a day every day since the first appointment. The orthotics she was using were comfortable and she felt the right level of support in the right areas of the foot. She was able to run with her orthotics and explained that she had much less foot and lower leg fatigue and was completing her running route in a shorter time. She had been able to increase her cadence and increase her personal best.
No further appointments were needed for this patient as she had been diligent with her plantar fasciitis treatment, understood that the heel spur was not the cause of pain and had resolved her heel pain.
Written by Karl Lockett
Sydney Heel Pain Clinic