,

Plantar Fasciitis Management

What Does Plantar Fasciitis Management Involve

Currently there is insufficient evidence to allow scientific clarity surrounding the most effective form of plantar fasciitis management. There are many different types of treatment for plantar fasciitis and each patient should be treated individually. The recommended plantar fasciitis management for one person may not be suitable for another as there are multiple contributing factors to this frustrating heel pain condition. Many patients resort to self treatment and online research in an attempt to resolve their condition before seeking professional plantar fasciitis management from a suitably qualified healthcare practitioner. Treatment and management of plantar fasciitis should most definitely involve measures to unload the plantar fascia mechanically. This can be achieved via the use of a touch and hold orthotic, designed by prescription and worn for up to 6 weeks diligently. Plantar fasciitis management may involve a referral for ultrasound imaging or MRI. X-rays are of less benefit in these circumstances. Imaging usually forms part of a plantar fasciitis management plan if the practitioner suspects tears in the plantar fascia itself. The treatments that maybe useful are treatments such as shockwave therapy which has been proven to stimulate healing via an increase in blood capillaries and new collagen. In addition to touch and hold orthotics and shockwave therapy, the temporary application of rigid sports tape can be very beneficial and usually helps to reduce pain levels. However, due to skin irritation strapping should only be carried out short-term. Other common treatments are things such as acupuncture, dry needling, stretching techniques and footwear changes. In troublesome circumstances the plantar fasciitis management plans may involve injections of Cortisone to reduce stubborn inflammation.

How Long Should Plantar Fasciitis Management Plans Last?

The length of time that a patient is involved in a plantar fasciitis management plan will be determined by several factors, such as the severity of the condition and the length of time that they have been experiencing heel pain. Typically the patient may receive treatment and care for anywhere between three and six weeks. Chronic conditions and patients with severe obesity may receive care for longer due to the excessive load on the feet.

Plantar Fasciitis Symptoms

The typical symptoms of plantar fasciitis which will normally be described during the consultation are things such as pain at the base of the heel which is often more noticeable first thing in the morning when rising from bed. Patients who are undergoing plantar fasciitis management will often describe the feeling of a stone bruise under the heel or the sensation of a pebble inside the shoe. They describe what can be called “start up” pain whereby there is significant discomfort when walking, following long periods of being seated. In extreme cases the patient will also report throbbing or stabbing sensations under the heel or through the arch of the foot.

Who Offers Plantar Fasciitis Management

Podiatrists are expert in foot health and should be able to offer concise plantar fasciitis management plans. If the podiatrist that you see has a special interest in sports podiatry and has more exposure to biomechanical analysis than other foot conditions such as skin and nail, then there is a good chance that they will have more experience in the treatment of this painful condition.

Sydney heel Pain clinic offers appointments from five clinic locations across Sydney and executes plantar fasciitis management plans on a daily basis. The podiatrist at Sydney heel Pain clinic have vast experience and unparalleled knowledge around plantar fasciitis.

If you are in need of a plantar fasciitis management plan due to chronic heel pain then you may want to consult with the podiatrists at Sydney Heel Pain Clinic. Sydney Heel Pain Clinic can be reached on 93883322 or help@sydneyheelpain.com.au.

You may also wish to book on line: https://www.sydneyheelpain.com.au/book-online/ – just select the location you require.

Plantar Fasciitis Management

 

Heel Pain in Kids

WHAT CAUSES HEEL PAIN IN KIDS?

One of the most common causes of heel pain in kids is a condition known as severs. Severs disease, or Severs syndrome is a condition that occurs in children between the age of 7 and 14 years. This condition is known to be a growth plate problem and is associated with inflammation and irritation around the posterior aspect of the heel. Not all active children will develop Severs, but heel paid in kids is common who participate in lots of sporting activity. These children are sometimes going through a growth spurt. Heel pain and kids can lead to lack of participation and can cause the child to refrain from physical activity. These children will experience pain under the base of the heel and also around the back of the heel, and the discomforts can be relentless. The children will describe pain when walking and in particular when running or playing sports. Mums and dads are sometimes at a loss as they do not know what to do. There is nothing to see on the heel and bruising or inflammation are not associated with this condition. The condition seems to affect boys and girls similarly.

Quite often parents will visit the local doctor in order to seek advice and guidance, and they are often anxious to remove the pain from the child’s foot. Some doctors will refer for an x-ray of the foot but this is thought to be of little use. X-ray imaging does not lead to a specific treatment plan and is not always thought to be the correct approach when treating heel pain in kids. The x-ray images do reveal the growth plate and shows non-union of the heel bone, but this is normal for children in this age bracket.

TREATMENT FOR HEEL PAIN IN KIDS

The treatment for heel pain in kids should be a multi-factorial approach as there is more than one contributing factor to the pain. Footwear selection, calf stretching, assessment of biomechanics, elevating the heel and applying ice packs to the affected area are all treatments that should be considered in these children. Sometimes the use of prescription orthotics is beneficial for children who present with an inherent foot weakness. Not all kids with heel pain will require orthotics and some will benefit from simple heel wedges ranging from 7 to 10 mm. The application of cold packs will help to reduce pain and inflammatory change within the heel bone. Usually, footwear with an elevated heel and a small forefoot drop will allow the child to feel more comfortable. These shoes should also be relatively firm and robust and less flexible through the midsole. Heel Pain in kids is usually more manageable if the child is compliant with the above and in particular if they commit to regularly stretching the calf muscles. It is not usually necessary to refer for MRI or ultrasound. Sports podiatrists seem to have a good handle on Severs and physiotherapy is not usually necessary. Because children are young and healthy they seem to respond to treatment very quickly and very effectively. Severs can occur in 1 foot but is often seen in both feet. Parents can rest assured that the onset of the heel pain in kids is nothing to do with neglect on their part. The inherent foot weakness can sometimes be due to ligament laxity and while this is a genetic factor parents are not to blame.

heel pain in kids - severs disease

OTHER CAUSES OF HEEL PAIN IN KIDS

It is important to consider other causes of heel pain in kids such as stress fracture
and bone bruising. While plantar fasciitis and Achilles tendinitis are more readily seen in adults, this is not to say that they cannot affect children too. Ultrasound imaging is often sufficient in order to diagnose plantar fasciitis or Achilles tendinitis. A bone scan would be useful in determining stress fracture or bone bruising. Once again, severs is the most likely cause of heel pain in kids who are active and aged between 7 and 14 years, but parents should know that regardless of the treatment options, children will always grow out of this condition once the heel bone has fused.

