A 61-year-old lady presents to the clinic complaining of Plantar Fasciitis. She describes heel pain under the ball of her heel of approximately 3 weeks, and informs the Podiatrist that her pain is bad in the mornings when her foot hits the floor. Her heel pain has been getting worse since the warmer weather came about and coincides with an increase in the use of thongs / summer shoes. She admits that she had started to feel some “tight pulling” through the arch of her foot and describes the sort of arch pain that is common in Plantar Fasciitis. She has not seen her doctor nor any medical / allied health practitioner but has self-diagnosed her condition, via on line research. It is not uncommon for patients to experience arch pain, before the onset of aggressive heel pain. The arch pain can sometimes subside within a short time frame, but the heel pain becomes chronic as inflammation within the plantar fascia sets in.
This lady reports the use of thongs, ballet flats and soft summer sandals that offer minimal support, for the last 4 to 5 weeks. During this time she felt general foot fatigue and also developed cramps and stiffness in the calf muscles and shin area. The transition into summer shoes from colder weather footwear, which offered more support, was too quick. She was using these summer shoes to and from the office as well as around the house and was also walking in the thongs at weekends. This chain of events is extremely common in patients who develop heel pain, in particular Plantar Fasciitis.
This lady had been applying Voltaren Gel to her heel and arch pain on a daily basis. She had been rolling her foot on a frozen water bottle each evening before bed and described temporary relief, but an increase in pain afterwards. To this end, and because her heel pain was getting worse, she stopped using the frozen water bottle but continued applying the Voltaren Gel. Her husband had very kindly offered to massage this patients sore foot but she reported that this was too painful for her to tolerate, particularly in the arch area. The arch pain was too intense as his fingers moved from the heel, towards the toes. This lady had also soaked her feet in warm water with Epsom salts to no avail.
This lady usually enjoyed walker her dog each morning before work but her heel pain was too much to cope with. She reports that she was able to walk a little easier after the first 5 minutes, but that she was hobbling through the start. Upon her return from the walk, and after she would sit down to breakfast, she would limp as she got up from the dining chair to walk from the dining table. Her heel pain was so bad that she would need to hold on to the back of the chair for a minute or two. To this end, she decided to stop her morning walks. She was able to swim without pain due to this being a non-weight bearing activity. This is the preferred form of exercise for patients with Plantar Fasciitis.
This lady had come for treatment of her heel pain within a relatively short period of time since its commencement. Seeking treatment for Plantar Fasciitis within the first few weeks usually brings about quicker and more reliable results when it comes to treatment. Patients who leave their condition for more than a month or two usually take a little longer to heal and sometimes require more intervention. Plantar Fasciitis treatment can range from strapping and stretching through to orthotic therapy and footwear changes.
This lady was treated with sports tape, to strap and hold the affected foot, and to take strain off the Plantar Fascia. She felt immediate relief as she walked around the room and reported some reduction in heel pain. Her foot was still sore but felt a little easier.
It was explained to this patient that she needed to change her footwear in order to get on top of her heel pain. The shoes that she was wearing were too flat, too flimsy and not rigid enough to support the foot. Plantar Fasciitis will not recover quickly, if at all, if the footwear being used is unsupportive. Even if the footwear change is a temporary one, it is crucial to healing. This is not to say that the shoes that are recommended at the time of consultation need to be worn for ever. Patients can still revert back to the less supportive shoes such as thongs and ballet flats in future, but should be careful not to overuse them. At the first sign of heel pain or Plantar Fasciitis they should consider their choice of shoes around the time leading up to the heel pain symptoms, and then make changes accordingly. This lady was given a list of footwear brands and places where she can purchase appropriate shoes. It was explained to the patient what she should look for in a shoe.
This patient was asked to stop all of her home remedies, even if they provided short term relief. It is not uncommon for patients with Plantar Fasciitis to find short term relief from certain home treatments, only to find that there is long term irritation that prolongs the heel pain. This patient was asked to apply a soft ice pack to the affected heel and arch pain area, and to then strap the cold compress to the foot for approximately 30 minutes, as she lay down with her foot elevated.
She was also shown how to do safe and effective calf stretches.
This patient was reviewed after one week and reported approximately 30% improvement. Strapping was reapplied at follow up and there was no skin irritation from the sports tape. Patient was compliant and had been applying ice and performing calf stretches daily.
Patient reported no heel pain in the mornings nor at any other time of day. There was no pain on palpation of the heel as the patient was examined.
She was informed that she should start walking the dog in the mornings again but to stop and return to the clinic if the pain returned. She was also advised to be mindful of calf tightness and to maintain good calf range at all times.
Written by Karl Lockett