If you have a child with heel pain or if you would like to know more about heel pain in kids, please contact a suitably qualified sports podiatrist or reach out to the team at Sydney heel pain clinic.

Karl Lockett, sports podiatrist
help@sydneyheelpain.com.au
www.sydneyheelpain.com.au
02 93883322

Achilles Tendon Rupture

What is Behind An Achilles Tendon Rupture

If you have experienced an Achilles tendon rupture then you will be all-too-familiar with that snapping sensation and that acute pain that stops you in your tracks. When the Achilles tendon tears, it often happens mid stride or during an explosive movement. The podiatrists at the Sydney heel pain clinic commonly treat runners, basketball players, soccer players and a variety of other athletic people that don’t fully understand the signs and symptoms that precede the Achilles tendon rupture. “Quite often this injury will occur during one particular step or movement as the athlete attempts to propel themselves and move forwards or upwards quickly”, says Karl Lockett, sports podiatrist at the Sydney Heel Pain Clinic”. What these keen gym junkies do not understand is that quite often some of these injuries could have been avoided with correct intervention of biomechanical anomalies. One of the most common precursors to Achilles tendon rupture is ankle joint dysfunction due to tight , short calf muscles. The tightness in the calf muscles causes an increased load and pulling sensation on the Achilles tendon which if left untreated will eventually lead to Achilles tendon rupture. There are varying degrees of rupture and ultrasound imaging will often reveal micro tears, partial tears or complete rupture of this important weight-bearing tendon.

Achilles Tendon Rupture

Who Else Suffers from Achilles Tendon Rupture

Keen athletes are not the only candidates who suffer from these Achilles tendon ruptures. The podiatrists at the Sydney heel pain clinic also treat more sedentary individuals who may only partake in recreational walking. These patients are usually surprised to hear that they have developed an Achilles tendon rupture as they confess to being way too sedentary. Some of these individuals are carrying a few extra kilos in body weight and this in turn creates more stress on the foot and ankle and Achilles tendon. The extent of damage in these individuals may not be as severe as can be seen in the athletic type, and ultrasound imaging or MRI may reveal micro tears or partial tears. A complete Achilles tendon rupture is unlikely and less common in such individuals.

What are the Causes of Achilles Tendon Rupture

One of the most common causes of an Achilles tendon rupture is calf muscle restriction and extreme tightness. These people are the kinds of athletes who fail to perform diligent stretching techniques pre-and post exercise. “This goes to show the importance of calf muscle stretching when maintaining good foot and ankle health, not just to avoid Achilles tendon rupture, but other soft tissue injuries to such as plantar fasciitis or Achilles tendinitis”, says sports podiatrist Rami Ghorra. “As sports podiatrists we also highly recommend hamstring, quads and glutes stretching pre and post exercise”.

Other causes of Achilles tendon rupture would be the use of non-functional walking shoes or running shoes, which may lead to the calf muscle dysfunction. It can be highly beneficial to have your biomechanics assessed in the podiatry clinic, using video gait analysis and treadmills. This allows the sports podiatrist to recommend specific models of walking shoes or running shoes. Being fitted with the correct brand and model of shoe may sound like a simple solution but this can pay dividends and help you avoid injuries such as Achilles tendon rupture

Achilles Tendon Rupture Treatment

 The treatment for an Achilles tendon rupture will involve immobilisation of the affected tendon, which can be achieved a variety of ways. The sports podiatrists at the Sydney heel pain clinic will select one or a combination of treatments based on the severity of the condition. In more recent times shockwave therapy has been used as a treatment to accelerate the healing of an Achilles tendon rupture or less severe, Achilles tendinitis.

 In summary, if you feel a tightness in your calf muscles and you want to avoid an Achilles tendon rupture it is crucial that you address the problem sooner rather than later. Prevention is always better than cure. Achilles tendinitis is always one of the warning signs that should also be addressed and not ignored. If you are suffering with Achilles tendinitis this may be a precursor to an Achilles tendon rupture, and good physical assessments and biomechanical analysis would be a great way to avoid this crippling injury.

 

Karl Lockett and Rami Ghorra.

Sydney Heel Pain Clinic

 

Evaluation of Plantar Fasciitis Treatments

Evaluation of Plantar Fasciitis

An evaluation of plantar fasciitis and the treatment options that are available, is important in order to gain an understanding of the efficacy off all different management options. At the Sydney heel pain clinic, the main conditions that are treated are plantar fasciitis, Achilles tendonitis and bursitis. An evaluation of plantar fasciitis is important as it is the most common of all these conditions that the podiatrists treat. Some of the common treatments available are orthotics, shockwave therapy, immobilisation boot, footwear changes, dry needling and strapping.

Plantar fasciitis is a painful condition that can be debilitating and causes severe pain under the base of the heel. The condition can be excruciating and patients are are often required to modify their lifestyle in order to accommodate it. Commonly, patients will report significant pain after periods of rest. This can be referred to as start up pain and is often noted first thing in the morning when the patient takes their first few steps, or after long periods of being seated. Evaluation of plantar fasciitis patients also commonly reveals the feeling of a stone bruise under the heel or a pebble in the shoe. Furthermore, these patients find that there are often long periods of the day where they are free of any symptoms and are able to walk without any problems. These brief moments of relief are then masked and undermined by the return of the sharp stabbing pain through the base of the heel or the arch of the foot.

Evaluation of Plantar Fasciitis Treatments

Evaluation of Plantar Fasciitis Including Orthotics

An evaluation of plantar fasciitis sufferers who were treated with prescription orthotics was carried out at the Sydney heel pain clinic. It was found that those patients using firm inserts that provided control instead of cushioning responded to treatment within 4 to 6 weeks. It was concluded that soft orthotics allow the foot to compress the material and therefore creates hypermobility around the heel, which causes irritation and prolongs the condition. The evaluation of these plantar fasciitis suffers revealed a significant reduction in start up pain first thing in the morning and after long periods of being seated. The pain in the heel subsided immediately with the orthotics in place, although this did not mean that the condition had healed. The plantar fasciitis symptoms were deemed to have subsided when there was minimal or no pain when walking or when firm finger pressure was applied to the base of the heel, at the attachment of the plantar fascia. The evaluation of the plantar fasciitis first thing in the morning when rising from bed was also used as a “measuring stick”.

 

Evaluation of Plantar Fasciitis with Shockwave Therapy

Shockwave therapy was applied to patients with plantar heal pain and evaluation of plantar fasciitis symptoms were noted over an 8 week period. Shockwave therapy provides an instant analgesic effect and this was consistent throughout all patients. Commonly there are approximately 5 days of pain relief following the application of the shockwave therapy machine. Please note, that the analgesic effect is merely a positive side effect and is not the main reason for using it. Shockwave therapy is used to stimulate healing by increasing blood flow and the turnover of new collagen cells. Over the period of 4 to 6 weeks, the healing takes place albeit slowly. However it can be proposed that healing is quicker with shockwave therapy than without. Shock wave therapy as a “stand alone” treatment, when no other supportive intervention was applied, proved to be less reliable. This eludes to the fact that the single most important point in the healing of plantar fasciitis still remains to be the support for the plantar fascia itself.

More information on shock wave therapy here: https://www.sydneyheelpain.com.au/shock-wave-therapy/

Evaluation of Plantar Fasciitis that Includes Calf Muscle Stretching

When an evaluation of plantar fasciitis was made of the variety of treatments for the condition it was found that the heel pain problem improved quicker when calf stretching was included. It can be proposed that the restricted range of ankle joint motion due to tight calf muscles creates a stressful pulling on the heel and that this prolongs the condition. The evaluation of plantar fasciitis and Achilles tendonitis revealed the same beneficial findings that highlights the benefits of these stretching techniques. It should be noted that stretching alone does not provide the same benefits or a faster rate of healing without supportive intervention from the podiatrist. Supportive intervention can be provided via prescription orthotics, strapping techniques and footwear recommendations. Please note: calf stretching can over load the plantar fascia and prolong the condition if not done under instruction of an experienced podiatrist.

Please see the style of orthotics that work the best for plantar fasciitis here on our sister company website: https://www.heelclinic.com.au/

Please note that the above information should not be taken as medical advice and if you need an evaluation of plantar fasciitis or any other of your foot problems then you should consult with a qualified sports podiatrist.

 

Written by: Karl Lockett, Sports Podiatrist

The Problem With Evidence-Based Treatment for Plantar Fasciitis

Is There Sufficient Evidence-Based Treatment for Plantar Fasciitis

People suffering with plantar heel pain will often carry out online research in order to find evidence-based treatment for plantar fasciitis. Plantar Fasciitis is an extremely common condition and is thought to affect one in three people throughout their life. It is a condition that can stop you in your tracks and can be debilitating at times. Patients with plantar fasciitis will modify their lifestyle, stop exercising and become idol due to the severe pain. The common symptoms of plantar fasciitis are pain under the base of the heel and sometimes through the arch of the foot. The severity of the pain is often most crippling first thing in the morning when patients arise from bed. Evidence-based treatment for plantar fasciitis has tried to find the most reliable solutions in order to reduce or completely remove some of these symptoms. Many patients suffering with plantar fasciitis will jump on board the medical merry go round and will attempt to treat themselves with a whole variety of solutions. Most patients will visit more than one medical practitioner on their journey to become pain-free. Due to the fact that there is more than one contributing factor, treatment often fails. Many practitioners approach the condition from one angle and will miss important causes that allow the problem to persist. For this reason the condition can become chronic as practitioners have approached the problem from only one angle and failed. This will leave the patient frustrated and those proactive people will carry out extensive research online, searching for evidence-based treatment for plantar fasciitis.

The Short Falls of Evidence-Based Treatment for Plantar Fasciitis

The research papers that have attempted to find evidence-based treatment for plantar fasciitis often do not include all of the contributing factors. For example, one research paper studied the effectiveness of prescription orthotics against prefabricated orthotics. This paper was published in an Australian tabloid newspaper and did not address any other contributing factors whatsoever. It did not take into account things such as footwear, calf muscle stretching, body weight, level of activity, number of steps taken each day or other medical conditions affecting the patient. Many podiatrists have agreed that this particular research paper does not constitute evidence-based research for plantar fasciitis.

How to Carry Out Evidence-Based Research for Plantar Fasciitis

In order to effectively carry out evidence-based research for plantar fasciitis it is crucial that all of the contributing factors be considered. Specialist podiatrists who have extensive exposure to patients with plantar fasciitis are fully aware of all of the contributing factors. Therefore, if research were to be carried out these specialist podiatrists should be consulted. As mentioned earlier the contributing factors include but are not limited to ankle joint range of motion due to restriction in calf muscle range, footwear selection, body weight, other medical conditions that affect health and healing, the use of anti-inflammatory medication or ice packs, and shockwave therapy.

Plantar fasciitis patients searching for reliable treatments should be educated and mindful of the above information when selecting treatment.

In summary, there is insufficient evidence based research for plantar fasciitis and more work needs to be done before solid conclusions can be made. Only then can patients find reliable treatments from podiatrist, physios, allied health practitioners and doctors alike. It is understandable how frustrated and disappointed patient’s with heel pain become after entrusting their time and money in a variety of practitioners who struggle to get it right due to lack of evidence or experience. This is not to say that without the evidence based research, some practitioners can not get it right, as the podiatrists at Sydney Heel Pain Clinic have been treating plantar fasciitis and other causes of heel pain for many years.

Find the cause(s) , remove the cause(s), support the fascia > healing takes place.

,

Plantar Fasciitis Shoes

Do Plantar Fasciitis Shoes Exist?

A new patient undergoing plantar fasciitis treatment arrived at Sydney heel pain clinic requesting advice relating to the treatment of his condition, and wanted to know if there was such thing as plantar fasciitis shoes. And if so, which make or model would be best or most appropriate for his heel pain. This otherwise healthy individual had been experiencing plantar heel pain, and medial heal pain for more than 12 months. He was disappointed in the treatment he had received to date as none of it had been helpful. Typical of patients in his circumstances, this gentleman was proactive and carried out much research himself, and this led him to several websites that claimed to sell plantar fasciitis shoes. This patient had received 12 weeks of physiotherapy for his plantar fasciitis and had been advised to carry out stretching techniques and other forms of self-treatment at home. The physiotherapist had performed deep tissue massage through the arch of the foot and around the base of the heel and had also performed release techniques through the calf muscle. The physiotherapist had also mentioned plantar fasciitis shoes and offered to sell the patient a pair of MBT rocker bottom shoes for his condition. The patient tried on the shoes in the clinic but informed the physiotherapist that he found them to be unstable and made him feel off balance. To this end the patient did not proceed with the plantar fasciitis shoes but instead carried on with treatment. The physiotherapist advised the patient that without proper plantar fasciitis shoes his condition may take longer to heal. The patient reported to the sports podiatrist that the 24 hours that followed the treatment with the physiotherapist were less painful. For this reason he continued with the treatment. However, the benefits from the treatment were short-lived and the patient felt like he was stuck on a medical merry-go-round.

Plantar Fasciitis Shoes

This particular patient returned to his GP and requested further investigation for his plantar fasciitis. He mentioned plantar fasciitis shoes to the doctor but the GP confessed not to be experienced in this area and was not able to advise. The GP did follow instruction from the patient and organised an MRI of his painful right foot. The MRI report conclusively revealed plantar fasciitis, without the presence of heel spur. With this knowledge in mind the patient decided to continue being proactive in search of a successful remedy for his troublesome heel pain. What he was experiencing is not uncommon as many practitioners do struggle with plantar fasciitis treatment due to the wide variety of solutions that are readily available.

Evidence of Plantar Fasciitis Shoes

There does not seem to be any research relating to the effectiveness of plantar fasciitis shoes, and those companies that promote them do not have sufficient evidence to back up the theory.

This patient reported to the sports podiatrist that his heel pain was significant every single morning when rising from bed. This is common for plant fasciitis and it is rare that patients with this condition do not experience this start up pain. The pain can also be very noticeable after long periods of being seated. While this patient did not possess any specific plantar fasciitis shoes he did report to the podiatrist that he would step into a pair of running shoes every morning to help with the pain. Please note that functional running shoes will often assist in supporting the foot, and while they are not technically plantar fasciitis shoes they can help with the symptoms due to the high level of support. Once again there is no evidence surrounding the efficacy of running shoes in the treatment of plantar fasciitis.

Physical Examination – Did this Patient Require Support from Plantar Fasciitis Shoes

The sports podiatrist carried out a routine physical examination in order to diagnose the plantar fasciitis and discuss treatment options. The patient was informed that his signs and symptoms were definitely consistent with plantar fasciitis and this was backed up by the report from the MRI. The podiatrist advised the patient that the single most important factor in treatment of his condition was support for the plant fascia. The podiatrist also informed the patient that while he was not aware of any particular plantar fasciitis shoes, he should be given high levels of support from footwear in general. This could be backed up by the fact that the patient did in fact feel much better when wearing his Asics running shoes. The podiatrist explained to the patient that other forms of support would prove to be more beneficial such as prescription orthotics, strapping techniques and the use in extreme circumstances of immobilisation boots. The patient was informed that the high level of support allows the plantar fascia to rest and heal naturally without the use of medication or injection therapy.

This patient was booked in for a follow-up visit so that his treatment and full assessment could commence. This would involve the use of treadmill assessments and further physical and biomechanical assessments which would help to determine treatment. The patient was not prescribed plantar fasciitis shoes nor was he recommended to purchase these from any other place.

Once again, the podiatrist at the Sydney Heel Pain Clinic are not aware of any proven plantar fasciitis shoes that can assist in the treatment of the condition.

 

Written by Karl Lockett

Podiatrist

 

,

Case Study: Plantar Fasciitis Socks – Hit Or Miss?

Do Plantar Fasciitis Socks Exist and are they Beneficial?

A new patient visited the Sydney Heel pain clinic struggling with plantar fasciitis for at least 17 months, and presented to the podiatrist a pair of plantar fasciitis socks. She informs the podiatrist that she has been on some medical merry go round for several months and recently resulted to purchasing socks online after seeing them advertised through social media. The patient was suffering with plantar fasciitis and her left and right foot and this was causing significant heel and arch pain in both feet. This patient was approximately 20 kilos overweight and confesses to the podiatrist that she wishes to begin exercising but she is unable to do so due to the severe pain in both of her feet. She feels frustrated because she would like to lose weight and exercise but is unable to do so as both of her feet hurt. In addition to purchasing the plantar fasciitis socks this patient had paid a visit to her GP, foot specialist, physiotherapist, chiropractor, naturopath and two podiatrists. The podiatrist at the Sydney Heel Pain Clinic being the third podiatry consultation that this patient had attended in at 12 months period.

This patient had been given cortisone injections on two separate occasions into both of her feet and her platter fasciitis persisted. The physiotherapist who she paid a visit to encouraged strength training and a long list of exercises- none of which relieved her symptoms.

This patient reported a significant pain after she had been seated for long periods and would also experience a throbbing sensation if she was sitting or lying in her bed. The throbbing sensations more troublesome in her left foot compared to her right foot and she reports being left side dominant. Frustrated with the pain this patient would use one frozen bottle of water and roll her arches across it on a day today basis. She had heard about plantar fasciitis socks through social media but had avoided purchasing these in favour of more mainstream treatments.

The foot specialist that the patient had paid a visit to instructed her to persist with more conservative treatments and advised the patient that he would not perform surgery as a first line of treatment. He was unable to comment on the efficacy of the plantar fasciitis socks. This patient did spend some time with her GP and was referred for imaging. The reports that this patient received confirmed that there was no heel spur but that the plantar fascia was thinking and calcified, which is typical of plantar fasciitis.

The patient purchased plantar fasciitis socks online and began to where them immediately. She advised the sports podiatrist that she felt quite secure due to the pressure that the socks applied to the arches of her feet. It is quite likely that the benefit felt from the socks was simply you to desensitisation of the nerve endings due to the hugging effect of these socks. The patient also went to bed with the socks on but had to remove them at approximately 2:00 a.m due to them feeling too restrictive. She removed the plantar fasciitis socks and the next morning when she woke from her bed she did report a slight improvement in general foot pain. She describes to the sports podiatrist that it is difficult to say whether or not a plantar fasciitis socks actually reduced the symptoms of the condition itself, or more over they were just relieving general foot fatigue and soreness. Due to these small changes, the patient became hopeful and continued the day-to-day use of her plantar fasciitis socks. However, she decided not to use them at bedtime due to the discomfort.

The patient also reported that while she was using the plantar fasciitis socks she was also mindful that she had increased the frequency of her calf stretches. She began to become confused and was not sure which one of the two therapies was helping. To this end, she stopped stretching her calf muscles and allowed the plantar fasciitis socks to act as the main treatment.

 

Plantar Fasciitis Socks

As is usually the case with plantar fasciitis, the symptoms of this condition fluctuated greatly from day to day. Typically, patients with plantar fasciitis will have good and bad days without rhyme or reason. The increase or decrease in symptoms can sometimes be due to the number of steps taken in a day, the choice of footwear used from day to day or even things such as body temperature due to changes in the weather which can affect circulation. Patients who are attempting to resolve the condition are unable to put their finger on what is helping or what is making things worse. This patient continued to use her plantar fasciitis socks for 7 weeks before coming to the conclusion that there did not seem to be a significant improvement. This is likely due to the fact that plantar fasciitis responds to high levels of support which unloads the plantar fasciitis. It can be said that there is insufficient unloading of the plantar fascia and insufficient support from the plantar fasciitis socks, and to this end this is probably the reason why the socks were not particularly beneficial.

The sports podiatrist at the Sydney Heel Pain Clinic explained the benefits of unloading the plantar fascia to the patient and offered to treat her with either rigid sports tape to strap the feet or customised orthotics to unload the plantar fascia.

Treatments Other Than Plantar Fasciitis Socks That Have Been Tried and Tested

The podiatrist explained to the patient that the orthotics would be the most reliable and effective way to support the plantar fascia and that they would be more effective than the plantar fasciitis socks. The sports podiatrist also explained the benefits of shockwave therapy, https://www.sydneyheelpain.com.au/shock-wave-therapy/ , and due to the fact that this patient had to be struggling for a long period of time, she presented as an ideal candidate for shock wave therapy which would break down some of the scar tissue and therefore promote the turnover of new healthy collagen. The shock wave therapy also acts to stimulate blood flow and has been proven to increase the number of small blood vessels in the area. These more scientific treatments which have undergone more research present as more effective and more reliable treatment options than treatments found online such as plantar fasciitis socks. However, this is not to say that plantar fasciitis socks may not be useful for some people either with heel pain or other foot related conditions.

Lack of Research Into the Efficacy of Plantar Fasciitis Socks

More research is probably needed into the effect of plantar fasciitis socks before it can be conclusively claimed that they are in effective. It would be important to exclude a large number of variables when trying the socks such as footwear, number of steps taken in a day, level of activity, type of sporting activity engaged in, body weight, gender and other medical conditions that can affect the foot.

It can be concluded from this case study that there are more reliable treatment options for plantar fasciitis than the use of plantar fasciitis socks. At tthis stage, the podiatrists at the Sydney Heel Pain Clinic do not, and do not plan to stock plantar fasciitis socks due to the lack of scientific research associated with the product. However, this is not to say that an individual should not try the socks if they have foot related conditions. Perhaps the socks may be beneficial for some people with general foot fatigue or other conditions, but they may not be beneficial in the treatment of plantar fasciitis.

Please be aware that the information contained in this case today should not be taken as general medical or podiatry advice. If you have plantar fasciitis or if you wish to receive treatment for the condition you should probably consult with a suitably qualified sports podiatrist or sports medicine doctor. Please be mindful of the above information before purchasing or using plantar fasciitis socks.

This article was written by Karl Lockett of Sydney Heel Pain Clinic

This image below involves the use of the Swiss Dolorclast machine for shock wave therapy

https://www.sydneyheelpain.com.au/shock-wave-therapy/

Swiss Dolorclast machine for shock wave therapy

MEDIAL HEEL PAIN – WHAT IS IT?

The Cause of  Medial Heel Pain

As sports podiatrists we are commonly asked the question, what is causing my medial heel pain. Truthfully, there is more than one cause of pain on the medial side of the heel, but the most common would be plantar fasciitis. Plantar fasciitis is a condition associated with inflammatory change within the fascia under the sole of the foot. Usually, the heel pain overrides pain through the arch of the foot, more distally. If you are suffering with medial heel pain, then you will probably notice that the pain is very apparent first thing in the morning when your foot hits the floor. This is very common and very typical of plantar fasciitis. The heel pain is also usually present when standing up and walking from a seated position. Therefore, after you have been driving or sitting down for dinner you may feel discomfort as you begin to move.

medial heel pain

Another cause of medial heel pain is thought to be Baxter’s nerve impingement. The entrapment of the nerve on the medial side of the heel is thought to cause a referred pain similar to that of plantar fasciitis. Imaging using MRI is used for in the circumstances.

Another cause of media heel pain is tibial nerve entrapment through the tarsal tunnel. This is less common than the medial heel pain associated with plantar fasciitis. Again, imaging with MRI can be useful in diagnosing tarsal tunnel syndrome. On occasions, surgical intervention is required in order to release the nerve in the tarsal tunnel, and to relieve the medial heel pain.

Plantar Fasciitis – What Causes Medial Heel Pain?

The cause of medial heel pain from plantar fasciitis is multifactorial. Weight gain, an increase in body weight, an increase in physical activity over a short period of time, tightness through the muscles in the lower leg and biomechanical anomalies are just a few of the common causes of plantar fasciitis. Other things such as poor choice of footwear can also lead to medial heal pain and plantar fasciitis.

Treatment for Medial Heal Pain

The selected treatment for medial heel pain will depend on the diagnosis. There are several treatments for the main or the most common condition, plantar fasciitis. Shockwave therapy is a relatively new and a very successful way of treating medial heel pain when plantar fasciitis is associated. Shockwave therapy stimulates blood flow and helps with the turnover of new healthy cells. There is an analgesic side effect with the treatment although this is not the main reason for carrying out the treatment. Shockwave therapy is normally carried out in the clinic once a week and is performed at least three times and up to six times. The medial heal pain usually dissipates slightly after each session.

Other treatment options for medial heal pain coming from plantar fasciitis are things such as orthotic therapy. A firm orthotic shaped in such a way that it touches and holds the plantar fascia, without pressing against it and attempting to raise the arch higher than its resting height, is a great way of unloading the plantar fascia. Plantar heel pain, medial heal pain and other foot ailments will ordinarily feel much better with the use of such an orthotic. At the Sydney heel pain clinic, the podiatrists use 3D technology to capture the shape of the patient’s foot and a 3D printer is used to manufacture these devices. Not all orthotics are made equally, and some generic and even prescription orthotics fail when not designed properly. The sports Podiatrist becomes the architect, whereby they select the material, the shape, the height, the width of the orthotics and which modifications or deflections should be added.

If a patient has excruciating medial heal pain and they are unable to walk without severe compensation then the use of an immobilisation boot is definitely appropriate. There are several types of immobilisation boots available to practitioners, but the Sydney heel pain Clinic only use a Swiss branded device which has been proven to be more successful than any others.

At the Sydney Heel Pain Clinic, all patients will go through a biomechanical assessment. Following this assessment on a treadmill using 3D digital software, the podiatrist is able to detect biomechanical anomalies and frequently is able to determine what the cause of the medial heal pain was. Once the assessment has been completed and the data analysed, the podiatrist can simply recommend very specific shoe models or footwear types that should be used in order to treat the condition. Sometimes, the medial heal pain will subside with a simple change in footwear.

More often than not, there will be some tight muscle groups affecting the foot and ankle which is prolonging the medial heal pain. The podiatrist will usually demonstrate and request specific stretching techniques in order to assist.

The Sydney Heel Pain Clinic have a mobile phone application which contains information relating to the stretching techniques in addition to other important information associated with the rehabilitation of the medial heal pain.

The information above is not strictly medical advice and if you are suffering with plantar fasciitis or any other form of medial heel pain then it is important that you seek an accurate diagnosis from a medical practitioner.

 

Article written by Fatemeh Abdi

Sports podiatrist

Sydney Heel Pain Clinic

Sydney Heel Pain Clinic can be contacted on 93883322 or help@sydneyheelpain.com.au. The sports podiatrist treat all foot and leg pain including plantar fasciitis, Achilles Tendonitis, heel spurs. Medial heel pain, plantar heel pain, posterior heel pain and also bursitis. We are registered with all health funds and also accept care plans from your GP. Please note that there will be a gap payment for all care plan patients who are receiving treatment for plantar fasciitis and other heel pain conditions.

If you are suffering with medial heel pain and need to make an appointment you can also complete a contact form on our web site by clicking request an appointment or book online.

 

A 10-Year-Old Boy With Heel Pain After Walking To School

History – Heel Pain After Walking

A mother of two children presented to the Sydney heel pain clinic with her 10-year-old boy who was complaining of heel pain after walking to school. He was experiencing heel pain in both feet and had been struggling for approximately 4 months. His mum explains to the sports podiatrist that he would complain of pain in both heels after physical activity and walking in general. His mum was extremely concerned as he also described heel pain after walking around the floorboards at home. This young boy was otherwise fit and healthy and was physically active. He plays basketball and football at school and engaged in approximately 5 sessions of sporting activity each week. The heel pain that he experienced was also quite severe after his sporting activity. His mum describes a significant growth spurt and an increase of two shoe sizes in 6 months. The 10-year-old schoolboy paid a visit to his local doctor who referred the family to the local imaging center for x-ray. The findings from the x-rays were of no particular significance and did not lead to any specific treatment plan. Please note that the most common cause of heel pain in children between 7 to 14 years of age is Severs syndrome which is a growth plate problem in the heel. X-ray imaging does not necessarily confirm the diagnosis of Severs. Moreover, the signs and symptoms such as heel pain after walking and tenderness with palpation of the posterior and plantar heel surface are more useful in determining the diagnosis. Severs is also more common in physically active children and in particular those who are growing quickly.

In frustration, the mother of this child paid a visit to her local physiotherapist who recommended stretching and strengthening exercises. After 5 weeks of physiotherapy there was no significant improvement. The mother was concerned that she was to blame and that her footwear choice had led to the problem. She was reassured that this was not the case and that the school shoes were typical school shoes worn by most children. The 10-year-old school boy explained to the sports podiatrist that he did feel some relief if he applied cold ice packs to his heels in the afternoon after walking home from school. The heel pain after walking home from school was more severe than the pain experienced in the mornings. The mother explained that the child had been forced to reduce his physical activity and was disappointed that he was unable to participate in as much sport as he would like to. In addition to heel pain after walking, it was apparent that there was significant heel pain after running and sprinting, which is typical for inflammatory heel conditions.

 

Heel Pain After Walking

Why had the Child Developed Heal Pain After Walking, and Running?

In order to determine the cause of this patient’s heel pain after walking to school the sports podiatrist carried out a biomechanical assessment on the treadmill and a thorough physical assessment was performed. Foot measurements were taken in the standing, weight bearing position and the semi weight bearing position. Arch heights were measured and rear foot angle and calcaneal bisection were also measured. The podiatrist assessed the patient for ligament laxity and also analysed the range of motion through the foot and ankle. Firm pressure was applied to the posterior aspect of the calcaneus and the base of the heel and the patient reported significant pain, similar to the heel pain after walking to and from school. The sports podiatrist confirmed the diagnosis of Severs syndrome.

It was a parent after the physical and biomechanical assessment that this young boy demonstrated a genetic soft ligament type within the foot and ankle, and this was leading to extreme foot instability. During gait there was significant over pronation bilaterally with severe heel eversion in both feet. Both inner longitudinal foot arches were low and measured between 10 and 12 mm bilaterally. It was explained to the mother that due to the child’s age he demonstrated a weaker foot type which may strengthen post adolescence. Once again the patient was reassured that these findings were quite common and quite normal. it was also explained to the patient and the patient’s mother that Severs syndrome is a condition that children grow out of once the heel bone develops and naturally fuses. The heel pain after walking to and from school would subside with treatment. Treatment options were discussed in order to make the child more comfortable and assist in his physical movement during the developmental stages of foot growth.

Treatment Plan to Reduce the Heel Pain After Walking to and from School

In order to reduce the heel pain after walking to and from school the sports podiatrist outlined a multifactorial treatment plan.

Primarily it was important to reduce the load through the Achilles tendon due to the excess pulling on the posterior aspect of the heel bone. The pulling of the calf muscle through the Achilles tendon onto the heel would certainly be a contributing factor in the heel pain after walking, jogging and running. Therefore, the patient was advised to use 12 mm heel lifts inside his footwear at all times. Calf stretching was demonstrated and instructed. The patient’s mother installed the Sydney heel pain mobile phone application which contained the information outlining the detailed treatment plan. The stretching technique with diagrams was included in the application. A list of useful treatments and importantly a list of things to avoid were also included in the mobile phone application. The 12 mm heel lifts would certainly reduce the heel pain after walking but it was also important that the patient begin to perform regular calf stretching. Due to the foot instability and excessive for pronation, rigid sports type was applied to both feet in order to provide extra support. This would reduce the strain on the foot and ankle and therefore unload the stress on the heel. With the rigid sports tape in place the patient began to walk around the corridors and the treatment rooms and provided feedback. Immediately, there was a rapid reduction in heel pain after walking around the clinic. This implied that the inherent foot weakness was a contributing factor and that stabilising both feet and ankles would assist in reducing the heel pain from the Severs syndrome. The footwear that the patient was using had become significantly worn and had compressed quickly. Arrangements were made for the school boy to wear non standard shoes in the form of orthopedic style footwear offering extra support. These shoes were readily available in athletes foot. These shoes would assist and relieve the heel pain after walking but would not be appropriate for use during sporting activity. Therefore, the sports podiatrist requested that’s the patient return within the next week so that his sporting footwear could also be assessed. At this appointment they would have the opportunity to discuss progress and also reapply the rigid sports tape. At the 1 week follow up appointment the patients mother was satisfied and reported that her son had much less heel pain after walking to and from school. The school boy reported to the sports podiatrist that he felt stable and supported with the rigid sports tape in place. Sporting footwear assessment was made and further recommendations were provided. The patient was advised that he could return to physical activity providing that he was comfortable and able to do so. His pain levels would be the key factor in restricting the level and amount of physical activity. Patients mother reported that the child had been diligent and was performing calf stretches on a day-to-day basis.

The Sports podiatrist informed the patient and his mother that there would be no changes to the treatment plan due to the significant improvement and the lack of heal pain after walking. A follow-up appointment was made for 6 weeks and the patient was instructed to return to the clinic if there was a problem.

Please be advised that information contained in this case study is specific to one particular patient with heel pain after walking and should not be taken as medical advice. If you are suffering with foot or heel pain you should inquire with a medical practitioner.

This article was written by Rami Ghorra of Sydney Heel Pain Clinic.

 

 

How To Heal Plantar Fasciitis Quickly

How to heal plantar fasciitis quickly – Our patient database shows that healing is between 3 to 6 weeks once treatment starts (average)

Many patient’s will ask us if it possible to heal plantar fasciitis quickly, and if so how. However, the length of time that it will take for plantar fasciitis to heal is dependent on many factors. First of all, the length of time that the patient has been suffering with heel pain can affect the healing time. People with chronic plantar fasciitis who have been in pain for several months will tend to take a little longer to heal. Like most patient’s these people will experience heel pain in the morning when getting out of bed and after periods of being seated. They feel a sharp pain under the base of the heel and often report the feeling of a stone bruise, or a pebble in the shoe. As with most inflammatory heel conditions, plantar fasciitis is reversable but the healing time will vary. An average tine of 4 to 6 weeks is usually the case once we assess and commence correct treatment, including asking the patient to refrain from “homework”. (Most patients are inadvertently aggravating the plantar fascia with home remedies / physio exercises)

When we are asked, how to heal plantar fasciitis quickly, it is important to assess the severity of the condition via physical examination. If there is a huge jump response when we apply pressure to the heel this may indicate a severe case, and in some patients this means the use of and artificial aid and / or shock wave therapy to speed things up. More severe cases can take 8 weeks plus.

How to Heal Plantar Fasciitis Quickly with Shock Wave Therapy

Shock wave therapy is a treatment that we use commonly in order to heal plantar fasciitis quickly. The treatment is thought to increase the rate of tissue repair by stimulating the turnover of new blood capillaries in the tissue which brings more blood into the area. There is also said to be new collagen development on the tissue. Shock wave therapy was, and still may be used to treat and break down kidney stones. It has a much wider use now and is common place in sports medicine. In addition to treating heel pain and plantar fasciitis it is  used for Achilles Tendonitis, tennis elbow and joint pain. It is a safe treatment with no known side effects. The treatment also has a numbing sensation and the heel pain usually subsides immediately, for a number of days, while the long term healing takes place.

How to Heal Plantar Fasciitis Quickly with Weight Loss

Plantar fasciitis is sometimes associated with weight gain and when these slightly heavier people as us how to heal their plantar fasciitis quickly, they usually suggest losing weight. While we agree that this weight loss helps, we also point out that non obese people still suffer with heel pain from plantar fasciitis and so there are other factors to consider. Also, it is difficult for people to lose weight when they can’t exercise due to the foot pain.

Do Orthotics Help to Heal Plantar Fasciitis Quickly?

Yes, definitely. If designed correctly and shaped well, a pair of custom orthotics will help the plantar fasciitis to heal quickly. Not every patient needs orthotics and so we carry out a bio mechanical assessment first and consider other things that need to be addressed such as the above mentioned factors. We use a “ Touch and hold” device which does not push against the plantar fascia or try to raise the foot arch higher than its natural resting point. Arch based supports can be a problem as they do the opposite and can press hard against the sole which prolongs the unwanted stress on the plantar fascia. Usually, once the orthotics are inserted into the shoe the heel pain from the plantar fascia subsides within a few weeks. It is important that the patient is using firm soled shoes a opposed to softer and more flexible alternatives. This is also a way to resolve the condition when the patient ask us how to heal plantar fasciitis quickly.

Following a detailed physical assessment the podiatrist will also be able to determine whether to use ice or heat packs. Plantar Fasciitis is known to be an inflammatory condition and so will sometimes respond to the use of cold treatment to reduce that inflammatory process. However, if we need an increase in blood flow then the use of heat packs may have its place. So if a patient asks us how to heal plantar fasciitis quickly, and can they use ice, we need to assess the heel pain first in order to male that decision.

There are some really good exercises that will help the plantar fasciitis to heal quickly, but not many. The home remedies coming from old science seem to do more harm than good and can prolong the condition. This is because they load the fascia and re irritate it. Following a bio mechanical assessment, the sports podiatrist will recommend specific exercises, if any at all are needed. Not all patients will need to carry out home remedies or exercises outside of the clinic. Most of the time, there is a calf muscle issue that affects the foot and the ankle and therefore affects plantar fasciitis via the heel. It is very easy for the sports podiatrist to identify this and select the required stretching.

If you have heel pain and you are wondering how to heal plantar fasciitis quickly you should seek the help of a podiatrist that specialises in heel pain. It is best to treat the condition early rather than allowing it to set in or become chronic. Plantar fasciitis can worsen over time and become excruciating if left alone. Sometimes, the fascia can split and become torn and this can extend the length of time needed for the plantar fascia to heal.

At Sydney Heel Pain Clinics the podiatrists are helping people learn how to heal plantar fasciitis quickly every day and can be reached on help@sydneyheelpain.com.au or 02 92883322.

Sydney Heel Pain Clinics operates from 4 locations across Sydney and the western suburbs. The clinic is lead by Karl Lockett, a podiatrist from the United Kingdom. Karl has a special interest in plantar fascia and other causes of heel pain. The head office is at 88 Phillip Street, Sydney, and there are other clinics in North Sydney, Parramatta, Miranda and Narellan. The team has one female podiatrist, Fatemeh Abdi and 2 associate podiatrists Rami Ghorra and Omar Mohamad. All of the podiatrist have day to day exposure to heel pain and mainly plantar fasciitis and have a variety of treatment options that they use. The exact treatment plan will depend on the specifics of the individual and may involve one or a combination of treatments.

All podiatrists are registered with AHPRA, Medicare and all health insurance companies. Each treatment for plantar fasciitis or heel pain has a specific code which is recognised by the health fund.

You are able to read case studies of previously treated patients here on this link

Article written by Karl Lockett

Plantar Fasciitis Video – Sydney Heel Pain Clinic | Podiatrists | Heel Pain: